Uterine problems
Many women who have uterine problems may have no problems getting pregnant, but they may have difficulty in keeping the pregnancy as they tend to miscarry. Most women have no symptoms, some women will have scanty periods, and if the woman has no uterus she will have no periods, (but remember there are many causes of absent periods). Some patients may also complain of heavy periods (due to fibroids).
Incidence
2-5%
Causes
Fibroids
Fibroids are benign growths of the muscle of the womb; they are very common especially in older women. Approximately one fifth to one third of all women has fibroids. Fibroids are more common amongst some racial groups such as Africans and afro Caribbean women. Fibroids can vary in size and in location, either inside the cavity wall itself (intramural), bulging from outside wall of the womb (subserous) or bulging inside the cavity of the womb (submucousal). Fibroid can be found hanging on a stalk either outside or inside the womb (pedunculated). Some women with fibroids experience no symptoms at all, others may experience symptoms, such as heavy periods, heavy painful periods, and pressure symptoms such as abdominal distension, these symptoms depend on the size, number and location of fibroids.Most women who have fibroids are fertile and have no problems with keeping the pregnancy. However, if the fibroid significantly distorts the cavity of the womb, it may interfere with embryo implantation. Also fibroids can displace the Fallopian tubes and ovaries.Most fibroids are diagnosed by ultrasound scan either through the abdomen (transabdominal scan) or through the vagina (transvaginal scan), sometimes MRI imaging may be required to add more information about the location of fiboids. Fibroids can also be diagnosed at operations such as laparoscopy and hysteroscopy. They can also be picked up by HSG.
Uterine Polyps
Uterine polyps, these are very common small growths dangling in the cavity of the womb. They can interfere with conception by acting like a coil.
Intrauterine adhesions
Intrauterine adhesions, known as Ashermans syndrome, is scar tissue inside the uterine cavity, this can cause absent periods, interfere with conception, and can increase the risk of miscarriage.
Endometrial lining
Both too thin and too thick an endometrium could reduce the chance of conception. In general 8-12 mm endometrial thickness is good when measured by ultrasound scan around day 10-12 of the cycle.There is an association between open cavity and poor outcome following IVF treatment.
Congenital Problems
Congenital problems (problems from birth) e.g. absent uterus, the uterus has not developed sufficiently in size (hypoplastic uterus). Abnormally shaped uterus such as T shaped uterus, double uterus, birconuate (two-horned uterus), unicornuate (a half uterus) and uterine septum (this is the most common congenital abnormalities and is associated with the highest incidence of reproductive failure such as recurrent miscarriage).
Adenomyosis
The term adenomyosis refer to a relatively common condition in which cells like the one that line the inside of the womb (endometrium) are present in the muscles of the womb. The abnormally located endometrial tissue tends to bleed with menses creating small fluid filled collections inside the womb muscles. The womb may become larger, globular and tender. Adenomyosis tends to occur in women who are in their 30s and 40s particularly if they have had children. Adenomyosis is benign condition and does not cause cancer. The cause of adenomyosis remains unknown. Most women with adenomyosis do not experience any symptoms, while others may suffer heavy painful periods and or pelvic pain during intercourse. Many women with adenomyosis will have endometriosis as well. The diagnosis is usually suspected by vaginal ultrasound. MRI can be helpful when ultrasound does not give definite results. Most commonly adenomyosis is mistaken for another common condition, uterine fibroids. The effect of adenomyosis on fertility is not clear but it may lower fertility.
A forgotten coil
How common is the problem of forgotten coil (IUCD)? There is no published data ascertaining the frequency of forgotten IUCD. However, the author believes that the problem is probably underestimated or under reported. Although rare, it is important to consider the possibility of a forgotten IUCD as a cause of unexplained infertility (Marcus et al. Fertility Sterility, 2011).
