Can abnormal uterus cause infertility?

It can be the cause of infertility and also maybe the cause of spontaneous abortion. It is difficult to say in which case a woman will have infertility because of shape problems and in which case has not. Sometimes women discover that she has, for example, the cornus uterus or some other abnormality in maternity, after delivery and before they don’t recognize that because all is fine, they become pregnant without problem. If we try to see statistic, the spontaneous abortion arrive much more often in women with some abnormality of shape when uterus has septum inside, when uterus has little cavity, when uterus, for example, is unicornos much more often we can has implantation failure or repeated abortion or premature delivery and this kind of things of course may happen more often.

Yes, it is considered that approximately 3% of women who suffer from problems in getting pregnant or suffer from pregnancy losses may be associated with having irregularly shaped uterus or with some congenital abnormalities. Having congenital abnormalities also called  congenital malformations are the most frequent.

The uterus is a third of the equation of fertility in women because the other two thirds are the ovaries and the tubes. The uterus, when we mentioned the uterus, we might speak of problems with the lining of the uterus or in the endometrium. However, abnormalities in the uterus whether those abnormalities are innate or whether ladies are born with those abnormalities (like congenital abnormalities in the uterus) although those were or whether those are acquired both of those are associated with fertility issues. I start briefly by discussing the congenital abnormalities. Congenital abnormalities in the uterus involve, for example, a unicornuate uterus or ladies who are born with only one horn of the uterus and rather than a complete uterus. Other congenital forms are a uterine Septum or a uterine ridge inside the lining because the ridge present inside the lining is most of the time avascular – there’s no blood supply and obviously if an embryo is going to sit there to implant, there’s no blood supply to support it and that’s one of the reasons. There are lots of other anomalies in the uterus which are still on the congenital that might be associated like a didelphic uterus which might be associated as well to a lesser extent mainly uterine septum is one of the most commonly seen ones when it comes to the congenital. Other causes where that are acquired are the presence of polyps that are similar to skin tags, they are small bumps inside the lining that might impede embryos from implanting. Other causes are fibroids. The difference between a fibroid and the polyp is a fibroid is a collection of smooth muscles, so if you touch the fibroid, the fibroid most of the time is spherical and it’s quite tough compared to a polyp which is in general a little bit softer and not every fibroid causes infertility but if the fibroid is pressing on the lining, it might prevent implantation. So these are the causes that are in the uterus that might be associated with fertility. Other causes might be scarring tissue inside the lining which are called adhesions. Other causes as well might be infections in the lining (like chronic endometritis) these might cause fertility issues. Other causes might be fluid in the lining that might prevent embryos from implanting.

Generally we say the shape of the uterus does not significantly contribute to fertility problems. Many times these different shapes of the uterus we pick up in a different setting even at the time of cesarean section, or an incidental scan. So it’s not necessary that the shape of the uterus especially if it’s like uterus didelphys and all it is not necessary that it causes fertility problems. The one shape of the uterus which the research has shown that it has increased the risk of miscarriage is uterine septum. If there is a septum in the uterine cavity, they’ve seen that has increased the risk of miscarriage therefore, treatment of that by removing the septum improves their chances or rather decrease the risk of miscarriage but generally, we do not recommend any treatment for the other different shapes of the uterus to improve fertility.

We know what a normal uterus looks like – in that you’ve got: the muscle of the womb and the lining in the womb that regenerates every month and there’s lots of very subtle, weird, wonderful abnormalities in terms of the way uterus looks and it’s in its shape and size. You can have a uterus that’s got sort of two horns rather than just one cavity in itself, you can have a uterus that’s got a muscle strand or a septum down the middle of it and there’s some evidence that women who’ve got one of these subtle abnormalities are more likely to have problems with fertility and miscarriage than if you don’t have one of these abnormalities. Whether those abnormalities really cause the problems – we don’t really know. If you’ve got one of these subtle abnormalities, you may have a slightly increased risk of having problems. There’s no great data though that shows that actually surgically fixing one of these problems, which is the only way you can act on them, actually improves the outcome and the vast majority of women that have got one of these subtle abnormalities, have absolutely no problems at all. There is the risk that if you go in and necessarily treat one of these subtle problems surgically, it could cause more problems than actually you have in the first place. In most scenarios, it’s a bit of a watching and a waiting brief, making people know a small increase in risk and perhaps only acting in those people who found to have a problem and are also having problems conceiving or also having problems with miscarriage. The default is to investigate and probably do nothing and only and only act if you really need to.