17738 Uterine Factor Infertility

Overview

Uterine factor infertility (UFI) is a type of infertility where a problem with the uterus (the womb) stops an embryo from implanting or growing. This can happen because of a missing uterus, scar tissue inside the uterus, fibroids, polyps, or other structural issues.

It's not the most common type of infertility. Problems with ovulation or sperm are more common. But structural uterine issues are found in about 1 in 10 women having fertility tests.

It can affect women and people with a uterus of any age who are trying to conceive. Some people are born with a missing or unusual uterus, while others develop scar tissue or fibroids later in life.

Symptoms

Common symptoms

• No obvious symptoms — infertility is often the first sign
• Painful periods
• Heavy or irregular bleeding

Symptoms in children

• In most cases, children have no symptoms. But some girls born without a uterus do not start periods at the usual age.

Symptoms in older adults

• As a person ages, fibroids may cause heavier bleeding or pelvic pressure, but this is not always related to infertility.

Causes

Main causes

• Uterine fibroids (non-cancerous growths in the womb)
• Uterine polyps (small overgrowths of tissue)
• Intrauterine adhesions (scar tissue, as in Asherman syndrome)
• Congenital anomalies (e.g., absent uterus, double uterus, or irregular shape)
• Uterine infection (endometritis)

Risk factors

• Previous uterine surgery, such as a C-section or fibroid removal
• History of uterine infections after delivery or miscarriage
• Radiation therapy to the pelvic area
• Genetic conditions that affect reproductive development

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number right away.

Book a routine appointment if:

• See a healthcare provider if you have been trying to conceive for 12 months without success (or 6 months if you are over 35)
• If you have very painful periods, irregular bleeding, or pelvic pain that is affecting your daily life
• If you have concerns about your fertility or have had repeated miscarriages

Diagnosis

A doctor will start with your medical history, a physical exam, and a discussion about your menstrual cycle and pregnancy history. If needed, they will order imaging tests to look at the shape and lining of your uterus.

Tests that may be done

• Pelvic ultrasound — a scan that uses sound waves to create a picture of your uterus, ovaries, and cervix.
• Sonohysterography — an ultrasound with a small amount of fluid placed inside the uterus to make the lining easier to see.
• Hysterosalpingogram (HSG) — an X-ray test that shows the inside of the uterus and whether the fallopian tubes are open.
• Hysteroscopy — a thin telescope inserted through the cervix to look directly inside the uterus.
• Magnetic resonance imaging (MRI) — detailed pictures of the uterus and surrounding structures.

What to expect at your appointment

Most of these tests are done in an outpatient clinic and take less than an hour. Some may cause mild cramping. You can usually go home the same day and return to normal activities.

Treatment

Treatment depends on the specific cause, your symptoms, and your future fertility goals. The aim is to improve the uterus so that an embryo can implant and grow.

Self-care at home

• Work with a fertility specialist or gynecologist to create a plan that fits your situation
• Keep a record of your menstrual cycle and any symptoms
• Stay physically active and manage stress, but avoid extreme exercise that may stop your periods
• Ask your doctor about prenatal vitamins with folic acid if you are trying to conceive

Medical treatments

Medical treatments may include hormonal medications to help prepare the uterine lining, and procedures to remove fibroids, polyps, or scar tissue. In some cases, assisted reproduction like in-vitro fertilization (IVF) may be used. A doctor will discuss the best options and risks with you.

When is surgery considered?

Surgery may be recommended to remove fibroids (myomectomy), remove polyps, or cut adhesions inside the uterus (hysteroscopic adhesiolysis). For someone born without a uterus, surrogacy or uterine transplant may be options in certain countries, but these are complex and not available everywhere.

Living with this condition

Living with uterine factor infertility can be emotionally difficult. It may take time to learn your options, and you may need to lean on your partner, family, or friends. It helps to have regular check-ins with your doctor and to set boundaries about how much you want to talk about fertility.

Lifestyle tips

• Avoid smoking and recreational drugs
• Limit alcohol to the recommended low-risk amount or avoid it while trying to conceive
• Maintain a healthy body weight — this supports hormone balance
• Get enough sleep and find ways to reduce stress, like talking, meditation, or hobbies

Diet and exercise

Eat a balanced diet with plenty of vegetables, fruits, whole grains, and lean protein. Moderate exercise like walking, swimming, or yoga is safe and beneficial. Unless your doctor says otherwise, try to stay active for at least 150 minutes per week.

Mental health and emotional wellbeing

Trying to conceive when your body feels like it is not cooperating can cause grief, anxiety, and depression. These feelings are normal. It is important to acknowledge them and seek support.

Prevention

Most causes of uterine factor infertility cannot be prevented. However, you can lower the risk of uterine infections by practicing safe sex and getting prompt treatment for pelvic infections. Avoiding unnecessary uterine surgery can also reduce the chance of scar tissue.

Vaccines

There is no specific vaccine to prevent this condition, but staying up to date with recommended vaccines, such as the HPV vaccine, can help protect against some gynecologic health problems.

Screening programmes

Regular pelvic exams and Pap smears can detect problems early. If you have fertility concerns, ask for a referral to a gynecologist or fertility specialist.

Complications

If left untreated

• Ongoing difficulty getting pregnant or staying pregnant
• Worsening pain or heavy bleeding if fibroids or polyps are present
• Emotional distress and relationship strain without support

Long-term outlook

The outlook for uterine factor infertility depends on the cause. Many structural problems can be treated successfully, and assisted reproduction offers hope for many. Even when a uterus cannot be fixed, there are still paths to parenthood, such as surrogacy or adoption. You do not have to face this alone.

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