Uterine Abnoramalites

Perhaps the single largest factor in pregnancy a is the uterus. Many women find that having an abnormality of the uterus is a factor in their inability to carry a pregnancy or in their inability to conceive a pregnancy.

The Septate Uterus

The septate uterus is the most common congenital uterine anomaly and is a condition where a wall or septum partially or fully separates the uterus into two complete cavities. This congenital factor is suspected of affecting one in four woman who have reproductive failure.

A uterine x-ray, called a hysterosalpingogram or HSG, along with gathering clinical facts, is used to make the initial diagnosis. The HSG procedure is often used to detect scar tissue, polyps, fibroids or a uterus which is abnormally shaped. Treatment for septate uterus is surgical since hormones are not of much benefit in this instance.

A metroplasty, the surgical procedure used to remove the septum which divide the uterus, can be done either through a hysterscope (a telescope-like device that is placed in the vagina and then into the uterus) or via a small incision in the abdomen, called a laparomaty. There is less time involved in recovery using the hysteroscope than the laparotomy.

The success rate of this surgery indicates that about 80 percent of women who have undergone the surgery to remove the septum and reshape their uterus have gone on to become pregnant and to carry the baby to term.

For more information about Septums please follow these links:

http://yourtotalhealth.ivillage.com/uterine-septum.html

http://www.advancedfertility.com/uterus.htm

http://fertstert.wordpress.com/2008/11/04/hysteroscopic-resection-of-the-uterine-septum-is-it-always-a-necessity/

Hystroscopicresectioningof septum

SHG - SIS Study to detect uterine abnormalities

Fibroids

Uterine fibroids are growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas.

The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure.

Fibroids can range in size from small, pea-sized growths to large, round ones that may be more than 5–6 inches wide. As they grow, they can distort the inside as well as the outside of the uterus. Sometimes fibroids grow large enough to completely fill the pelvis or abdomen.

A woman may have only one fibroid or many of varying sizes. Whether fibroids will occur singly or in groups is hard to predict. They may remain very small for a long time, suddenly grow rapidly, or grow slowly over a number of years.

For more information:

http://www.acog.org/publications/patient_education/bp074.cfm

http://www.nichd.nih.gov/publications/pubs/fibroids/sub1.cfm#treatments

http://www.fibroidsecondopinion.com/fibroids-and-pregnancy/

http://www.myomectomy.net/

Polyps

Uterine polyps sometimes cause problems with fertility - or can increase the risk of miscarriage. A "normal" uterine cavity and endometrial lining is necessary in order to conceive and maintain a pregnancy.


For more information:

http://www.advancedfertility.com/uterinepolyp.htm

http://www.fertilityfactor.com/uterine-polyps.html

Tubal Factor Infertility (TFI)

When an obstruction prevents the egg from traveling down the tube, the woman has a blocked fallopian tube. It can occur on one or both sides. This is also known as tubal factor infertility, and is the cause of infertility in 40% of infertile women.

How Do Blocked Fallopian Tubes Cause Infertility?

Each month, when ovulation occurs, an egg is released from one of the ovaries. The egg travels from the ovary, through the tubes, and into the uterus. The sperm also need to swim their way from the cervix, through the uterus, and through the fallopian tubes to get the egg. Fertilization usually takes place while the egg is traveling through the tube.

If one or both fallopian tubes are blocked, the egg cannot reach the uterus, and the sperm cannot reach the egg, preventing fertilization and pregnancy.

It's also possible for the tube not to be blocked totally, but only partially. This can increase the risk of a tubal pregnancy, or ectopic pregnancy.

What is Hydrosalpinx?

A specific kind of blocked fallopian tube, hydrosalpinx is when a blockage causes the tube to dilate (increase in diameter) and fill with fluid. The fluid blocks the egg and sperm, preventing fertilization and pregnancy.

Can You Get Pregnant With a Blocked Fallopian Tube?

If only one fallopian tube is blocked, but the other is clear, it may still be possible to achieve pregnancy. It depends on how well the ovary on the side of the clear tube is functioning, and also what caused the blocked tube in the first place.

Plus, since ovulation takes place on different sides from month to month, when the ovary on the blocked side ovulates, pregnancy cannot be achieved. So it may take longer to get pregnant.

What are the Symptoms of Blocked Fallopian Tubes?

Unlike anovulation, where irregular menstrual cycles may hint to a problem, blocked fallopian tubes rarely cause symptoms. A specific kind of blocked fallopian tube, called hydrosalpinx, may cause lower abdominal pain and unusual vaginal discharge, but not every woman will have these symptoms.

However, some of the causes of blocked fallopian tubes might lead to hints of a problem. For example, endometriosis and pelvic inflammatory disease may cause painful menstruation and painful sexual intercourse. But these symptoms don't necessarily point to blocked tubes.

What Causes Blocked Fallopian Tubes?

The most common cause of blocked fallopian tubes is pelvic inflammatory disease (PID). PID is most often the result of a sexually transmitting disease, but it isn't always related to an STD. Also, even if PID is no longer present, a history of PID increases the risk of blocked tubes.

Other potential causes of blocked fallopian tubes:

• Current or history of an STD infection, specifically Chlamydia or Gonorrhea
• History of uterine infection caused by an abortion or miscarriage
• History of a ruptured appendix
• History of abdominal surgery
• Previous ectopic pregnancy
• Prior surgery involving the fallopian tubes
• Endometriosis

How are Blocked Tubes Diagnosed?

Blocked tubes are usually diagnosed with a specialized x-ray, called a hysterosalpingogram, or HSG. This test involves placing a dye through the cervix, using a tiny tube. Once the dye has been given, the doctor will take x-rays of your pelvic area.

• All About Hysterosalpingogram (HSG)

If all is normal, the dye will go through the uterus, through the tubes, and spill out around the ovaries and into the pelvic cavity. If the dye doesn't get through the tubes, then you may have a blocked fallopian tube.

It's important to know that 15% of women have a "false positive," where the dye doesn't get past the uterus and into the tube. The blockage appears to be right where the fallopian tube and uterus meet. If this happens, the doctor may repeat the test another time, or order a different test to confirm.

Other tests that may be ordered include ultrasound, exploratory laparoscopic surgery, or hysteroscopy (where they take a thin camera and place it through your cervix, to look at your uterus). Blood work to check for the presence of Chlamydia antibodies (which would imply previous or current infection) may also be ordered.

What are the Potential Treatments for Blocked Tubes?

If you have one open tube, and are otherwise healthy, you might be able to get pregnant without too much help. Your doctor may give you fertility drugs to increase the chances of ovulating on the side with the open tube. This is not an option, however, if both tubes are blocked.

In some cases, laparoscopic surgery can open blocked tubes or remove scar tissue that is causing problems. Unfortunately, this treatment doesn't always work. The chance of success depends on how old you are (the younger, the better), how bad and where the blockage is, and the cause of blockage.

If just a few adhesions are between the tubes and ovaries, then your chances of getting pregnant after surgery are good. If you have a blocked tube that is otherwise healthy, you have a 20% to 40% chance of getting pregnant after surgery.

But if thick, multiple adhesions and scarring are between your tubes and ovaries, or if you have been diagnosed with hydrosalpinx, surgery may not be a good option for you. Also, if there are any male infertility issues, you might want to skip surgery. In these cases, IVF treatment is your best bet.

Also important to note is that your risk of ectopic pregnancy is higher after surgery to treat tubal blockage. Your doctor should closely monitor you, if you do get pregnant.

For more information:

http://www.advancedfertility.com/tubal.htm
http://www.beachcenter.com/surgical/tubal.shtml

Sources:

Conceiving After Tubal Surgery: Fact Sheet. American Association of Reproductive Medicine. Accessed November 6, 2008. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ConceivingAfterTubalSurgery.pdf

Hydrosalpinx: Fact Sheet. American Association of Reproductive Medicine. Accessed November 6, 2008. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/hydrosa(1).pdf

Testing

• In about 20 percent of cases, infertility is due to a cause involving only the male partner.
• In about 30 to 40 percent of cases, infertility is due to causes involving both the male and female.
• In the remaining 40 to 50 percent of cases, infertility is due entirely to a cause involving the female.

There are several basic tests that everyone should have before beginning treatment:

Cycle Day 3 (CD3) blood work. This is blood drawn on the 3rd day after you get your period. This blood draw will check different hormone levels. You can check a complete list of hormone levels here

Hysterosalpingogram (HSG) - This is a test where dye is inserted using a catheter into your cervix to watch the flow from your tubes to your uterus. This will tell you if you have anything blocking your tubes. Here is more information about the HSG

Semen Analysis (SA) - This is your husbands/partners part in the testing. What it will check for is amount, motility and morphology of his sperm. Keep in mind that even if you have a diagnosed issue, you should not rule out issues with your husband, in fact, 30% of cases the cause is attributed to both male and female factors, meaning there is an issue with both of you. For a chart of normal and abnormal results click here

Additional testing:

Besides the above tests that everyone should have, there a a couple of other tests that you should consider, especially if your doctor feels it is needed or after all other tests are done you feel you need more answers.

Laproscopy - Check here for more information

Sonohysterogram (SIS or SHG) - Check here for more information

7 day past ovulation (7dpo) bloodwork - This will check if you have ovulated and if your progesterone levels are considered high enough. If you have a short luteal phase you should ask about this.

Diagnostic Hysterscopy - Check here for more information