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
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