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Uterine abnormalities that can contribute to infertility and spontaneous abortion include:

• Intrauterine adhesions
• Congenital uterine abnormalities
• Acquired uterine abnormalities
  • endometrial polyps
  • uterine myomas

Intrauterine Adhesions

Intrauterine adhesions can cause infertility by obliterating the endometrial cavity and preventing implantation of the fertilized egg. The most common cause of intrauterine adhesions is dilatation and curettage (D&C) of the uterus. The risk for developing intrauterine adhesions increases with the number of D&C procedures and has been estimated at about 16% with a single D&C and 33% after 3 procedures. In addition to D&C, other possible causes of intrauterine adhesions include infections, Cesarean section delivery, and myomectomy (surgical removal of uterine fibroids).

Intrauterine adhesions can cause reduced menstrual bleeding, infertility, and miscarriage. Treatment of intrauterine adhesions involves surgery by either surgical dissection of the adhesions or laser vaporization of the adhesions. The goal of surgery is to restore the normal anatomy of the uterus and, therefore, increase the likelihood of conception. Studies have shown that the efficacy of surgical treatment of intrauterine adhesions for achieving a successful pregnancy depends upon the severity of the adhesions. Approximately 85% of women with mild to moderate intrauterine adhesions who undergo surgery achieve a successful term pregnancy while only about 50% of women with severe intrauterine adhesions achieve a successful term pregnancy following surgery.

Congenital Uterine Abnormalities

Congenital uterine abnormalities are anatomical abnormalities of the uterus that are acquired during fetal development. The most common type of congenital uterine abnormality is a uterine septum - a condition in which a wall (septum) separates the uterus into two halves. Women with a septate uterus are at increased risk for spontaneous pregnancy loss and about 20% of miscarriages occur in women with this condition. The diagnosis of a uterine septum is usually established with a combination of hysteroscopy and laparoscopy. Surgical correction by hysteroscopic septum division, a procedure known as hysteroscopic metroplasty, the the preferred treatment for this condition. Studies have shown that the miscarriage rate can be reduced significantly in women with a septate uterus following hysteroscopic metroplasty.

Acquired Uterine Abnormalities

In contrast to congenital uterine abnormalities that occur during fetal development, acquired uterine abnormalities are abnormalities of the uterus that develop after birth. The two most common types of acquired uterine abnormalities are:

• Endometrial polyps
• Uterine myomas (fibroids)

Endometrial Polyps

Endometrial polyps are small, benign growths of tissue on the endometrium that are a frequent cause of abnormal uterine bleeding, however, their role in infertility is currently not well understood. Endometrial polyps can be identified by techqiques such as trasviginal ultrasound, hysterosalpingography, or sonohysteroscopy. Standard treatment involves removal of the polyps by electrosurgical resection with a device known as a retroscope. Studies have shown that surgical resection of endometrial polyps in infertile women significantly improves the chances of conception and live birth within one-year.

Uterine Myomas

Uterine myomas, commonly called uterine fibroids, are benign tumors that occur in the smooth muscle of the uterus. It has been estimated that 20% to 50% of women age 30 or older have uterine myomas. They can occur either as single or multiple tumors and their size can vary widely. Less than 1% of uterine myomas become malignant (cancerous) tumors. About 50% of women with uterine myomas will exhibit clinical symptoms of the disease with abnormal uterine bleeding being the most common symptom. Other symptoms (usually associated with large uterine myomas) may include: