The uterus plays a critical role in supporting conception and pregnancy. Successful embryo implantation and fetal development depend on a healthy uterine environment. Below are key uterine factors that can lead to infertility:
1. Endometrial Insufficiency
- Types:
- Endometrial Atrophy: Thin or underdeveloped endometrial lining.
- Endometrial Hyperplasia: Abnormal thickening of the endometrium.
- Luteal Phase Endometrial Dysfunction: Poor endometrial receptivity during the luteal phase, hindering embryo implantation.
2. Uterine Malposition
- Retroverted or Retroflexed Uterus: A backward-tilted uterus may prevent the cervix from being submerged in seminal fluid, reducing sperm entry.
- Excessive Anteversion: Severe forward tilting can also impair conception.
3. Uterine Anomalies (Congenital or Acquired)
- Common Types:
- Congenital absence of the uterus: Rare but absolute barrier to pregnancy.
- Bicornuate uterus: A heart-shaped uterus with two “horns.”
- Septate uterus: A uterine cavity divided by a fibrous or muscular septum.
- Unicornuate uterus: A single-horned uterus.
- Impact: Anomalies may cause implantation failure, recurrent miscarriage, preterm labor, or placental abnormalities.
4. Hypoplastic Uterus (Underdeveloped Uterus)
- A small or immature uterus may lack the capacity to support embryo growth, leading to infertility or recurrent pregnancy loss.
5. Intrauterine Adhesions (Asherman’s Syndrome)
- Causes: Post-traumatic scarring from procedures (e.g., D&C) or infections.
- Location:
- 56% in the uterine cavity.
- 24% involving both the cavity and cervical canal.
- 20% at the uterine isthmus.
- Effects: Adhesions distort the uterine cavity, block fallopian tube openings, or reduce endometrial blood flow, leading to infertility or miscarriage.
6. Endometritis (Chronic Uterine Inflammation)
- Mechanisms:
- Inflammatory exudates damage sperm or disrupt embryo implantation.
- Compromised endometrial nutrient supply hinders embryo development.
7. Uterine Fibroids (Leiomyomas)
- Impact: Submucosal or intramural fibroids may distort the uterine cavity, block fallopian tubes, or impair implantation. Even small fibroids can interfere with placental development.
Diagnosis and Management
Women experiencing infertility should undergo thorough evaluation, including:
- Imaging: Ultrasound, hysteroscopy, or MRI to assess uterine structure.
- Endometrial biopsy: To detect inflammation or insufficiency.
- Surgical correction: For adhesions, fibroids, or septums (e.g., hysteroscopic resection).
If conventional treatments fail, IVF (in vitro fertilization) may bypass uterine obstacles or address concurrent tubal or ovarian issues.
Key Takeaway: Early diagnosis and tailored treatment are crucial. Uterine abnormalities account for ~15% of female infertility cases, but many can be managed effectively with medical or surgical interventions.
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