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Chapter 4 - Uterine and Tubal Causes of Infertility

Published online by Cambridge University Press:  25 February 2021

By
Abha Maheshwari
Edited by
Siladitya Bhattacharya  and
Mark Hamilton
Siladitya Bhattacharya
Affiliation:
University of Aberdeen
Mark Hamilton
Affiliation:
University of Aberdeen
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Summary

Uterine and tubal abnormalities alone or in combination with other factors are present in 17%–25% of all couples who seek care for infertility treatment. The prevalence is higher in older women and in those with secondary infertility. Although suspected at the history, it is usually confirmed by ultrasound/ laparoscopy and/or MRI depending on the cause. Multiple pathologies are identified under the umbrella of tubal and uterine factors, some are associated with infertility but very few are proven to be the only cause of infertility. Treatment depends on the condition. It ranges from no intervention to surgery to in vitro fertilisation (IVF). With advances in the technology of IVF, surgery is becoming a lost art, especially for tubal factors. Various surgical techniques have been suggested for uterine factors. Given most tubal and uterine factors have association rather than causation for infertility, the effect of surgery on improving fertility is debatable. We will discuss the causes of uterine and tubal factors, their implications on fertility, diagnostic modalities and treatment options with limitations of the available evidence. A good history and a high index of suspicion along with primary and secondary prevention of tubal and uterine factor infertility are important to prevent long-term implications.

Keywords

hydrosalpinxtubaluterineadenomyosisendometriosisectopicpelvic inflammatory diseaseuterine septumuterine anomaliesbicornuate uterus
Type
Chapter
Information
Reproductive Medicine for the MRCOG , pp. 31 - 42
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

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Further Reading

Chua, SJ, Akande, VA, Mol, BWJ. Surgery for tubal infertility. Cochrane Database of Syst Rev 2017; (1): CD006415. DOI: 10.1002/14651858.CD006415.pub3.CrossRefGoogle ScholarPubMed
El-Toukhy, T, Campo, R, Khalaf, Y, et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet. 2016;387(10038):2614–21.CrossRefGoogle ScholarPubMed
Jayaprakasan, K, Polanski, L, Sahu, B, Thornton, JG, Raine-Fenning, N. Surgical intervention versus expectant management for endometrial polyps in subfertile women. Cochrane Database Syst Rev. 2014;(8): CD009592. DOI: 10.1002/14651858.CD009592.pub2.Google ScholarPubMed
National Collaborating Centre for Women’s and Children’s Health. Fertility: assessment and treatment for people with fertility problems, 2nd ed. London: RCOG Publications; 2013.Google Scholar
Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015;103:e44–50.CrossRefGoogle Scholar
Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline. Fertil Steril 2017;108:416–25.Google Scholar
Practice Committee of the American Society for Reproductive Medicine. Uterine septum: a guideline. Fertil Steril. 2016;106:530–40.Google Scholar
Royal College of Obstetricians & Gynaecologists. Uterine and tubal factor subfertility. https://elearning.rcog.org.uk//uterine-and-tubal-factor-subfertility/uterine-and-tubal-factor-infertilityGoogle Scholar
Saridogan, E, Becker, CM, Feki, A, and Working group of ESGE, ESHRE, and WES. Recommendations for the surgical treatment of endometriosis. Part 1: Ovarian endometrioma. Gynecol Surg. 2017;14(1):27.Google ScholarPubMed
Toaff, R, Ballas, S. Traumatic hypomenorrhea-amenorrhea (Asherman’s syndrome). Fertil Steril. 1978;30(4):379–87.Google ScholarPubMed

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