The uterus plays a central role in reproduction by providing the environment necessary for embryo implantation and pregnancy development. Although uterine factors account for a relatively small percentage of infertility cases (approximately 1%), structural or functional abnormalities of the uterus can significantly affect implantation, increase miscarriage risk, or complicate pregnancy.
When properly diagnosed, many uterine conditions can be successfully treated, improving the chances of conception and a healthy pregnancy.
Uterine Fibroids are noncancerous growths that develop within or around the uterus. Their impact on fertility depends largely on their size and location.
Submucosal fibroids (inside the uterine cavity) are most likely to interfere with implantation.
Larger fibroids may distort the uterine cavity.
Some fibroids may increase miscarriage risk or cause pregnancy complications.
Surgical removal (myomectomy) may improve fertility outcomes in selected cases.
Endometrial Polyps are small, benign overgrowths of the uterine lining. They can:
Cause irregular bleeding or spotting
Interfere with embryo implantation
Reduce IVF success rates
Hysteroscopic removal of polyps (polypectomy) is a minimally invasive procedure that often improves implantation and pregnancy rates.
Some women are born with structural differences in the uterus. These abnormalities can affect implantation and increase the risk of pregnancy loss.
Common congenital anomalies include:
Septate Uterus – A fibrous or muscular partition divides the uterine cavity, often associated with recurrent miscarriage.
Bicornuate Uterus – A uterus with two cavities that may increase miscarriage or preterm birth risk.
Uterus Didelphys – A rare condition where two separate uterine cavities develop.
Some anomalies can be corrected surgically to improve reproductive outcomes.
Asherman’s Syndrome occurs when scar tissue forms inside the uterus, often after surgical procedures such as dilation and curettage (D&C), infection, or postpartum complications.
This condition may cause:
Light or absent menstrual periods
Implantation failure
Recurrent miscarriage
Treatment typically involves hysteroscopic removal of adhesions followed by hormonal therapy to restore the endometrial lining.
A healthy endometrial lining is essential for embryo implantation. When the lining measures less than approximately 7 mm during the implantation window, pregnancy rates may decrease.
Possible causes include:
Hormonal imbalances
Chronic inflammation
Reduced blood flow to the uterus
Long-term contraceptive use
Treatment options may include estrogen therapy, blood flow–enhancing strategies, and in selected cases, emerging therapies such as platelet-rich plasma (PRP).
Uterine abnormalities can usually be identified through:
Transvaginal ultrasound
Hysteroscopy (direct visualization of the uterine cavity)
Hysterosalpingography (HSG)
MRI for detailed structural evaluation
Accurate diagnosis is crucial for selecting the most appropriate treatment.
Management depends on the specific condition and its severity.
Hormonal therapy to regulate cycles and improve endometrial receptivity
Myomectomy for fibroids
Polypectomy for endometrial polyps
Hysteroscopic correction of septum or adhesions
If structural issues cannot be fully corrected or if fertility remains impaired, In Vitro Fertilization (IVF) may improve pregnancy chances by optimizing embryo development and timing of implantation.
Although uterine factor infertility is relatively uncommon, its impact on implantation and pregnancy can be significant. The good news is that many uterine conditions are treatable with modern medical and surgical techniques. Early evaluation and individualized care from a fertility specialist can greatly enhance the chances of successful conception and a healthy pregnancy.