Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T22:42:42.540Z Has data issue: false hasContentIssue false

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References

Maheshwari, A, Hamilton, M, Bhattacharya, S. Effect of female age on the diagnostic categories of infertility. Hum Reprod. 2008;23(3):538–42.CrossRefGoogle ScholarPubMed
Rutherford, AJ, Jenkins, JM. Hull and Rutherford classification of infertility. Hum Fertil (Camb). 2002;5(1 Suppl):S41–5.CrossRefGoogle ScholarPubMed
The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–55.Google Scholar
Akande, VA. Tubal disease: towards a classification. Reprod BioMed. 2007;15:369–75.CrossRefGoogle ScholarPubMed
Munro, MG, Critchley, HO, Broder, MS, Fraser, IS for the FIGO Working Group on Menstrual Disorders.FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet.2011;113:3–13.CrossRefGoogle ScholarPubMed
Grimbizis, GF, Di Spiezio Sardo, A, Saravelos, SH, et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod. 2016;31(1):2–7.CrossRefGoogle ScholarPubMed
Chami, A, Saridogan, E. Endometrial polyps and subfertility. J Obstet Gynaecol India. 2017;67(1):9–14.CrossRefGoogle ScholarPubMed
ASRM (Practice Committee of American Society of Reproductive Medicine). Removal of myoma in asymptomatic patients to improve fertility and/or reduce miscarriage rate: A guideline. Fertil Steril. 2017;108:416–25.Google Scholar
ASRM (Practice Committee of American Society of Reproductive Medicine). Role of tubal surgery in era of assisted reproductive technology: a committee opinion. Fertil Steril. 2015;103(6):e37–43. DOI: 10.1016/j.fertnstert.2015.03.032.CrossRefGoogle Scholar
Maheshwari, A, Gurunath, S, Fatima, F, Bhattacharya, S. Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update. 2012;18(4):374–92.CrossRefGoogle ScholarPubMed

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

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×