Uterine Problems and Fertility and Infertility

Advanced Fertility Center of Chicago
Specialists in Infertility and Reproductive Medicine
Gurnee & Crystal Lake, Illinois

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 possible implantation of an embryo. If no embryo implants (she is not pregnant) her body recognizes that she is not pregnant at the end of that menstrual cycle and it sheds the lining and starts the regeneration process over again.

hysteroscopy of normal endometrial 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 images of a uterus with a normal endometrial lining that is 11.5 mm thick. Image on right shows the uterus outlined in blue and the "triple stripe" uterine lining (landing pad for the embryos) outlined in yellow. Cervical canal is also well visualized. The vaginal area can not be seen because the ultrasound probe is in the vagina.

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 images of an 11.5 mm lining). There is some ongoing debate as to "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 could possibly reduce chances for a successful pregnancy.

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 determine whether there are any defects inside the cavity.

A uterine polyp seen with hysteroscopy

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Normal uterine configuration vs. uterine septum

Ultrasound, particularly 3D ultrasound, a newer technology, is very useful in characterizing the shape of the uterine cavity

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

A septate uterus can cause reproductive problems such as miscarriage, preterm labor or preterm labor and birth. A septum in the uterus is like extra muscle "pushing down" from the top into the cavity.

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

Uterine problems causing infertility or miscarriage