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Uterine Factors

How Abnormalities of the Uterus Contribute to Infertility

By Gwen Morrison

Abnormalities of the uterus can be a factor in infertility and the inability to carry a pregnancy to term for many women.

The most common congenital uterine anomaly, according to RESOLVE: The National Infertility Association, is the septate uterus. A septate uterus is described as a condition where a wall or septum partially or fully divides the uterus into two cavities. It is estimated that one in four women will have repetitive reproductive failure due to this congenital factor.

The initial diagnosis is made through clinical facts and by using a uterine X-ray (hysterosalpingogram or HSG). The HSG is a procedure that is often used to detect abnormalities such as scar tissue, polyps, fibroids or an abnormally-shaped uterus.

"Treatment is surgical," says Dr. Ricki Pollycove of San Francisco, Calif. "Unfortunately, hormones don't show much benefit in fertility success in women with septal defects."

The surgical procedure that is performed to remove the septum that divides the uterus is called metroplasty. It can be done either hysteryoscopically (through a telescope-like device that is placed in the vagina and then into the uterus) or through a small incision in the abdomen called a laparotomy. When women choose hysteroscopy, there is typically a shorter recovery time.

The clinical literature indicates that approximately 80 percent of women who have undergone surgery to remove the septum and reshape the uterus have successfully become pregnant and carried the baby to term.

"DES stands for di-ethyl-stilbestrol," Dr. Pollycove says. "It was given to some pregnant women in the 1940s to the 1950s, thinking that it lowered the risk of miscarriage."

DES is a synthetic hormone that was later discovered to have no effect on miscarriage prevention. Unfortunately, the data eventually indicated that it did cause a number of embryological abnormalities in the children of the women who had taken it over those 20 years.

Want to see more?

• Check out our Article Library.
• When Life Is a Pain: The Facts on Endometriosis
• Trouble Conceiving? Get the Right Medical Care!
• Private Suffering: The Issue of DES Daughters
• Talk about it!

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