Year: 2021 | Month: December | Volume: 11 | Issue: 12 | Pages: 220-224
DOI: https://doi.org/10.52403/ijhsr.20211229
Uterine Disorders and Infertility
Neerja Sharma
Specialist Obstetrics and Gynaecology, MGH MCD Hospital, New Delhi
ABSTRACT
Uterine factors contribute significantly to female infertility, constituting 5% of all cases. This article explores key uterine disorders affecting fertility, including adenomyosis, fibroids, Müllerian anomalies, chronic endometritis, thin endometrium, and endometrial polyps. Adenomyosis, characterized by increased intrauterine pressure and abnormal inflammatory responses, poses challenges to spontaneous conception and assisted reproductive techniques (ART). Medical management, including Gonadotropin-Hormone-Releasing-Hormone Agonists and Letrozole, along with innovative approaches like High-Intensity Focused Ultrasound (HIFU), aim to improve pregnancy outcomes. Fibroids, responsible for <10% infertility cases, disrupt uterine architecture and vascularity. Diagnosis through MRI and hysteroscopy informs treatment decisions, with hysteroscopic myomectomy recommended for submucosal fibroids. Magnetic Resonance Guided Focused Ultrasound (MRgFUS) shows promise but requires further validation. Müllerian anomalies, observed in 8.13% of infertility cases, present varied outcomes. Diagnosis involves hysteroscopy, hysterosalpingography, and advanced imaging. The association of recurrent pregnancy loss with Müllerian anomaly remains debated. Chronic endometritis (CE), linked to decreased endometrial receptivity, affects 15% of infertile women undergoing IVF. Accurate diagnosis through hysteroscopy and biopsy informs antibiotic treatment. Thin endometrium and Asherman syndrome contribute to implantation failure. Early recognition and investigation are crucial for appropriate intervention. Endometrial polyps, common in subfertile women, are often removed before assisted reproductive procedures. The article emphasizes the importance of a comprehensive diagnostic approach, considering factors such as age, fibroid size, and endometrial involvement. Surgical interventions, including adenomyoma resection and myomectomy, aim to improve fertility outcomes, but risks like uterine rupture must be considered. The role of novel techniques like HIFU and MRgFUS offers alternatives but requires further research.
In conclusion, uterine factors significantly impact fertility, necessitating a thorough understanding and tailored interventions to enhance reproductive outcomes.
Key words: Uterine factors, infertility, adenomyosis, fibroids, Müllerian anomalies, chronic endometritis, thin endometrium, endometrial polyps, assisted reproductive techniques, medical management, surgical treatment.