Uterine Factor Infertility: Symptoms, Causes, Treatment

What are the symptoms of uterine factor infertility?

The symptoms of uterine factor infertility are not always obvious and may not present with noticeable signs. However, some potential symptoms and related conditions include:

• Irregular Menstrual Cycles: Irregular or absent periods may indicate underlying uterine issues.
• Recurrent Miscarriages: Multiple miscarriages can be linked to structural abnormalities or issues with the uterine lining.
• Pelvic Pain: Chronic pain in the pelvic region might be associated with uterine fibroids, uterine polyps, or other structural problems.
• Heavy or Prolonged Menstrual Bleeding: Conditions like fibroids or polyps can cause heavy periods or bleeding between cycles.
• Difficulty Conceiving: Difficulty becoming pregnant after a year of unprotected intercourse may point to uterine factor infertility.
• Abnormalities Detected on Imaging: Issues like a bicornuate uterus, septate uterus, or scarring (Asherman’s syndrome) might be found during fertility evaluations.

Uterine factor infertility can be caused by structural abnormalities, scarring, or issues with the uterine lining that prevent embryo implantation or successful pregnancy maintenance.

What are the causes of uterine factor infertility?

Uterine factor infertility can be caused by a variety of conditions that affect the structure or function of the uterus. Some common causes include:

• Congenital Uterine Abnormalities: Structural issues present from birth, such as a bicornuate uterus, septate uterus, or unicornuate uterus, can affect fertility by interfering with implantation or pregnancy development.
• Uterine Fibroids: Noncancerous growths in the uterus, especially submucosal fibroids, can distort the uterine cavity and impede embryo implantation.
• Endometrial Polyps: Benign growths in the lining of the uterus (endometrium) can block the uterine cavity and affect embryo implantation.
• Asherman’s Syndrome: Scarring within the uterine cavity, often caused by previous surgeries (like dilation and curettage), can lead to infertility by reducing the available space for embryo implantation.
• Endometrial Lining Issues: Thin or poorly functioning endometrial lining, often linked to hormonal imbalances, can prevent successful embryo implantation.
• Chronic Endometritis: Inflammation of the uterine lining due to infection can affect implantation and increase the risk of miscarriage.
• Adenomyosis: A condition where the inner lining of the uterus (endometrium) grows into the muscular wall of the uterus, leading to pain and heavy bleeding, and possibly affecting fertility.
• Uterine Adhesions: Scar tissue within the uterine cavity can block or distort the space needed for a healthy pregnancy.

These causes can lead to difficulty with conception, recurrent pregnancy loss, or complications during pregnancy.

What is the treatment for uterine factor infertility?

Treatment for uterine factor infertility depends on the specific underlying cause. Here are some treatment options:

• Surgical Correction:
• Hysteroscopic Surgery: Used to remove uterine fibroids, polyps, or scar tissue (e.g., in Asherman’s syndrome).
• Uterine Septum Resection: Performed to correct congenital uterine abnormalities like a septate uterus.
• Laparoscopic or Open Surgery: For larger fibroids or complex anatomical issues, such as severe adhesions.
• Hormonal Therapy:
• Estrogen Therapy: Used to improve a thin endometrial lining.
• Medications (e.g., GnRH agonists): Can help manage conditions like adenomyosis or endometriosis.
• In Vitro Fertilization (IVF): In cases where surgical correction is not effective, IVF may be recommended to bypass uterine challenges.
• Surrogacy: For severe uterine factor infertility where carrying a pregnancy is not possible, using a gestational carrier may be an option.
• Antibiotics: In cases of chronic endometritis, antibiotics may be prescribed to treat the underlying infection.
• Uterine Transplant (Experimental): For women with absolute uterine factor infertility (e.g., those born without a uterus), uterine transplantation is an emerging, though still experimental, option.

Treatment plans are individualized based on the specific uterine issue, overall reproductive health, and personal preferences.