Abnormalities of the uterus can contribute to the inability to get pregnant. Uterine fibroids can distort the endometrial cavity making it difficult for implantation and can be treatable. Another cause within the uterus is scarring or adhesions from previous surgery or infection of the endometrium. Asherman syndrome is a term used to describe scar tissue inside the uterus. The scarring can be mild with thin stretchy bands of scar tissue, or more severe dense, thick bands.
Sometimes, an abnormality of the uterus happens before birth. Like other organs in the body, a woman’s reproductive organs form with she is still a fetus inside her mother’s uterus. The reproductive organs include the uterus and fallopian tubes. Sometimes the uterus and fallopian tubes may not form like they should. These malformations are called mullerian anomalies. There are many types of mullerian anomalies, including failure for the uterus or tubes to form (agenesis), a complete duplication of the uterus, cervix, and vagina (didelphys), two uteri sharing a single cervix and vagina (bicornuate), a single uterus with a fibrous band going down the center of the uterus (septate), and normal uterus with an incidental dent in it (arcuate).
There are several ways we can evaluate your uterus and endometrial cavity for scarring or a mullerian anomaly. Saline infused sonohysterography (SIS or hydrosonogram) is a specialized test using transvaginal ultrasound. During your office visit, a small amount of sterile fluid is placed in your uterus by inserting a small plastic tube through your cervix. Filling the cavity with water allows the doctor to examine the space and shape of the endometrial cavity to look for any abnormalities. This is a quick and only minimally uncomfortable exam.
Hysterosalpingogram is a specialized x-ray used to evaluate the fallopian tubes as well as the uterus. A special dye that appears white on x-ray is placed in your uterus by inserting a small plastic tube through your cervix. This dye is helpful for your physician to evaluate the fallopian tubes, but also any abnormalities inside your uterus.
Finally, hysteroscopy may be used to look inside your uterus. A thin camera is passed through your cervix into the uterus. This gives your doctor a direct view inside the uterus, which will give your doctor the most accurate information about the uterine cavity. It can be done either in the office with mild pain medication or in a surgery center under anesthesia.
Treatment of uterine scarring, or a septate uterus involves hysteroscopy. A doctor can remove the scar tissue or fibrous bands with specialized scissors or cautery devices during hysteroscopy.