Normal uterus: The uterus is a hollow, thick-walled, muscular organ of the female reproductive tract that is located between the bladder and the rectum, in the lesser pelvic area.The uterus has an inverted pear shape. In the adult, it measures about 7.5 cm in length, 5 cm wide at its upper part, and nearly 2.5 cm in thickness.
The uterus has three layers: the inner lining (endometrium); the middle muscular layer (myometrium); and the outer layer (perimetrium). The uterus is connected to the fallopian tubes, the cervix, and to the vagina via the cervix. The main purpose of the uterus is to nourish a fetus prior to birth. In menstruating females, the ovaries release eggs that travel via the fallopian tubes to the uterus. If fertilized, the egg will implant itself to the wall of the uterus and the fetus will develop. The uterus nourishes and protects the fetus until birth.
Abnormalities of the uterus can have an impact on the ability of a woman to conceive and to carry a pregnancy successfully. Some women have an abnormally developed uterus from birth (congenital) while others may develop a uterine problem due to infection or surgery (acquired).
Fertility problems involving the uterus include:
- Uterine fibroid such as submucosal fibroids could have a significant impact on the ability of woman to conceive and carry a pregnancy successfully. However, benign polyps or tumors (fibroids or myomas) are common in the uterus, and even though some types can impair fertility by blocking the fallopian tubes or by disrupting implantation many women who have fibroids or polyps can become pregnant.
- Congenital abnormalities Congenital anomalies of the uterus have been associated with infertility and adverse pregnancy outcomes. Congenital uterine anomalies can be detected among infertile women and in women with recurrent pregnancy losses.
- Asherman’s syndrome is the presence of scar tissue (adhesion) in the uterine cavity, it is also known as intrauterine adhesions. If the condition is severe enough and the entire uterine cavity is scarred, the woman will not menstruate. When scarring is not so serious, then menstruation is generally very light.
- Adenomyosis is the presence of endometrial tissue which is a tissue that makes up the lining of the uterine cavity in the myometrium ,the muscle of the uterus. The adenomyosis can spread throughout the myometrium or can form nodules called adenomyomas. It is a benign non-cancerous condition and it is common disorder. Adenomyosis is very similar to endometriosis and both are considered to be progressive, the uterine lining is growing where it should not be growing. Adenmomyosis may contribute to infertility.
Getting pregnant and abnormal uterus
It depends on the abnormality of your uterus. Generally speaking, uterine abnormalities do not affect your ability to become pregnant. You may not even realize that you have an abnormality.
- Agenesis: This is very rare case. It happens when the vagina does not form properly, or is very short. There may be a very small uterus or none at all. This is usually picked up when a girl doesn’t start her periods. It can also make sex very uncomfortable. The condition can be treated with surgery, and if you have agenesis of the uterus, you might also consider counseling. The only way for a woman with agenesis to have a baby is by surrogacy.
- Uterus didelphys This is when the uterus has two inner cavities. Each cavity may lead to its own cervix and vagina, so there are two cervixes and two vaginas. This is also a uncommon case and it is possible to conceive if you have this type of abnormality, and have a normal pregnancy.
- Unicornuate uterus A unicornuate uterus is half the size of a normal uterus and there is only one fallopian tube. It is also a rare abnormality. It develops in the earliest stages of life, when the tissue that forms the uterus does not grow properly. With unicornuate uterus, even though you probably have two ovaries, only one will be connected to your uterus. it is perfectly possible to conceive.
- Bicornuate uterus Instead of being pear-shaped, this type of uterus is shaped bit like a heart, with a deep indentation at the top. It is called a uterus with two horns, because of its shape. It shouldn’t affect your fertility, but you have a higher risk of miscarriage if you do conceive.
- Septate uterus This is the type where the inside of the uterus is divided by a muscular or fibrous wall, called the septum. The septum may extend only part way into the uterus which is called partial septate uterus or it may reach as far as the cervix in this case complete septate uterus. A septate uterus may make it more difficult for you to conceive and may increase your risk of miscarriage.
- Arcute uterus it looks more like a normal uterus, except it has slight indentation at the top. It is a common abnormality and it doesn’t usually make conceiving difficult.
Treatment & Diagnosis of Uterine Anomalies
Not all abnormalities need to treatment and some can be treated, but the treatment itself may carry risks. All surgical repairs should only be considered only after a thorough evaluation and an extensive discussion between patient and the doctor. Uterine anomalies can be detected by vaginal examinations and imaging techniques below are list are list of exams that could be used for diagnosis: