Uterine Factor Infertility
Uterine factor infertility can be due to an abnormal uterus or uterine cavity that is distorted due to uterine fibroid tumors, polyps, scar tissue or birth defects. The uterine cavity can be evaluated via an X ray test called a hysterosalpingogram (HSG) or by a special ultrasound known as saline enhanced sonohysterogram (SHG). These procedures can determine if the uterine cavity is abnormal. Alternatively, a minor surgical procedure called a hysteroscopy can be performed where a lighted tube with a camera is inserted into the uterine cavity for evaluation. At time of hysteroscopy, many abnormal findings can be surgically corrected.
Many women have benign uterine tumors commonly known as fibroid tumors. These tumors can range in size from small at a couple of millimeters up to a foot or more in diameter. There is an association with infertility if the fibroid tumors are within the wall of the uterine muscle (intramural) or within the uterine cavity (submucosal). Fibroid tumors that are pedunculated (on a stalk) or just beneath the uterine surface (subserosal) are not associated with infertility under most circumstances. Fibroid tumors may also increase pregnancy related complications of miscarriage, placental abruption and preterm labor. Fibroid tumors can be safely removed by conservative surgery where the uterus is preserved to allow future pregnancy. Removal of fibroid tumors may increase the pregnancy rate from 20 to 80% after the surgery.