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There Are Many Causes of Uterine Disease
1. Birth defects of the uterus are primarily associated with repeated miscarriages or premature delivery as opposed to infertility. One of the more common birth defects results in repeated first trimester miscarriages.
This anomaly is called a uterine septum, which is a wedge (septum) of tissue that has poor blood supply. As a result, when an embryo attaches to the septum, a pregnancy will progress normally for a brief period of time, but ultimately the blood supply needed to sustain the developing fetus is inadequate and an early miscarriage will occur.
Often confused with a septum, the bicornuate uterus is more commonly associated with second trimester pregnancy loss. Diagnosis is typically by a combination of one or more studies including hysteroscopy, hysterosalpingogram, ultrasound, MRI as well as laparoscopy.
Fortunately, a septum can be surgically corrected and is typically accomplish by an outpatient procedure with a quick recovery and excellent prognosis.
2. Tumors, such as polyps or fibroids can cause reproductive difficulties, either in the form of infertility or miscarriages. Smaller tumors such as polyps are “tonsil like” projections in the interior of the uterus.
Most studies show that they do not cause reproductive problems when they are small. Some recent studies, however, have shown polyps to be associated with a change in conception rates.
Diagnosis is typically by ultrasound, hysterosalpingogram, sonohysterogram, or hysteroscopy. Independent of the desire to conceive, removal of polyps may be warranted medically as they can occasionally be associated with abnormal tissue changes that can be precancerous. Treatment is primarily surgical as an outpatient with a quick recovery time.
The effect of fibroids in reproduction is a complex topic. These tumors are benign but can cause many different symptoms. Generally, size and location are the most important determinants as to whether they can cause infertility, miscarriage, or preterm labor.
What appears to be clear is the larger the tumor and the closer the tumor to the endometrial cavity (the site of embryo attachment), the greater is the significance. Removal of the larger tumors that are closest to the uterine cavity have the greatest beneficial impact on reproduction.
Conversely, surgical treatment of fibroids can sometimes lead to increased difficulties with reproduction by unintended scar tissue formation. Certain treatment strategies exist that can prevent such scar tissue from forming and should be discussed before surgical removal of these fibroids.
Surgery for fibroids is often as an outpatient but sometimes a larger incision will require an overnight stay. Unfortunately, medical treatments are generally not effective in the management of individuals wishing to conceive.
3. Scarring of the endometrial cavity can rarely occur as a result of infection or bleeding complications that follow a miscarriage or delivery. The scar tissue can be surgically removed in many patients, but requires extensive training and experience for a good outcome. The surgical procedure is typically performed on an outpatient basis.
4. An insufficient response of the endometrial cavity to inadequate levels of progesterone can cause a poor environment for conception or can result in repeated miscarriages.
Diagnosis of this condition has been notoriously difficult and has traditionally involved biopsies that can be uncomfortable and expensive. At RMCRM, hormonal profiles in combination with ultrasound are a preferred method. Treatment could be as simple as a medication such as Clomid or progesterone and estrogen.
We provide services for the diagnosis and treatment of infertility.
Our services include an outstanding IVF and donor egg program.
We offer all levels of treatment including infertility testing intrauterine insemination (IUI), medical treatment, and advanced laparoscopic surgery. Most of our patients become pregnant without requiring IVF.
Monday-Thursday 8AM - 5PM
Friday 8AM - 1PM
Our patients can reach us for emergencies 24 hours a day by calling our main number, and selecting choice #1, which pages our medical or nursing staff.
If your situation is life threatening, dial 911 or go directly to your local ER.