Uterine Polyps, Asherman Syndrome & Uterine Anomalies

Key concepts of uterine polyps, Asherman syndrome (uterine scarring) & uterine anomalies

• Uterine polyps, Asherman syndrome (uterine scarring) and uterine anomalies are known contributors to infertility and may complicate pregnancy.
• Uterine polyps, also called endometrial polyps, are small growths that develop on the lining of the uterus (endometrium) and may cause infertility by preventing sperm from reaching the egg or the embryo from implanting.
• Asherman syndrome occurs when scar tissue that can result from infections or surgery forms inside the uterus, making it difficult for embryo implantation and growth.
• Uterine anomalies are a variety of structural abnormalities in the uterus generally present from birth that can interfere with embryo implantation and increase the risk of miscarriage and pregnancy complications.
• Many women are unaware of these three conditions until they have trouble conceiving.
• Conceive NJ  can diagnose these issues and effectively treat them, often resulting in improved fertility and pregnancy outcomes.

Uterine polyps (endometrial polyps), uterine polyp symptoms, causes & treatment

Uterine polyps, also called endometrial polyps, are bulb-like growths on the uterine lining (the endometrium) that can vary in size and number. Polyps may protrude into the uterine cavity, sometimes interfering with a woman’s fertility. Uterine polyps are generally noncancerous but can rarely develop into cancerous tumors over time.

Uterine polyps attach to the uterus lining by a stalk. They can also develop in the cervix and sometimes drop down into the vagina. Uterine polyps and uterine fibroids are both types of growths in the uterus, but fibroids are growths in the uterine muscle unlike polyps, which grow from the uterine lining (endometrium).

Related reading: Uterine fibroids

Uterine polyp symptoms

Many women with uterine polyps do not experience any symptoms. This is often why the polyps are only discovered when a fertility specialist is evaluating a woman having trouble conceiving.

When symptoms do occur, most are related to abnormal bleeding. Symptoms include:

• Heavy or prolonged menstrual bleeding.
• Spotting or bleeding between periods.
• Bleeding after intercourse.
• Irregular menstrual cycles.
• Recurrent miscarriage.

Uterine polyp causes and risk factors

Fertility medicine has not determined the exact cause of these polyps and most cases are due to unknown factors. However, certain risk factors have been identified:

• Age (most common in women age 40-49).
• Hormonal imbalance, particularly of estrogen.
• Elevated body weight.
• High blood pressure.
• Medications for breast cancer.

Treatment for uterine polyps and their effect on fertility

Uterine polyps change the uterine environment and often have an effect on fertility. These growths can:

• Block sperm from traveling through the uterus to the fallopian tubes to fertilize an egg.
• Prevent an embryo from implanting in the uterus or developing through pregnancy.
• Cause consistent inflammation that disrupts the uterine environment.

We diagnose uterine polyps through ultrasound and tests such as hysterosalpingography, hysteroscopy or a saline sonogram. These are several methods of in-office evaluation that provide a view inside the uterus.

Uterine polyp treatment

It’s possible our specialist and the patient may decide to monitor the polyps, if they do not appear to be causing problems conceiving or if symptoms are mild. While medications can relieve the symptoms of polyps, they do not actually treat them. Small polyps may resolve on their own, but removal is recommended if the woman experiences infertility.

The most common treatment is hysteroscopic polypectomy, which is a minimally invasive way to remove polyps. This is usually done on an outpatient basis and has a low risk of complications. It is also effective. The Journal of Clinical Medicine reports that about 72% of women undergoing hysteroscopic polypectomy had a positive pregnancy result following the surgery.

Uterine anomalies (uterine abnormalities)

Uterine anomalies, also called uterine abnormalities, are structural irregularities in the uterus. These are often congenital, meaning present from birth, though some abnormalities can be acquired later in life.

Before birth, the uterus normally develops by tissue fusing together to form the hollow cavity of the uterus that can accept an embryo and carry a pregnancy. These congenital uterine anomalies occur when the tissue does not fuse correctly to form the normal hollow cavity. Acquired anomalies may result from surgery, trauma or infection.

Prevalence of uterine anomalies

A study by the Human Reproduction Update reports the following rates of the presence of uterine anomalies:

• 5.5% of women in general.
• 8% of women with infertility.
• 13.3% of women with a history of miscarriage.
• 24.5% of women diagnosed with both infertility and history of miscarriage.

Symptoms of uterine anomalies and their effects on fertility & pregnancy

Uterine anomalies reduce fertility by interfering with embryo implantation or increasing risk of miscarriage and recurrent miscarriage. They also increase the risk of pregnancy complications, such as preterm birth, abnormal fetal position and need for C-section delivery.

Symptoms often don’t present with uterine anomalies. They are often found during evaluation for infertility. Symptoms in addition to the aspects of infertility noted above include:

• Having painful periods.
• Not having a period (amenorrhea).
• Pain with sex.
• Pelvic pain.

Types of uterine anomalies such as bicornuate & septate uterus

The primary types of uterine abnormalities are septate uterus, bicornuate uterus, unicornuate uterus and a T shaped uterus. There are other additional rare anomalies that may occur as well. A common finding is an Arcuate uterus, which is not felt to be an actual uterine anomaly but rather a minor variation of a normal uterus.

Septate uterus

This anomaly occurs when a wall of tissue (a septum) divides the uterine cavity into two halves. This can interfere with implantation and increase miscarriage risk, as well as causing issues with pregnancy such as pre-term labor and a breech position of the baby.

Bicornuate

A bicornuate uterus has a heart shape. It is partially split in two with two horn shapes at the top. It affects fertility by causing recurrent miscarriage. It also causes pregnancy complications such as preterm delivery, fetal growth restriction and breech births.

Unicornuate uterus

This abnormality occurs when only one side of the uterus develops, generally with a cervix connected to the vagina and a single fallopian tube. It can make getting pregnant more difficult and cause miscarriage and preterm delivery.

Women with a unicornuate uterus, which is smaller than a normal one, can get pregnant. But they are more likely to face pregnancy complications such as breech birth, premature delivery and need for a C-section. In addition, some women with a unicornate uterus may be born with only one kidney. That is why a thorough evaluation with an expect fertility specialist is important in women with uterine anomalies.

View images of uterine anomalies at MedlinePlus.

Uterine anomaly diagnosis and treatment

We diagnose these abnormalities with a physical exam, ultrasound imaging evaluations and hysteroscopy. A major recent breakthrough in diagnosing uterine anomalies is the use of a 3-D ultrasound. This specialized ultrasound technique uses advance imaging software to generate a 3D rendering of the uterus referred to as “the impossible view.” At Conceive NJ, every new patient evaluation includes a 3-D ultrasound exam to look for and diagnose uterine anomalies and to ensure that they are not missed during testing.

Hysteroscopy, which is a procedure using a camera to look inside the uterus, can be used to both diagnose uterine anomalies as well as correct them in certain cases.   

Often such abnormalities do not require treatment intervention. But to address these uterine issues causing infertility or painful symptoms, we may recommend surgical correction.

Surgically removing the septum in a septate uterus through hysteroscopy may improve fertility and lower risk of miscarriage. Surgery for a bicornuate or unicornuate uterus is generally reserved for severe cases. Treatments depend on the abnormality, the patient’s situation and their unique anatomy and pregnancy goals.

In vitro fertilization (IVF) may also help those with uterine abnormalities achieve pregnancy.

Asherman syndrome (uterine scarring), its causes, symptoms & treatment

Uterine scarring, also known as intrauterine adhesions or Asherman syndrome (Asherman’s syndrome), occurs when scar tissue forms inside the uterus. The scar tissue can build up and close off open space in the uterus.

Scarring can result from uterine surgical procedures, cancer treatments, infections or trauma. Dilation & curettage, often performed after miscarriage or abortion, and C-section can cause this uterine scarring.

Asherman syndrome symptoms & diagnosis

Symptoms aren’t always present but when they are they include:

• Light or absent menstrual periods.
• Infertility.
• Recurrent miscarriage.
• Pelvic pain.

Many people discover they have uterine scarring when being evaluated for symptoms such as abnormal bleeding or infertility. We diagnose this condition following a discussion of medical history and by imaging tests such as ultrasound, hysteroscopy and saline sonography.

Asherman syndrome treatment

The main treatment – particularly for those experiencing infertility who wish to have a child – is hysteroscopic surgery to remove scar tissue. This can be done at the diagnosis stage above when we identify scarring during the hysteroscopy.

After surgery, hormone therapy along with placement of a temporary uterine catheter may be used to prevent new adhesions from forming. Successful treatment often restores normal menstrual cycles and improves fertility.

In conclusion

These various uterine conditions affecting women require close attention for evaluation of symptoms, effects on fertility and accurate diagnosis to devise a treatment plan if necessary. We encourage women to pay attention to the symptoms above and to contact their physician for an evaluation if the symptoms become bothersome or cause worry.

New testing and treatment modalities including 3-D ultrasound and in-house hysteroscopy have modernized the approach to uterine anomalies and uterine scarring.

In cases of infertility, abnormal bleeding or recurrent miscarriage, an evaluation by our fertility specialist may be in order for women desiring pregnancy or for relief of their symptoms.