This page explains how Uterine Factor Infertility relates to IVF treatment. All information is educational. Talk to your reproductive endocrinologist about how this condition may affect your specific situation and treatment plan.
What is Uterine Factor Infertility?
Uterine factor infertility refers to structural or functional abnormalities of the uterus that interfere with implantation or the ability to carry a pregnancy. These can include congenital anomalies (such as a uterine septum or bicornuate uterus), acquired conditions (such as fibroids, polyps, or adhesions from surgery or infection), and endometrial issues affecting receptivity.
How common is it?
Uterine abnormalities are found in 10 to 15 percent of women being evaluated for infertility or recurrent pregnancy loss. The impact on fertility varies significantly by the type, size, and location of the abnormality.
How Uterine Factor Infertility affects IVF
The uterus is where the embryo must implant and grow, so uterine abnormalities can affect implantation rates and increase the risk of miscarriage. In IVF, a uterine evaluation is standard before any embryo transfer. Depending on the type of abnormality, surgical correction before transfer may significantly improve outcomes. For a small number of cases involving severe uterine abnormality or absence, gestational carrier (surrogacy) may be considered.
Typical IVF approach
Hysteroscopy is the primary tool for evaluating and treating many uterine conditions. Polyps and submucosal fibroids are often removed before transfer. Uterine septa can be corrected hysteroscopically. Adhesions (Asherman syndrome) can be surgically divided. Endometrial receptivity assays (ERA) may be used for people with repeated implantation failure to optimize the timing of transfer. Progesterone and estrogen support for lining preparation in frozen embryo transfer cycles.
Factors that support success
- Identifying and surgically treating correctable uterine abnormalities before embryo transfer
- Ensuring the endometrial lining reaches adequate thickness and morphology before transfer
- Endometrial receptivity testing (ERA) for those with repeated unexplained implantation failure
- Hysteroscopy to confirm a clear uterine cavity before each treatment cycle
- Addressing any ongoing infection or inflammation before proceeding with transfer
Your emotional experience matters
The medical side of infertility is only part of the story. Here is what many people in the IVF community want you to know about the emotional side of this diagnosis.
- Learning that your uterus has a structural issue can feel frightening, particularly if you are also processing prior losses that may have been related.
- Many uterine factor conditions are very treatable. A diagnosis is not a prognosis.
- If you are navigating recurrent implantation failure or repeated losses, the emotional exhaustion is real. You are allowed to feel the weight of this.
- For those who face the possibility of needing a gestational carrier, the grief of not being able to carry a pregnancy yourself is valid and deserves to be honored.
- You are not defined by the anatomy of your uterus. Your capacity to love and parent is not determined by what a hysteroscopy finds.
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What uterine abnormalities affect IVF success?
Several uterine conditions can affect IVF implantation rates and pregnancy outcomes. Submucosal fibroids (those that protrude into the uterine cavity) and endometrial polyps are associated with reduced implantation. A uterine septum can increase miscarriage risk. Intrauterine adhesions (Asherman syndrome) can impair the lining. Many of these conditions can be treated before embryo transfer, which often improves outcomes.
Do fibroids always need to be removed before IVF?
Not all fibroids require surgery before IVF. The decision depends on the type, size, and location of the fibroid. Submucosal fibroids that distort the uterine cavity are most likely to affect outcomes and are typically recommended for removal. Intramural fibroids that do not affect the cavity may not require surgery. Your reproductive endocrinologist will assess your specific situation.
What is an ERA test and who is it for?
The Endometrial Receptivity Array (ERA) is a test that evaluates whether the endometrium is receptive to embryo implantation at the standard time used for transfer. It is typically recommended for people who have had two or more failed embryo transfers with good-quality embryos and no other identified cause. The ERA can identify a "personalized embryo transfer" window that may improve implantation.
Can a uterine septum be corrected before IVF?
Yes. A uterine septum is a band of fibrous tissue that divides the uterine cavity, and it can be removed through a hysteroscopic procedure. This is generally a straightforward outpatient surgery. After removal and healing (usually 1 to 3 months), most people can proceed with embryo transfer. Correction is often recommended before IVF because a septum is associated with both implantation failure and increased miscarriage risk.
Medical disclaimer: This page provides general educational information only. It is not medical advice and should not replace guidance from your doctor, nurse, or reproductive endocrinologist. Every person's treatment is unique. Always consult your care team before making any decisions about your medications or treatment plan.
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About the author
Viv
BSc, Patient Advocate
Founder, TrackMyIVF
I built TrackMyIVF because I needed it during my own journey. Every feature comes from real experience.