uterus

Adenomyosis and your fertility

Adenomyosis and fertility: Princeton IVF blog

Adeno what?

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Most women have never heard of adenomyosis, but most gynecologists have, and it is a condition that may affect your chances of having a baby.


What is adenomyosis?

Adenomyosis is a disease where the glands that line the uterine cavity (the endometrium) are growing into the muscle of the uterus (the myometrium). In the past adenomyosis was considered a form of endometriosis, a disease in which the glands that normal grow in the endometrium grow outside of the uterus.

What are the symptoms of adenomyosis?

The symptoms of adenomyosis are similar to those of fibroids, painful and heavy periods. Not everyone with adenomyosis had symptoms though.

How is adenomyosis diagnosed?

In the past and sometimes still, adenomyosis was diagnosed when the tissue from a hysterectomy (removal of the uterus), usually done on someone who is thought to have fibroids, is examined in the laboratory. Sometimes, adenomyosis can be seen on ultrasound and can be seen even better on MRI.

Does adenomyosis affect fertility?

In the past, the answer was unclear. Recent research suggests that it may harmful to your fertility. Women undergoing with adenomyosis undergoing IVF had lower implantation rates, lower pregnancy rates, lower live birth rates and higher miscarriage rates.

How is adenomyosis treated?

Most adenomyosis is treated by hysterectomy, but this is not an option for fertility patients. There are newer experimental procedures such as ultrasound ablation, but it is not clear how safe and effective they are.

Live birth after uterine transplant

Live birth after uterine transplant: Princeton IVF blog

Doctors at Baylor University deliver the first US baby born following uterine transplantation

A few years back, doctors in Sweden performed the first successful uterine transplant. Several academic fertility centers in the US have tried to replicate this here, and doctors at Baylor announced they were the first to do so.

Why would one want to transplant a uterus?

It is impossible to carry a baby without a uterus, also known as the womb. The early embryo implants itself into the wall the uterus about a week after conception and through the placenta and umbilical cord, its interface to the uterus, the fetus gets all of the nutrients and oxygen it needs to grow and even to survive.

Some women are born without a uterus (such as in the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome), some have scar tissue in the uterus and others have had their uterus removed (a hysterectomy) for fibroids, cancer or some other reason. While there have been many many cases of ectopic pregnancies, where a pregnancy implants outside the uterus, these pregnancies nearly always need to be terminated early on since they can result on the death of the mother, and almost never results in a live birth of a baby. There is also interest in using a transplanted uterus in transgender women.

Are there alternatives ways to have baby without a uterus?

Currently, there is a very effective way of having a baby without a womb, and it is called Gestational Carrier IVF.  The eggs are harvested from the intended mother, sperm is collected from the intended father, and fertilization is performed in the IVF laboratory. The embryos are grown and transfered into the uterus another woman, referred to as a gestational carrier after her uterus is prepared for pregnancy using hormonal treatments. This can be costly (but much less so than a uterine transplatation), is illegal in some states and most importantly, the pregnancy is carried and delivered by someone else other than the intended mother.

How is a uterine transplant performed?

The uteri used for transplantation can be obtained from living donors or women who have recently passed away and offered their organs up for donation. Using an open incision (laparotomy in medical jingo), the donor uterus is attached the various blood vessels to ensure it has good supply and to attached to nearby structures to hold it in place. It is not attached to the fallopian tube.

How does a woman get pregnant after uterine transplantation?

IVF (in vitro fertilization) is required to achieve pregnancy since without a connection between the tube and uterus, pregnancy would otherwise be impossible. In years past, fertility surgeons, connected fallopian tubes to the uterus, but that operation has been abandoned since it rarely worked. IVF bypasses that problem and offers the best chance for pregnancy.

Are more uterine transplant babies coming?

The doctors at Baylor have another woman pregnant after uterine transplantation and IVF, a few more attempts planned. A number of women undergoing the procedure have not been successful. Other centers are trying this as well, but the costs are so high and it is not covered by insurance, so it not clear how widespread this will become.