Uterine and Tubal Factor Infertility
Tubal Factor Infertility affects about 25% of all couples who seek care for infertility treatment. This usually includes complete fallopian tube obstruction and partial tubal blockage from tubal scarring. Tubal factor infertility is most commonly the result of a prior pelvic infection, such as pelvic inflammatory disease, which may have happened without any symptoms. Additional causes of tubal factor infertility are endometriosis, scarring from prior surgery, and other causes such as a ruptured appendix. In Vitro Fertilization (IVF) was originally invented to help couples affected by tubal factor infertility to conceive and this is still the most effective way to achieve pregnancy for tubal factor patients. Occasionally, women develop fluid in their fallopian tubes called a hydrosalpinx. This fluid has been correlated with an adverse effect on pregnancy rates with IVF. The current recommendation is that hydrosalpinges be removed prior to proceeding with IVF, as they may decrease pregnancy rates.
Sometimes anatomic abnormalities of the uterus can contribute to infertility. The primary causes of uterine factor infertility are endometrial polyps, uterine fibroids, and endometrial scarring (Asherman’s syndrome). Endometrial polyps are overgrowths of the endometrium and most of the time are benign and usually do not have negative impact of fertility. However, they have been correlated with decreased pregnancy rates after IVF and with an increased risk of miscarriage. Consequently they are routinely removed prior to in vitro fertilization or other infertility treatments.
Uterine fibroids are very common benign tumors of the uterine muscle. They may be a cause of infertility if they lie directly under the endometrial lining or are large enough to distort the endometrial cavity. If this is the case they may also negatively impact pregnancy. Your doctor may recommend fibroid removal depending on the location, size and number of fibroids.
Asherman’s syndrome or scarring in the endometrial cavity is most commonly caused by prior intrauterine surgery, such as dilation and curettage (D&C). It is rare, occurring in only about 1% of cases after D&C. This can be diagnosed on Hysterosalpingogram or saline infusion sonography. Your doctor will usually recommend surgical correction with hysteroscopy as the scarring may decrease pregnancy rates with treatment and predispose to miscarriage.