Among the most common uterine issues affecting a woman’s fertility are growths, such as uterine fibroids (noncancerous muscle growths) or endometrial polyps (growths attached to the inner wall of the uterus), or abnormalities in the shape of the uterus.
Uterine-related issues have few symptoms and are typically diagnosed using imaging tests or during a pelvic exam.
Treatment, if needed, usually involves surgery to correct a structural abnormality or to remove the uterine fibroids and/or polyps.
What are uterine fibroids, polyps and other abnormalities that affect fertility?
The uterus (womb) is the area of a woman’s body where an embryo embeds and then develops into a fetus. Physical issues with the uterus such as growths or any irregularities to its structure can contribute to female infertility, recurrent miscarriage or complications during delivery.
Uterine-related problems that can affect fertilty include uterine fibroids, polyps and abnormalities in the structure of the uterus.
Also known as myomas or leiomyomas, uterine fibroids are noncancerous growths on the uterus’ muscular wall. Uterine fibroids often produce no symptoms, so many women do not even know they have them. If they become large enough, fibroids can obstruct the embryo from implanting on the uterine lining and prevent the mother from carrying the pregnancy to term.
According to the American Society for Reproductive Medicine, 5-10 percent of infertile women have fibroids. But some studies have shown that most women have fibroids, although most of these are asymptomatic. The exact cause of uterine fibroid growth is unknown, although research suggests genetics and female hormones (estrogen and progesterone) may play a part.
There are three main types of uterine fibroids: Subserosal, intramural and submucosal.
Subserosal fibroids grow mostly outside of the uterus and into the abdominal cavity. Many times they do not cause symptoms.
Intramural fibroids originate and grow within the wall of the uterus, and may negatively impact fertility and increase the risk of pregnancy loss.
Submucosal fibroids grow and develop on the inside of the uterus and may also cause infertility and miscarriage.
Subesrosal and submucosal types may also be pedunculated, meaning they have a stalk of tissue.
Uterine polyps
Uterine polyps are bulb-shaped and caused by the overgrowth of the glandular tissue lining (called the endometrium) of the uterus.
Polyps can interfere with fertility by preventing a fertilized egg (embryo) from implanting in the uterine wall correctly.
Uterine abnormalities, congenital and acquired
Uterine anomalies are anatomical problems with the uterus that women are either born with (congenital) or that develop over time (acquired). Congenital abnormalities occur when a woman’s uterus does not develop normally. These malformations are usually present in a woman without symptoms.
Congenital abnormalities include:
Septate uterus is when the uterus cavity is divided, or partitioned, by the septum (wall). This is the most common congenital abnormality and can be surgically corrected using hysteroscopy.
Bicornuate is a division of the uterus cavity into two (rather than one) space, giving this abnormality its second name, the heart-shaped uterus. Surgery is usually not needed.
Unicornuate is when only half the uterus forms during development. A woman with this condition will likely have two ovaries but only one will be connected to her uterus.
Didelphys, also called the double uterus, is when a woman develops two separate uterine cavities, each with its own cervix.
Acquired uterine abnormalities, such as scarring of the uterus or the development of scar tissue, occurs when an infection or surgery alters the uterine lining. These scars can damage the lining of the uterus, making it more difficult to conceive or carry a pregnancy to term.
Symptoms and diagnosis of uterine infertility factors
Uterine fibroids may be asymptomatic but, depending on size and location, can cause heavy menstrual cycles, pain and pressure symptoms. Polyps are very common and may be asymptomatic but occasionally cause irregular bleeding.
Many, and possibly most, uterine anomalies don’t cause symptoms, and many women may not discover issues until they have a pelvic exam or an ultrasound. When symptoms do occur, women may experience:
Never having had a period. If the abnormality is obstructive, meaning that menstrual blood cannot flow out of the body, then the patient will have a build-up of blood behind the obstruction and the patient may have severe pain.
Spotty or irregular bleeding during periods.
Recurrent miscarriages.
Preterm labor or abnormal positioning of the baby during pregnancy or labor.
Pain when inserting a tampon or during sex.
A physician can typically diagnose issues with the uterus during a pelvic exam or using imaging tests such as ultrasound or MRI. In some cases, a physician may also recommend a hysteroscopy.
During this procedure, a doctor inserts a thin, lighted tube (hysteroscope) through the vagina and cervix into the uterus. This tube allows the physician to examine the inside of the uterus, allowing him or her to remove any growths if needed or to remove a congenital defect such as a septum.
If a uterine issue is present, it may not require treatment or impact fertility. The physician will determine if treatment is needed, depending upon the size of the growth or abnormality and whether it is affecting a woman’s health or fertility.
Treatment for uterine fibroids, polyps or other abnormalities
Not all women with uterine fibroids require treatment, and many cases only require medication. In cases where fertility is affected, surgery to remove fibroids (called a myomectomy) is usually recommended. This may be through the abdomen using a large incision, laparoscopy or robotic surgery. If the fibroid is entirely or mostly in the uterine cavity, it may be removed using hysteroscopy, which is entirely a vaginal approach.
In rare cases, a patient with severe discomfort or bleeding due to uterine fibroids may undergo a hysterectomy, which removes the entire uterus. This eliminates the possibility of future pregnancies.
These are easily removed with a hysteroscopy, a minimally invasive procedure to view and remove abnormalities.
Uterine abnormalities
As with other uterine issues, treatment for uterine abnormalities depends upon the nature of the anomaly, its size and whether or not it is affecting fertility or a woman’s health. Surgery is the usual treatment if needed.