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What Is Uterine Factor Infertility & Is A Womb Transplant An Option?

There are many causes of infertility, these include female and male factors. One of the important female factors that needs to be looked at is uterine factor. This was highlighted in the news recently with the story of the first baby born after a successful uterine transplant. This procedure is only applicable in specific cases when no other option is viable.

What are the causes of uterine factor infertility?

Fibroids which are benign fibrous growth in the uterine wall depending on location they might, bulge into the uterine cavity or extrude to the outside, or press on the tubal entrance into the uterus.  Adhesions or scar tissue in the uterine cavity. Endometritis affecting function of the endometrium. Malformations such as bicornuate uterus (or a uterus with two cavities).

How is uterine factor infertility diagnosed?

Ultrasound is the best method for assessing the uterus. This a simple in office procedure utilizing sound waves to create the image of the uterus and any anatomical anomaly. Hysterosalpingogram is a procedure done in the radiologist’s office, where dye is placed in the uterus and x-ray is used to visualize the uterus and the patency of the fallopian tubes. Hysteroscopy is an ambulatory procedure, the patient under anesthesia undergoes the procedure. A telescope with camera attachment is inserted through the cervix and the uterine cavity is visualized. The advantage is the ability to correct abnormalities that are visualized. 

What is a hysterosalpingogram?

As mentioned above this procedure which utilizes x-ray to visualize the interior structure of the uterus also the structure of the fallopian tubes. Since the procedure involves dye that is radiopaque and injected in the uterus, it can visualize if the tubes are patent and the dye spills out the fallopian tubal ends.

What is hysteroscopy?

Ambulatory diagnostic procedure that visualizes the interior of the uterus, with the distinct advantage of being a therapeutic procedure where the anomalies can be corrected at the same time. The disadvantage is that it does not give information on the fallopian tube ends where the eggs are picked up from the ovary.

What is a myomectomy?

Surgical procedure in which the surgeon removes the fibrous growth. Taking meticulous care not to cause excessive adhesions (scar tissue) although this is a definitive procedure to remove fibroids, some potential complications do exist such as in any surgical procedure involving general anesthesia. Also there is always the potential of recurrence which is not infrequent

What is uterine unification surgery?

Uterine malformations are one of the reasons for transplant as mentioned in the news recently especially an absent uterus, however a bicornuate which is a type of malformation can be fixed surgically by unification surgery. This is a major surgical procedures in which the uterus with two cavities are surgically corrected to form only one normal cavity.

Can uterine factor be permanently fixed?

Although many of the treatments mentioned are potentially permanent for uterine factor infertility, it would make sense and it would be wise to evaluate uterine factor issues whenever a patient attempts another pregnancy.

What if uterine factor cannot be corrected are there other options?

Besides uterine transplant as an extreme procedure, many alternatives exist when there is a uterine factor.  Recruiting a gestational carrier can be an option. A gestational carrier can be a relative or a person known to the couple. The gestational carrier carries the baby created from the patient’s own egg and sperm, the embryo is then transferred to the gestational carrier. The gestational carrier is usually someone who already gave birth to her own children and completed her family before helping someone else to achieve the same.

Uterine factor is an important cause of infertility and the physician should address all the relevant issues with the patient especially that they are very successfully corrected.

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