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Advanced Fertility Center of Chicago ivf

Uterine Problems Can Cause Infertility or Miscarriage

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A (fairly) normal uterine cavity and endometrial lining are necessary in order to conceive and maintain a pregnancy. There are several conditions related to the cavity or the lining that can cause problems.

  • When a woman has her menses (period) the endometrial lining of the uterus and some associated blood is shed. Then a new lining is regenerated over the next few weeks or so and eventually becomes receptive to implantation of an embryo.

  • If no embryo implants, her body recognizes that she is not pregnant and it sheds the uterine lining and starts the regeneration process over again.


Hysteroscopic view of inside a normal uterine cavity
Hysteroscopic view of inside a normal uterine cavity.
Office hysteroscopy - we are looking up from the cervix at the top of the uterine cavity.
The tubal ostia (openings of fallopian tubes into uterus) are the dark spots at 3 and 9 o'clock.


Ultrasound image of a uterus with a normal endometrial lining
Ultrasound images of a uterus with a normal endometrial lining thickness of 11 mm


Ultrasound picture with uterus and lining outlined
Same image showing the outer contour of the uterus outlined in red and the "triple stripe" endometrial (uterine) lining outlined green. Cervical canal is well visualized at lower right.


Problems of the uterus and uterine lining that can cause or contribute to reproductive problems such as infertility or recurrent miscarriage:

  • Uterine Polyps
  • Uterine Fibroids (proper medical terminology is myoma or leiomyoma)
  • Intrauterine adhesions - scar tissue within the uterine cavity, also called Asherman's Syndrome. This can interfere with conception, or can increase the risk of a miscarriage.
  • Congenital uterine malformations, such as a bicornuate uterus, a T-shaped uterus, or a uterine septum
  • Luteal phase defect - an uncommon condition that involves inadequate development of the microscopic and cellular changes in the endometrial lining of the uterus after ovulation and exposure to the hormone progesterone.
  • Thin endometrial lining - this is also uncommon. We like to see a lining of at least 8mm in thickness when measured by ultrasound at the time of maximal thickness during the cycle (see above ultrasound picture of an 11.2 mm lining).

There is some debate about "how thin is too thin", as well as to "how thick is too thick".

  • In general, 8-13 mm is good, less than 6 is potentially a problem, and greater than 15 or so might possibly reduce chances for successful pregnancy.

During IVF treatment, the uterine lining starts at about 3mm thick at the end of the menstrual period. After estrogen levels rise sufficiently, the lining of the uterus thickens by about 1mm each day during IVF.


Hysteroscopy is a surgical procedure that involves insertion of a narrow telescope-like instrument through the vagina and cervix into the cavity of the uterus (endometrial cavity). The cavity is then distended with fluid (such as salt water) and can be visualized through the scope. This procedure allows us to see any defects inside the cavity.

Uterine polyp seen by hysteroscopy
Large uterine polyp on the "floor" of the uterine cavity - seen with hysteroscopy


Ultrasound is a very useful tool for evaluating the pelvis and the uterus and its lining, or endometrium. 3D ultrasound, a newer technology, is particularly good at helping doctors to characterize the shape of the uterine cavity.

Normal uterine configuration vs. uterine septum

normal uterus in the coronal plane
Ultrasound of a normal uterus in the coronal plane
The endometrial cavity has a smooth triangular shape
Cervix is at the bottom of the image


uterine septum on a coronal plane


A uterine septum on a coronal plane from 3D ultrasound
Endometrial lining and uterine cavity = C
Muscle part of uterus = M
Septum "pushing down" into cavity = S
A septum is like extra muscle "pushing down" from the top into the cavity


unicornuate uterus 3D ultrasound coronal plane


This ultrasound image (3D) is a coronal plane showing a unicornuate uterus
The cavity (at "C") only goes to one fallopian tube (goes up to her right tube)
The other side of the uterus and the left tube are congenitally absent

Congenital uterine abnormalities such as a unicornuate, septate or bicornuate uterus can cause reproductive problems such as miscarriage, preterm labor and preterm birth.


septate uterus
Office hysteroscopy image of a uterine septum looking up from cervix towards top of uterus
Septum dividing the cavity at "S"
The left side of her uterine cavity is at "L", the right side is at "R"



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4920 N. Central Ave
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Chicago, IL 60630

Phone: (773) 794-1818
Fax: (773) 794-1819

GURNEE
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30 Tower Court
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Gurnee, IL 60031

Phone: (847) 662-1818
Fax: (847) 662-3001

CRYSTAL LAKE
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820 E. Terra Cotta Ave (Rte 176)
Suite 118
Crystal Lake, IL 60014

Phone: (815) 356-1818
Fax: (815) 356-1866

4920 N. Central Ave
Suite 2C

Chicago, IL 60630

Phone: (773) 794-1818
Fax: (773) 794-1819

30 Tower Court
Suite F
Gurnee, IL 60031

Phone: (847) 662-1818
Fax: (847) 662-3001

820 E. Terra Cotta Ave (Rte 176)
Suite 118
Crystal Lake, IL 60014

Phone: (815) 356-1818
Fax: (815) 356-1866

TESTIMONIALS

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I am so grateful for Advanced Fertility Center. I just had my son Leland. I want to thank Dr. Catenacci and all of the nurses that helped us. Especially Ashley in the Crystal Lake office. You made this process easier by being supportive and positive. Thank you very much!

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Dr. Sherban and his staff are the most amazing, compassionate, and supportive people. After almost 5 years of trying to conceive, going through numerous tests and meeting with another clinic closer to home, who told me my chances even with IVF were still very low, a good friend recommended advanced fertility center of Chicago. Best decision we ever made! We now have 2 amazing children who are now 5 and 3 years old! I cannot stress enough how amazing this staff is, they make you feel like family!

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Our experience was amazing with Dr. Cantanucci and all of the nurses (especially Ashley). After ttc for 4 years and at 41 years of age, we became pregnant after 1 round of IVF, and had our beautiful boy this past October. Can't thank them enough!

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2/7/15 our son was born all thanks to the assistance of Dr. Sherbahn and his staff. Everyone was so helpful and here for all our questions, worries, etc. They want this for you just as much as you want this for you! Handled with pure professionalism and care from the very start! Thank you advanced fertility!

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