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Uterine Factors

How Abnormalities of the Uterus Contribute to Infertility

By Gwen Morrison

"It can lead to abnormalities of the upper vagina, especially flattening of the cervical 'neck' as it enters the upper vagina," Dr. Pollycove says. "Infertility associated with DES exposure is infrequent, usually due to either an abnormal 'T' shape to the uterine cavity or inadequate strength of the cervix due to its abnormal development." Dr. Pollycove explains that this generally results in spontaneous miscarriage as opposed to being infertile.

Other reproductive difficulties, as outlined by RESOLVE, that have been associated with exposure to DES include hypoplastic uterus (underdeveloped); irregular uterine lining; ectopic pregnancy; premature labor or incompetent cervix, which may result in painless, cervical dilation; and subsequent premature delivery.

"It's hard sometimes to treat these problems," Dr. Pollycove says. "A cerclage (a special, sturdy stitch placed surgically around the cervical neck) can often help the woman with the weak cervix, but the T-shaped cavity does not hold on to a pregnancy long enough if quite severe."

The National Infertility Association defines Asherman's syndrome as the presence of scar tissue in the uterine cavity (intrauterine adhesions). In a severe case, where the entire uterine cavity is scarred, the woman does not menstruate. Where the scarring is less severe, women may have light periods.

"Asherman's syndrome is basically a loss of the normal lush lining of the uterine cavity," Dr. Pollycove says. "Most often this is after an endometrial curettage (a scraping procedure to empty the cavity of pregnancy tissue; post-spontaneous, incomplete or elective abortion). Scar tissue can form and cause an inhospitable environment of he uterine cavity."

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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