Uterine abnormalities: uterine septums, scarring and structural causes of infertility

Uterine abnormalities caused by both abnormalities of the uterus from birth and those that occur after birth, can affect fertility and the chance for conception. Both congential and aquired uterine abnormalities are significant causes of both infertility and recurrent pregnancy loss.

Congenital uterine abnormalities

Typically congenital abnormalities , present from birth and referred to as Mullerian anomalies, occur when the uterus is forming in the fetus. The uterus develops from a specialized type of tissue called Mullerian tissue.  During embryonic development, a female fetus actually starts out with two small uteri (plural of uterus) – one near each kidney.  As the fetus develops, each uterus migrates down toward the tissue that ultimately becomes the vagina, and toward the middle of the patient’s body where it fuses with the uterus from the other side.

Under normal circumstances, the wall where the two uteri join reabsorbs completely – from the bottom of the uterus to the top – resulting in a triangular shaped uterine cavity.Any alteration of this development can lead to a Mullerian anomaly.

The most common Mullerian abnormalies include:

• septate uterus
• bicornuate uterus
• unicornuate uterus
• uterine didelphys

To learn more about uterine septums

Aquired uterine abnormalities

In addition to the congenital uterine abnormalities described above, there are a variety of other uterine abnormalities that can develop after birth.  These are referred to as “acquired abnormalities”. Examples include endometrial polyps, intrauterine adhesions, and uterine fibroids.

These conditions frequently cause symptoms – such as increasingly severe menstrual cramps, heavier or irregular vaginal bleeding, or changes in bowel or bladder function.  On some occasions, patients are unaware that they have these conditions and they are only discovered as part of a fertility evaluation.  Typically large fibroids can be detected during a pelvic examination, however smaller fibroids, fibroids within the uterine cavity, polyps, and adhesions can only be detected by some sort of imaging technique – either a sonogram, an HSG, or a sonohysterogram.