Uterine Pathology

The uterus is one of the main causes of reproductive failure. This includes implantation failures and repeated miscarriages.

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    The uterus as a cause of implantation failure and repeated miscarriages

    To achieve pregnancy naturally or through assisted reproduction treatments, a uterus in good reproductive condition plays a key role.

    Infertility linked to uterus-related causes can occur either due to malformations in the anatomy of the uterus or due to the existence of different benign pathologies such as polyps, adenomyosis, myomas, adhesions, etc.


    The uterus is a muscle that contains a cavity in the centre in the shape of an inverted triangle and is located in the female pelvis. It comprises three tissue layers.

    A very thin, serous membrane that lines the walls of the uterus.

    The thickest layer of the uterus, composed of the most flexible tissue in the entire body, which will expand with pregnancy as the foetus grows and, after delivery, will contract again.

    The inner layer of the uterus. Formed of tissue that thickens and flakes off with each menstrual cycle. The endometrium is the layer that comes into direct contact with the embryo during implantation.

    Both uterine malformations and anomalies in any of its layers can be a cause of infertility.

    Uterine pathology assessment

    When treating uterine problems associated with infertility, diagnosis requires a comprehensive study of the uterus. Due to its morphology and changing nature throughout the menstrual cycle, the uterus can hide defects depending on when the examination is performed.

    In the initial proliferative phase (post-menstruation), the existence of endometrial pathology such as myomas or polyps can be assessed.

    In the late proliferative phase (pre-ovulatory), we explore the endometrial morphology, the endometrial cavity, and the fallopian tubes.

    The luteal phase (post-ovulatory) is the best time to evaluate myometrial pathology, mainly adenomyosis, which is the existence of implants of the same endometrial tissue but in the muscle thickness and not in its usual place.

    The uterus is a key organ for human reproduction, whether natural or through assisted reproduction treatment. The semen travels through the uterus to the fallopian tubes to fertilise the egg. Once fertilization has taken place (in the tubes), the embryo travels to the uterus to implant in its internal layer or endometrium, which will be responsible for providing optimal conditions to nourish the embryo and make it develop into a full-term pregnancy.

    The main uterine pathologies such as congenital anomalies or malformations, the well-known endometrial polyps, myomas or uterine synechiae, can be the origin not only of infertility due to implantation failure, but also of repeated miscarriages and even premature or preterm deliveries.

    Uterine pathology diagnosis

    The most relevant medical procedures involved in diagnosing uterine pathologies are as follows:

    Transvaginal ultrasound is a simple test where the specialist views the entire uterine cavity, tubes and ovaries. It is part of any gynaecological visit and provides the specialist with information to further study infertility.

    Using 3D ultrasound, the specialist can also assess the tissues volumetrically, allowing a reconstruction of the uterine cavity and by adding the Doppler option, correct organ vascularisation.

    After transvaginal ultrasound (TVU), magnetic resonance imaging (MRI) has become the most efficient examination procedure for diagnosing uterine pathologies.

    It can provide details that may go unnoticed with ultrasound, such as endometriosis or adenomyosis implants, and the existence of fibroids or adenomyomas, etc.

    Furthermore, its different perspectives and images allow uterus anatomy to be assessed. It’s an extremely useful diagnostic tool, although it requires ample experience on the part of the specialist to interpret the findings and their possible impact on reproductive potential.

    This diagnostic procedure enables a direct study of the uterine cavity and cervical canal for the detection, diagnosis, and treatment of a possible intracavitary uterine pathology.

    It is generally performed during an appointment and does not require sedation. Diagnostic hysteroscopy’s big advantage is that the specialist views the uterus cavity in real time and can identify polyps, fibroids and/or synechiae that could go unnoticed with other tests.

    Endometrial vascularisation and morphology are determining factors in embryo implantation. Therefore, these are factors that must not only be taken into account during diagnosis but must be monitored throughout the entire assisted reproduction treatment process, particularly in the endometrial preparation phase.

    Endometrial vascularisation and morphology will condition the endometrium to acquire the optimal thickness and trilaminar structure for embryo implantation and future gestation.

    Main uterine pathologies

    The main non-cancerous uterine pathologies in women of reproductive age are:

    • Uterine malformations
    • Endometrial hyperplasia, endometrial polyps, endometrial polyps, myomas, endometritis
    • Endometriosis of the uterine wall (adenomyosis)
    • Intrauterine adhesions, Isthmocele, Asherman’s Syndrome
    • Uterus morphology, such as retroversion and others
    • Hydrosalpinx
    • Cervicitis
    • Abnormal uterine bleeding

    Symptoms of problems in the uterus

    Although the most common symptomatology such as bleeding usually leads us to uterine fibroids, there are times when patients do not experience any discomfort in this regard or it’s another type of pathology.

    The most common symptoms of problems in the uterus are usually:

    • Discomfort in the pelvic area
    • Inability to urinate or constant need to urinate
    • Gas and constipation
    • Abdominal distension
    • Very heavy and long-lasting menstruations
    • Pain during intercourse

    Diagnosis and treatment personalisation

    The most relevant medical procedures involved in the diagnosis of uterine pathologies are the following:

    At Equipo Juana Crespo, the study of the uterus is essential before considering any embryo transfer, whether from your own eggs or from a donor.

    The 3D ultrasound performed on the first visit and the MRI are a regular part of our array of diagnostic tests. Based on the study and conclusions of these two tests, the specialist can continue to prescribe complementary diagnostic tests such as diagnostic hysteroscopy or establish a treatment strategy aimed at correcting uterine pathologies.

    Types of treatment for uterine pathologies:

    The Juana Crespo Team surgery unit performs these treatments. Generally after ovarian stimulation and always before endometrial preparation to ensure that the uterus is in perfect condition before embryo transfer.

    Indicated for women with deficient or no endometrial growth. Consists of the application of plasma rich in growth factors and platelets administered both by puncture and by instillation.

    Minimally invasive intervention aimed at resolving uterine pathology such as myomas, polyps, adenomyomas, etc., or to correct uterine malformations such as uterine septum, T-shaped uterus, etc.

    Frequently Asked Questions

    What tests are required? Do I need to visit the clinic?2023-01-04T10:36:06+01:00

    The medical procedures to be followed for a possible uterine problem are wide-ranging and depend on each patient’s clinical picture. To perform the appropriate diagnostic tests, it is necessary to visit the clinic, where one of our specialists will determine the procedures to be followed in each case.

    How is the diagnosis and treatment of uterine problems done?2023-01-04T10:37:23+01:00

    The symptomatology associated with uterine problems are warning signs that the patient can observe, then request an appointment with her trusted gynaecologist. However, sometimes there are no specific symptoms, so in many cases the diagnosis is reached after an infertility appointment.

    Next, based on the recommended medical procedures, a diagnosis is made to enable treatment for uterine problems.

    Can I still get pregnant despite this diagnosis?2023-01-04T10:56:56+01:00

    Often, especially at older ages, infertility is not due to a single cause. In such cases it is essential, in addition to treating the uterus, to consider a strategy focused on the entire reproductive system.

    However, we have many cases where, after uterine surgery, a natural pregnancy is achieved without the need for in vitro fertilization.

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