The uterus and your fertility.
The uterus is where the embryo implants and grows for nine months – it is quite literally the home of every pregnancy. Changes of the uterus or the uterine lining can make implantation more difficult, but they can be clarified well and, in many cases, treated.
Implantation: the role of the uterine lining.
For a fertilised egg to become a pregnancy, the embryo must implant in the uterine lining (the endometrium). This lining builds itself up anew in every cycle: in the first half of the cycle, the hormone oestrogen makes it grow in thickness; after ovulation, progesterone prepares it specifically for implantation – you can read more on our page about luteal phase deficiency.
Implantation therefore needs both: a well built-up, receptive uterine lining and a uterine cavity in which the embryo finds room. If either of these is impaired, it can be one reason why a pregnancy is a long time coming – or why it ends early. In cases of repeated early pregnancy losses, it is therefore also worth looking at the uterus; you can find more on our page about the miscarriage work-up.
What can make implantation more difficult.
Several changes of the uterus can play a role in fertility: congenital malformations such as a dividing wall in the uterine cavity (septum); adhesions inside the uterine cavity, for example after procedures or inflammation (in pronounced form known as Asherman's syndrome); polyps of the uterine lining; fibroids that protrude into the uterine cavity; and a uterine lining that builds up insufficiently (“thin lining”).
Important to know: none of these diagnoses automatically means that a pregnancy is impossible – many of these changes remain without consequences or can be treated well. What is decisive is the individual work-up: what exactly is present, and does it play a role in your situation at all?
How we clarify the uterus.
From the painless ultrasound examination to hysteroscopy – the work-up proceeds step by step and only ever as far as your findings require.
Detailed first consultation
We discuss your medical history, your cycle, previous procedures and pregnancies – for example as part of a first fertility consultation. This determines which examinations make sense.
Ultrasound & cycle monitoring
With the vaginal ultrasound we assess the shape and structure of the uterus as well as the uterine lining. During cycle monitoring we follow how the lining builds up over the course of the cycle – together with the relevant hormone values from our own laboratory; our page on the hormone status gives an overview.
Hysteroscopy if needed
If there are abnormal findings, a hysteroscopy can be useful: a fine camera is introduced into the uterine cavity via the natural route – entirely without an incision. This allows polyps, adhesions or a septum to be assessed directly and often treated in the same procedure.
Discussion of findings & plan
We discuss all results with you in detail – and together develop a plan that fits your findings and your wish for a child.
Treatment paths: individual rather than one-size-fits-all.
Which treatment makes sense depends entirely on the findings. Changes inside the uterine cavity – such as polyps, adhesions or a septum – can frequently be treated as part of a hysteroscopy. If the uterine lining builds up insufficiently, its build-up can be supported hormonally and accompanied by ultrasound. And sometimes the work-up also shows: no treatment is needed at all.
We advise against attempts to “build up the lining” on your own initiative – whether and how support makes sense is decided individually by our doctors based on your findings and together with you.
The uterus in fertility treatment.
The uterine lining has a firm place in fertility treatment: in IVF, the embryo transfer is deliberately planned so that the lining is well built up and receptive – its build-up is followed by ultrasound and supported hormonally if needed. We also keep an eye on the lining during an insemination or in a spontaneous cycle.
If the work-up reveals a treatable change of the uterus, it is included in the overall planning – resulting in a coherent path to your longed-for child instead of isolated single steps.
The uterus is only one of many possible factors
An unfulfilled wish for a child often has several contributing causes. You will find an overview of the most common reasons – from tubal patency and fibroids & cysts to male infertility – on our causes page.
Uterus and fertility: your questions.
What role does the uterus play in getting pregnant?
A central one: in the uterus, the embryo implants in the uterine lining and grows there throughout the entire pregnancy. Implantation requires a well built-up, receptive lining and a uterine cavity without relevant obstacles.
How does the uterine lining build up?
Anew in every cycle: in the first half of the cycle, the hormone oestrogen makes the lining grow; after ovulation, progesterone prepares it for implantation. If no pregnancy occurs, the lining is shed with the period – and the build-up starts again from the beginning.
Can I build up my uterine lining myself?
We advise against measures on your own initiative. Whether the lining is actually too thin can only be assessed by ultrasound over the course of the cycle – and whether hormonal support makes sense is decided individually by our doctors based on your findings. A healthy lifestyle supports the body, but does not replace a work-up.
What does “thin uterine lining” mean?
It means that the lining builds up insufficiently during the cycle. This can make implantation more difficult, but has various possible causes – from hormonal factors to adhesions. Whether this is an issue for you is shown by cycle monitoring via ultrasound; treatment depends on the cause, often with hormonal support.
What is a hysteroscopy?
During a hysteroscopy, a fine camera is introduced into the uterine cavity via the vagina and cervix – without an incision. This allows the cavity to be assessed directly; polyps, adhesions or a septum can often be treated in the same procedure. Whether a hysteroscopy makes sense depends on your findings.
Can malformations of the uterus be treated?
Frequently, yes: a dividing wall in the uterine cavity (septum), for example, can be corrected as part of a hysteroscopy. Not every malformation needs to be treated, however – whether a procedure improves your chances is assessed individually by our doctors.
What are polyps of the uterine lining?
Polyps are benign growths of the uterine lining that can protrude into the uterine cavity. Depending on their position and size, they can interfere with implantation. They can be detected by ultrasound or during a hysteroscopy – and removed as part of the hysteroscopy if needed.
What is Asherman's syndrome?
This is the term for pronounced adhesions inside the uterine cavity, which can develop after procedures or inflammation, for example. They can make implantation more difficult or change the menstrual bleeding. Adhesions can be detected during a hysteroscopy and frequently also released – we plan the further steps individually with you.
We fulfil your wish for a child!
Whether your uterus plays a role in your unfulfilled wish for a child can be clarified well – we accompany you along the way.
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