A GP guide to endometrial infertility

A variety of endometrial pathologies can impact fertility. Know how to diagnose and treat these in a timely manner to help maximise the chance of conception

Need to know:

  • A high-resolution ultrasound by an experienced sonographer is a crucial part of fertility investigation for identification of potential endometrial factors.
  • Endometrial polyps in women with subfertility warrant hysteroscopic resection.
  • Surgical removal of submucosal and large intramural (greater than 4cm, causing cavity distortion) fibroids improves reproductive outcomes.
  • Although adenomyosis can be associated with reduced fertility, effective treatment is still lacking.
  • Surgical correction of a uterine septum improves both implantation and live birth rates.
  • Asherman’s syndrome can be challenging to treat, with hysteroscopic adhesiolysis and the use of postoperative oestrogen supplements and/or IUDs producing the best outcomes.

Factors that influence successful implantation and subsequent pregnancy can be neatly conceptualised using a gardening metaphor.