Uterine Factor

The uterus or the womb can be the reason for infertility in some women. The uterus, a hollow thick-walled muscular structure which is lined by a functional hormone-dependent layer endometrium, into which the early embryo implants. Besides this, the uterus plays key roles in moving the sperm to the egg by delicate contractions.

The endometrium is the inner lining of the uterus responding to hormones of reproduction, estrogens, and progesterone. It can be viewed easily with the ultrasound and the trilaminar appearance ensures good estrogen action and readiness for receiving the embryo. Lack of estrogens, thyroid hormone and excess of prolactin can cause a thin endometrium. If the endometrium is devoid of the basal layer, the hormones cannot bring about the 8 mm trilaminar appearance. This leads to failure of implantation. however, if the basal layer is intact, the endometrium can be thickened with estrogens even in postmenopausal women.

The birth defects can range from the absence of uterus (Rokitansky Kuster Hauser syndrome) to intrauterine septum. Some of the defects can be corrected to enhance fertility-like excision of the intrauterine septum.

The fibroid is muscle tumors of the uterus which are not cancerous. However, the size and location can interfere with fertility. Laparoscopic or hysteroscopic myomectomy is the treatment of choice in selected cases. Laparotomy may be required in some cases. Fluoroscopic embolization and Hi FUS are not recommended by the FDA as they are still experimental for infertile patients. Uterine fibroids (also called myomas or leiomyomas) are benign (non-cancerous) tumors of muscle tissue that can enlarge and/or distort the uterus (womb) and sometimes the cervix. They start from the smooth muscle cells in the wall of the uterus. Fibroids are usually found as multiple tumors. It is estimated that uterine fibroids will affect eight in 10 African-American women and seven in 10 Caucasian women by the time they reach menopause. Fibroids usually become noticeable during the reproductive years and become smaller after menopause. Most cause no symptoms and do not require treatment. However, depending on their size and location in the uterus, they may cause symptoms and require treatment.

Fibroids happen when a genetically-altered single muscle cell in the wall of the uterus multiplies rapidly to form a tumor. The exact cause of fibroids is unclear, but evidence suggests that both genetics and hormones play roles. Estrogen (a hormone produced primarily by the ovaries) may stimulate growth of fibroids. After menopause, when estrogen levels are low, fibroids rarely grow and frequently shrink. Their growth and development may also be influenced by progesterone, a hormone produced by the ovary after ovulation and during pregnancy. There is no evidence that any nutritional or lifestyle factors affect fibroid growth and development. Similarly, medications such as low-dose birth control pills have little or no impact on fibroid growth.