After making the decision to start trying to conceive many women wonder if they will be able to get pregnant. While there are many factors that determine your ability to conceive, some common uterine conditions may easily be overlooked, which begs the question: “Is my uterus baby friendly?”
“For most women, the answer is yes,” explains Paulette Browne, M.D., fertility specialist at Shady Grove Fertility’s Fair Oaks, VA office. “Generally, about 20 percent of infertility is due to an issue with the uterus.”
However, there are several uterine conditions and factors that may make implantation more challenging. “Fortunately, for many women, surgery can correct issues such as fibroids and scar tissue and women will go on to get pregnant and ultimately carry the baby to term,” says Dr. Browne.
These five uterine conditions are the most common factors that can impact the “baby friendliness” of your uterus.
1. Uterine Polyps and Fibroids
Both polyps and fibroids are generally non-cancerous masses that grow and take up space in the uterus affecting the ability for an embryo to implant and grow. Polyps are an overgrowth of the endometrial lining and fibroids are smooth muscle tumors of the uterus.
“These obstructions in the uterus are the most common on our list of uterine factors that can make the uterus less ideal for pregnancy,” explains Dr. Browne. “Many women with uterine polyps and fibroids do not experience any symptoms, while others can have abnormal bleeding or cramping.” The masses are usually found through a saline sonogram or a hysterosalpingogram (HSG), which is a dye test used during a routine fertility work-up.
While some women with smaller masses are able to conceive, polyps and fibroids often need to be surgically removed. Once removed women can continue to try to conceive on their own or by using fertility treatment such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
2. Asherman’s Syndrome and Scar Tissue
“The presence of scar tissue, or adhesions, in the uterus, called Asherman’s syndrome, can also impact the ability for an embryo to implant in the uterus,” says Dr. Browne. “For many women, the formation of adhesions in the uterus is most frequently seen after surgical procedures including a dilation and curettage (D&C), fibroid removal surgery, or due to the occurrence of a retained placenta after the delivery of a baby.”
Symptoms can vary from patient to patient and can include light or absent periods, pain during the time that menstruation should be occurring (often times no blood presents because adhesions prevent it from exiting the uterus), and miscarriage.
The presence of adhesions in the uterus is generally confirmed through one of three tests:
A surgical procedure that allows your physician to look inside your uterus to investigate the source of abnormal uterine bleeding, or a cause of infertility or miscarriages.
An ultrasound-based test used to evaluate the uterine cavity. During this study, a small volume of saline is instilled into the uterus while an ultrasound is performed. This allows your physician to determine if fibroids or polyps (both benign) are protruding into the uterine cavity potentially disrupting embryo implantation.
An x-ray and dye test that your physician will use to detect several kinds of issues, such as polyps, fibroids, or scarring in the lining of the uterus, and blockages in the Fallopian tubes.
Women with a significant presence of scar tissue in the uterus are mostly frequently treated through a surgical procedure where the scar tissue is removed.
3. Increased Hormone Levels
“Recent studies have found that women who are preparing for an egg retrieval who have increased levels of progesterone prior to or on the day of their trigger shot have a decreased chance of pregnancy after the embryo transfer, which occurs several days later,” says Dr. Browne. “Research has shown high levels of progesterone create a hostile environment in the uterus that can directly affect the embryo’s ability to implant.”
In 2008, vitrification, an improved method used to cryopreserve eggs and embryos, was introduced. This improvement in technology drastically increased the pregnancy rates associated with previously frozen eggs and embryos. In many cases, these improvements have made frozen embryo transfers (FET) more successful than fresh transfers, especially when hormone levels, like progesterone, are found to be outside of an optimal range.
Freezing all of the available embryos to be used at a later time is an option that gives the woman’s body the time it needs to bring her hormone levels to a normal range. “Once hormones return to an ideal level, embryos will have a better chance to implant into the uterus,” says Dr. Browne. When freezing all of the embryos is determined to be the best course of action, the FET is generally planned for the following month or two.
Endometriosis occurs when the uterine lining grows in other parts of the body such as on the bowel, ovaries, and in the abdomen. Every month, the lining found inside the uterine sheds. Tissue found in other parts of the body also attempts to shed at the same time, often causing very painful periods and heavy menstrual bleeding. Many women with endometriosis have no symptoms except for infertility. It is estimated that 35 percent of women with unexplained infertility have endometriosis.
“Implantation can be difficult for women with endometriosis due to the presence of an abnormal protein found in their uterus. Similar to the impact that increased hormone levels can have on the uterus when the protein expression is deranged it creates a less receptive environment, decreasing the chance of implantation and ultimately pregnancy,” explains Dr Browne.
While surgery is recommended for women looking to decrease the pain associated with endometriosis, surgery has not been found to improve fertility. “The best option for women with endometriosis that are having trouble conceiving is to see a fertility specialist as soon as possible. Surgery could negatively impact the ovaries and as a result, the ability to conceive.”
Under most insurance plans, women with endometriosis do not need to wait the prerequisite 1 or 2 years prior to seeing a specialist.
“A hydrosalpinx is a blocked Fallopian tube that becomes dilated and filled with liquid. This liquid can spill into the uterus and affect the protein expression in the uterine lining. The presence of a hydrosalpinx has been found to decrease implantation rates and increase the occurrence of miscarriage,” says Dr. Browne.
A hydrosalpinx often occurs due to a previous infection such as chlamydia or gonorrhea, a ruptured appendix, or excessive tissue build up due to endometriosis. Symptoms vary, with some experiencing recurrent abdominal pain, while others will not have any symptoms. The presence of a hydrosalpinx is frequently discovered through an ultrasound or HSG.
To prevent the liquid found in the hydrosalpinx from spilling into the uterus, it is recommended that the affected Fallopian tube be tied off at the entry point or be removed completely. A woman with both tubes that become damaged may need fertility treatments such as IVF.
Overcoming Uterine Conditions
The first step to ensuring that your uterus is baby-friendly is a basic infertility work-up, or infertility evaluation. A work-up consists of three simple tests: bloodwork to measure hormone levels paired with an ultrasound on day 3 of your menstrual period and an HSG for the female partner, and a semen analysis for the male partner. While the information from these tests will give your physician the informational he/she needs to determine what’s making it difficult to conceive, it’s the HSG that’s the most telling regarding the status of your uterus.
“No matter the results, there are treatment options available to help nearly everyone grow their family,” says Dr. Browne.
If you have a known uterine condition that may be impacting your ability to conceive we recommend a consult to see a fertility specialist. To learn more, or to schedule an appointment, please call 1-877-971-7755.
Medical contribution by: Paulette Browne, M.D of Shady Grove Fertility’s Fair Oaks, VA office.