Anna Maria & Alexander

Uterus

Uterine fibroids and endometrial polyps are frequent findings which may interfere with embryo implantation regardless of how conception occurs. Fortunately, the most problematic fibroids occur within the uterine cavity and can usually be removed with hysteroscopy, a minor surgical procedure performed on an outpatient basis.

Fibroids arise from the muscle layer of the uterus. The pictures below show a large submucous fibroid being resected with an electric loop. The patient had a successful spontaneous conception shortly after surgery.

Submucous fibroid

Location of fibroids matters more than their size or number. Subserosal fibroids, as pictured below at laparoscopy, have little, if any, impact on the chance of a successful pregnancy.

Two subserosal fibroids outside the uterus

Endometrial polyps arise from the gland layer lining the uterine cavity. Large polyps can be apparent on vaginal ultrasound (upper picture) while smaller polyps usually are readily seen on saline infusion a sono-hysterogram (lower picture). Hysteroscopic removal of all polyps is recommended before IVF and other advanced treatments.

Inborn (congenital) abnormalities of uterine shape are relatively common. Septate uterus contains 2 small cavities within a unified uterine body (see images below). Other uterine abnormalities include scarring (Asherman’s syndrome), submucous fibroids and endometrial polyps. Most of these conditions can be corrected through outpatient hysteroscopy.                                                        

Ultrasound of a septate uterus (S=septum, C=cavities)

Hysteroscopic view of septum at arrow and 2 cavities in upper panel;
unified uterine cavity after incision of septum in lower panel