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.


Fibroids are usually found in or around the body of the uterus, but sometimes occur in the cervix (neck of the uterus). Fibroids within the uterus can be divided into three categories: subserosal, located in the outer wall of the uterus (55%); intramural, found in the muscular layers of the uterine wall (40%); and submucosal, which protrude into the uterine cavity (5%). Fibroids can be connected to the uterus through a stalk (pedunculated) or can be attached to nearby organs such as the bladder and bowel, or to the ligaments surrounding the uterus. Fibroids are rarely found outside the pelvic cavity.


Symptoms from fibroids are related to their size and location. Most women with uterine fibroids have no symptoms. The most common symptoms are abnormal uterine bleeding, pain and pelvic pressure


A rapidly enlarging fibroid may outgrow its blood supply and degenerate, causing pain and cramping Fibroids which are attached to the uterus by a thin stalk may twist and cause severe pain. Women with fibroids may also experience painful menstrual cramps.


Fibroids may grow in pregnancy and, based upon their clinical significance, they may change the baby’s presentation at the time of delivery. In addition, fibroids increase the risk of a cesarean section, miscarriage and premature delivery.


Abnormal uterine bleeding is the most common symptom associated with fibroids located in or near the lining of the uterus and is the main reason for requesting treatment.


Large fibroids may press on nearby pelvic organs. If the fibroid presses on the bladder, which lies in front of the uterus, urinary frequency or urgency may occur. Fibroids in the lower uterus may put pressure on the large bowel and rectum, which could cause painful bowel movements, constipation, hemorrhoids, or altered shape of stools.


The chance of a malignancy in a fibroid is extremely small.

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