Uterine abnormalities and infertility

According to the March of Dimes, 3 in 100 women are born with a defect in the size, shape or structure of the uterus.

When a girl is developing in the womb, two small tubes called Mullerian ducts come together to form her uterus. For some girls, the Mullerian ducts don’t come together completely and this can cause problems with the uterus, including:

• Septate uterus. This is the most common congenital uterine abnormality. In this condition, a band of muscle or tissue divides the uterus into two sections. This condition can cause women to have repeat miscarriages, so providers often recommend surgery to repair the uterus and reduce your risk of miscarriage.
• Bicornate uterus (also called heart-shaped uterus). In this condition, the uterus has two cavities instead of one large cavity. Most women with this condition don’t need surgery to repair it. 
• Didelphys uterus (also called double uterus). In this condition, there are two small, separate cavities, each with its own cervix (opening). 
• Unicornate uterus (also called one-sided uterus). This condition happens when only half the uterus forms. Surgery can’t make the uterus any larger. 

These abnormalities may cause infertility or complications at child’s birth and health. Usually though, most problems arise during pregnancy. Problems such as:

• Premature birth. The birth that happens before 37 weeks of pregnancy.
• Birth defects that may be caused by restricting the growth of parts of a baby in the womb. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body, and can cause problems in overall health, how the body develops, or in how the body works.
• Slow growth in your baby
• Breech position or other problems with the baby’s position in the womb. Breech position is when your baby’s bottom or feet are facing down right before birth. The best position for birth is when your baby is head-down.
• Needing to have a cesarean birth (also called c-section). 
• Miscarriage. 

There are though other uterine conditions that affect fertility, the uterine fibroids. Fibroids, also called myomas or leiomyomas, are benign growths made of muscle tissue in the uterus. This means you’re not born with fibroids; instead, they develop later in life.

Small fibroids usually don’t cause problems during pregnancy, but larger fibroids may cause complications, including:

• Trouble getting pregnant.
• Preterm labor.
• Your baby is in a breech position. This may make it necessary for you to have a c-section. 
• Placental abruption. This is a serious condition in which the placenta separates from the wall of the uterus before birth.
• Miscarriage.
• Heavy bleeding after giving birth

Symptoms of fibroids

• Heavy periods or periods lasting longer than a week
• Anemia. 
• Pressure or pain in your belly or your back.
• Pain during sex.
• Trouble urinating or having to urinate often.
• Constipation.

Some women with fibroids may need to be treated with medicine for pain in the belly and back. If the fertility specialist believes fibroids are making it difficult for you to conceive or causing you multiple miscarriages, they may recommend surgery (called myomectomy) to remove them.

What are uterine scars?

Scars or scar tissue in the uterus, also called Asherman syndrome. The scars can damage the lining of the uterus called the endometrium. They’re acquired conditions that can be caused by infections or conditions like endometriosis. They can also be caused by surgery on the uterus or cervix, like a procedure called dilation and curettage (also called D&C). A D&C is when tissue is removed from the uterus in certain situations like after a miscarriage.

Signs and symptoms of uterine scars include light, infrequent, or no periods; but some women may have no signs or symptoms. The scars though can cause trouble conceive, premature birth and repeat miscarriages. Your fertility specialist may use a procedure called hysteroscopy to find and remove scar tissue in the uterus.

How does the doctor evaluate if you have a uterine condition?

You may need more than one test to determine the conditions. Tests include vaginal or 3D ultrasound, sonohysterogram, hysterosalpingogram and/or an MRI. 

Treatment of an abnormally shaped uterus.

Surgery is the only treatment to correct an abnormally shaped uterus, yet many women with such abnormalities don’t have the need for surgery. The general recommendation of a surgery is essential only if women experienced recurrent miscarriages or has compromised fertility due to the uterine abnormality. It may also be recommended if she experiences uncomfortable pain regularly.

When appropriate, surgeons will most often perform minimally invasive surgery via laparoscopy or hysteroscopy. They use a thin tube with a camera that’s inserted through very small incisions in the woman’s abdomen or through the vagina and cervix to view into the uterus. If surgical correction needs to be done, it can be done at this time with special surgical instruments inserted through the tube.

Frequently asked questions about uterine fibroids

Q: Do fibroids cause weigh gain?

A: Fibroids can vary in size from as small as a seedling to as large as a watermelon, filling the space of your entire abdomen. With an increase in size and mass, increased fibroid weight translates into a weight gain in the affected woman. In fact, large fibroids can weigh several pounds and push against other organs in the abdominal cavity.

While women will notice a change in their weight, they most often notice the physical changes of weight gain in their pelvis or lower abdomen, giving off the appearance of pregnancy or extreme bloating.

Q: Do fibroids make you tired?

A: Women with uterine fibroids may feel tired or fatigued throughout the day. This is because fibroid symptoms, like pelvic pain, make it difficult to get a good night’s sleep. Anemia is another possible cause of fatigue in women with uterine fibroids. This condition occurs when someone has a decreased number of red blood cells that store and carry oxygen to the blood.

Because fibroids may cause excessive bleeding during menstruation, women may experience anemia and feel exhausted as a result. Additional symptoms include a feeling of weakness or shortness of breath.

Q: Can fibroids get cancerous?

A: According to Johns Hopkins Medicine, fibroids are not cancerous and do not increase the risk for uterine cancer.

Uterine abnormalities and IVF.

According to a study in Pubmed.gov which compared patients presenting a uterine anomaly between 1987 and 1992 with the normal population treated by IVF, results showed that the pregnancy rate obtained by the first patients is significantly lower than those obtained by the normal population. Also, the implantation rate by embryo transfer is 5.8% in the population with the uterine anomaly vs. 11.7% in the other group. These results significantly improve when the uterine anomaly can be treated. 

Embryo implantation is found to be affected by the shape and integrity of the uterine cavity. If a congenital uterine anomaly is present, this can possibly affect the ability of an embryo to implant, resulting in pregnancy loss. Additionally, other studies have suggested that the effects on fertility caused by uterine anomalies could be mediated through other infertility factors. For example, patients with uterine anomalies are more likely to have infrequent or no periods. They are also more likely to have endometriosis.

In any case, if you are considering a fertility treatment while having a uterine anomaly, consult with your fertility specialist in order to come up with the best plan for your specific case. MEDIPASS cooperates with some highly-experienced fertility specialists in Greece that will give you their undivided attention and act always according to your wants and needs.

You can dm/email us or book a free call with our customer success manager to further guide you along the process.