What is uterine factor infertility?
Uterine factor infertility encompasses several distinct conditions affecting the uterus: congenital anomalies (most commonly septate uterus), submucosal fibroids that distort the cavity, endometrial polyps, intrauterine adhesions (Asherman syndrome, often after prior uterine surgery or infection), and adenomyosis (endometrial tissue growing into the uterine muscle). Each has different implications for fertility and treatment.
Evaluation typically includes saline infusion sonography (SIS), hysteroscopy, or 3D ultrasound. Hysterosalpingogram (HSG) can identify some uterine factors but is less sensitive than SIS or hysteroscopy for cavity detail. MRI is sometimes used for complex anatomical assessment, particularly for adenomyosis and complex Müllerian anomalies.
How common is it among IVF patients?
Uterine factor is reported as a contributing diagnosis at 401 of 458 US clinics in the most recent CDC data, with an estimated 52,202 IVF cycles annually citing uterine factor.
Many uterine factors are correctable with hysteroscopic surgery before IVF. Polyps, septa, and submucosal fibroids can typically be removed in outpatient procedures with relatively short recovery, after which IVF outcomes are generally similar to patients without uterine factors. The IVF cycle counts therefore include both patients whose uterine factor was treated before IVF and those for whom it remains a co-existing diagnosis.
How uterine factor affects IVF outcomes
Outcomes depend strongly on the specific finding and whether it has been corrected. After successful hysteroscopic correction of a polyp, septum, or submucosal fibroid, IVF outcomes are generally similar to those for patients without uterine factor. Untreated submucosal fibroids and intrauterine adhesions are associated with lower implantation and live birth rates.
Adenomyosis is a more challenging case. Imaging-diagnosed adenomyosis has been associated with somewhat lower IVF live birth rates and higher miscarriage rates in observational studies, though the magnitude of the effect varies. Treatment options before IVF (GnRH agonist suppression, surgical management) are debated, and large randomized trials are limited.
Intramural fibroids that do not distort the cavity are common and the evidence on whether they should be removed before IVF is mixed. Most guidance suggests removal is not routinely indicated for non-cavity-distorting fibroids, though individualized decisions are made for large fibroids or those with rapid growth.
What approaches are commonly discussed
Treatment depends on the specific uterine factor:
- Hysteroscopic polypectomy. Outpatient procedure with brief recovery; pregnancy attempts can typically resume within 1-2 menstrual cycles.
- Hysteroscopic septum resection. Standard treatment for septate uterus, particularly for patients with prior pregnancy loss; effect on IVF outcomes specifically has been debated in recent randomized trials.
- Hysteroscopic myomectomy. For submucosal fibroids; abdominal or laparoscopic myomectomy for larger non-submucosal fibroids if removal is indicated.
- Adhesion lysis. Hysteroscopic treatment for Asherman syndrome; outcomes vary based on severity and prior treatments.
- GnRH agonist suppression. Considered before IVF in select cases of adenomyosis or large fibroids, with trade-offs in time-to-treatment.
Decisions about which uterine factors require surgical correction before IVF are individualized based on size, location, symptoms, prior reproductive history, and patient preferences.
Questions to ask your fertility specialist
If uterine factor is part of your diagnosis, the following questions can help structure the conversation:
- What is the specific finding, and how was it identified?
- Do you recommend correction before IVF? Why or why not?
- What's the recovery timeline before we can start an IVF cycle?
- What's your hysteroscopy or myomectomy success rate, and what complications should I be aware of?
- If we proceed with IVF without correction, what is the trade-off?
- For adenomyosis specifically, how do you typically approach pre-IVF management?
US fertility clinics with the highest reported uterine factor cycle volume
The list below ranks US fertility clinics by estimated annual cycles citing uterine factor as a diagnosis, derived from each clinic's CDC-reported total cycle count multiplied by the percentage of cycles citing this diagnosis. Volume is a signal that a clinic regularly treats this diagnosis. It is not a measure of success rate or quality. CDC does not publish per-diagnosis success rates at the clinic level, so a "best clinic for uterine factor" cannot be derived from this dataset alone.
How we computed these numbers
The clinic-level numbers on this page come from the CDC's National ART Surveillance System (NASS), specifically the 2022 ART Surveillance Report, which is the most recent dataset available. CDC publishes these reports on a two-year lag.
Estimated annual cycles for this diagnosis are computed by multiplying each clinic's total reported cycles by the percentage of cycles in which uterine factor was cited as a diagnosis. The CDC reports these percentages but does not publish absolute cycle counts per diagnosis, so the figures here are estimates.
A single IVF cycle can have multiple diagnoses recorded. A patient with both male factor and diminished ovarian reserve would have both diagnoses counted, which is why the percentages reported by clinics often sum to more than 100%. The "share of all CDC IVF cycles" stat above is therefore an approximation of how often this diagnosis appears in any cycle's record, not a percentage of cycles where it is the sole cause.
Editorial content on this page was last reviewed on April 30, 2026. We aim to update each diagnosis page when major guidelines from ASRM, ACOG, AUA, the Endocrine Society, or related professional bodies are revised.
Sources
- American College of Obstetricians and Gynecologists. Infertility Workup for the Women's Health Specialist. ACOG Committee Opinion No. 781.
- Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline.
- Centers for Disease Control and Prevention. 2022 Assisted Reproductive Technology National Summary Report.