Growing up in a big family with lots of younger brothers and sisters running around, you’ve always known that you wanted to start a family of your own one day. When you met your husband in your mid-twenties, you were delighted to find that he, too, had the same dream. But when you started trying for a baby, your dream quickly turned into a nightmare, as you kept experiencing miscarriage after miscarriage.

Recurrent miscarriage is one of the most painful, debilitating, and confusing experiences a person can go through. What many couples find particularly difficult is a lack of understanding as to why they can’t carry a baby to term. One of the potential causes behind this ongoing problem can be anatomical issues.

But what kind of anatomical issues can cause a problem like recurrent miscarriage?

Congenital abnormalities of the uterus

There are different types of abnormalities of the uterus, one of the most common being a bicornuate uterus. A bicornuate uterus is characterised by the two tubes of uterine tissue having the appearance of two horns joined together at the cervix. Sometimes, there is only one uterine horn present. If a woman has this abnormality, then it is possible that their baby will not have enough room to grow to its full size, and so a miscarriage or premature labour can occur.

Diethylstilboestrol (DES)

Diethylstilboestrol is a synthetic oestrogen that was used in the 1940s to treat miscarriage, ironically. In the 1970s it was realised that this drug caused problems in the daughters of the women that had been treated with it. DES-related abnormalities are very rare these days as only a few daughters that were exposed to the drug are still of childbearing age.

Fibroids

Uterine fibroids are the most common benign growth in women. As they are very rare before the age of 20, and don’t develop after the menopause, their appearance and growth have been linked to reproductive hormones. Although many women with fibroids become pregnant without any delays or complications, some fibroids can enlarge the uterus and distort the uterine cavity, triggering reproductive problems.

If the woman in question has a fibroid polyp, they will usually be advised to have it removed from the uterine cavity. This is especially necessary if the fibroids are very large and appear in a woman who has been experiencing recurrent miscarriages and is also planning to have assisted fertility treatments like IVF. Minimally invasive treatments for fibroids include uterine artery embolization and magnetic resonance imaging.

Intrauterine adhesions

Intrauterine adhesions are fine bridges of fibrous tissue which can cause the walls of the uterus to stick together. In mild cases, the adhesions can stop the endometrium from thickening at the right time in the menstrual cycle, and can stop an embryo from implanting successfully. In more severe cases, it can stop a woman from having periods altogether. Although adhesions in the uterus are very common and can resolve spontaneously, it is often recommended the adhesions are divided under a light anaesthetic.

Cervical incompetence

During a pregnancy, it is important that the cervix remains closed to allow the fetus and placenta to develop to a size that will allow a baby to be delivered. However, if the muscles of the cervix are weak, then the cervical canal can open at around 20 weeks. This is a problem because if the muscles of the cervix start to open, then the bacteria present in the vagina can cause inflammation of the membranes that are protruding into the vagina. The inflammation can then cause the membranes to weaken and sometimes burst, releasing liquor from the pool around the baby. This can in turn cause a miscarriage.

What are the anatomical causes behind miscarriage?

Unii tackles a difficult subject for any parent-to-be.