Acquired Uterine Abnormalities

Uterine Myomas

• Found in 5-10% of infertile women
• Cause of bleeding, pain and pressure, impact on fertility harder to define
  • Enlargement or deformity of the uterine cavity (inhibiting sperm or
  • embryo transport)
  • Obstruction of fallopian tubes
  • Distorted adnexal anatomy
  • Impaired uterine blood flow or chronic endometritis (interferes with
  • implantation)
• Submucosal fibroids most significant adverse effect on clinical pregnancy rates.
  • Might reduce IVF rates by up to 70%

Asherman’s Syndrome

• Intrauterine adhesions that result from trauma, inflammation and/or infection
• Hysteroscopy best for dx and tx
  • Misoprostol for cervical softening
  • Adhesions are lysed
  • Need physical barrier to keep uterine lining edges separated while healing
  • Cyclic HRT to re-epithelialize lining and reduce risk of recurrent adhesions

Endometrial Polyps

• Endometrial growths
• Increase in incidence with age
• Prevalence in infertile women 3-10%
• Polypectomy indicated when women symptomatic
• Polypectomy may improve fertility depending on size of polyp

Chronic Endometritis

• Chronic inflammation of the endometrium
  • May hinder implantation
• Associated with chlamydia and mycoplasma infections
  • Chronic retained POC?
• Diagnosis made histologically by doing endo bx
  • Presence of plasma cells
• Treated with antibiotics