The uterus is a hollow, pear-shaped muscular organ in the lower abdomen, above the vagina. It provides the passage for sperm to reach the egg and later receives the fertilized egg so it can implant. It is lined by the endometrium, which thickens each month in response to female hormones; if pregnancy does not occur, the extra lining is shed as the period. Uterine problems can block sperm from reaching the egg or prevent the embryo from implanting.
Position of the uterus
In about 80% of women the uterus tilts forward (anteverted) and in about 20% it tilts backwards (retroverted). Both are normal and do not usually affect fertility, unless a retroverted uterus is fixed in place by adhesions from endometriosis or pelvic infection; in that case the underlying condition is what affects fertility.
Size of the uterus
A markedly underdeveloped (hypoplastic) uterus, usually due to congenital or hormonal causes, can be associated with infertility or pregnancy loss.
Congenital uterine anomalies
Some women are born with differences in the shape of the uterus, such as a septum dividing the cavity (septate uterus), a heart-shaped uterus (bicornuate), a single-horned uterus (unicornuate), sometimes with a small extra horn, a double uterus (didelphys), or a slight indentation at the top of the cavity (arcuate uterus, usually a normal variant). A septum is the anomaly most linked to miscarriage and reduced fertility. These anomalies are best diagnosed with 3D ultrasound, MRI or hysteroscopy.
Adhesions inside the uterus (Asherman syndrome)
Scar tissue inside the uterine cavity can narrow or block it, making it difficult for an embryo to implant, and often causes very light or absent periods. It usually follows vigorous curettage after miscarriage or childbirth, or infection of the lining.
Thin endometrium
A lining that stays thin (generally under 7 mm at mid-cycle) is associated with lower implantation rates. It can follow damage to the basal layer of the lining from previous curettage or infection, or result from hormonal problems.
Infection and inflammation of the lining
Infection of the endometrium, for example by tuberculosis, or chronic endometritis, can impair implantation, and severe or untreated infection can cause scarring and adhesions as the body heals.
Treatment of uterine problems
Thin endometrium
The lining may be improved with estrogen treatment, particularly in frozen embryo transfer cycles, and by treating any underlying cause such as adhesions or chronic endometritis. Other treatments are being studied, but evidence for them is still limited.
Infection and chronic endometritis
Infections are treated with the appropriate antibiotics once the organism is identified. Prompt treatment matters, to prevent scarring and adhesions. Genital tuberculosis needs a full course of anti-TB treatment.
Uterine septum
A septum is removed by hysteroscopy, a minor procedure that restores a normal cavity, particularly recommended for women with miscarriage or infertility.
Rudimentary horn
A small extra horn with a cavity is removed, usually by laparoscopy, because a pregnancy implanting in it can rupture.
Asherman syndrome
Adhesions are divided under direct vision using hysteroscopy, followed by estrogen treatment to help the lining regrow and, often, a follow-up hysteroscopy to check the result.
International Guidelines
In line with global standards, Dr. Sabry follows the latest recommendations from the American Society for Reproductive Medicine (ASRM), European Society of Human Reproduction and Embryology (ESHRE), and Royal College of Obstetricians and Gynaecologists (RCOG). Thus, patients receive care that is safe, ethical, and evidence-based.
Our Patient Reviews
Discover what patients say about us on Google Maps, Vezeeta, and WhatClinic.
Why Choose Dr. Ashraf Sabry?
Dr. Ashraf Sabry, consultant in obstetrics, gynecology, fertility, and aesthetic gynecology, is recognized among the best OBGYN and fertility specialists in Cairo. With over 20 years of experience, he combines science and compassion to provide world-class care. Book your appointment through the contact page, WhatsApp, or call +201022224442.