Senior Consultant, Medical Genetics, Artemis Hospitals, Gurgaon, India
Part 5 of 12 in Finding Answers in Recurrent Pregnancy Loss
Anatomical Causes: Uterine Septum, Fibroids, and Cervical Incompetence
June 7, 2026
A uterine septum is a well-established anatomical cause of recurrent pregnancy loss, while the role of an arcuate uterus remains unclear. Intrauterine adhesions and large uterine fibroids can also cause loss, most likely by disrupting the vasculature and placentation of the embryo; endometrial polyps may contribute as well.
In the second trimester specifically, cervical incompetence should be considered when there's a history of recurrent spontaneous rupture of membranes with otherwise normal ultrasounds, bulging membranes through the cervix, or painless cervical dilatation: this is largely a clinical diagnosis based on history. Management involves cervical surveillance from 14-16 weeks with ultrasound monitoring of cervical length, and cervical cerclage if length falls below 25mm before 24 weeks.
This guide is based on a live Jivo Masterclass — Dr. Kanika Singh taught doctors across Africa on June 7, 2026.
FROM THE LIVE Q&A
Dr. Isaya
My question is about sperm collection. In my clinic I often see couples where the male is over 50 years old. What are the chances of getting good quality sperm, and what are the implications for implantation?
Dr. Kanika Singh
I will not be able to give you details about specific sperm selection procedures, as in our hospital this is a multidisciplinary process involving the IVF specialist and the andrology laboratory. But in terms of the genetic implications: above the age of 50, there is a high chance that sperm quality is reduced, and the sperm DNA fragmentation index is likely to be elevated. Unless we specifically test for it, we do not know the exact level, but even without testing, there is a significant chance that sperm DNA quality is impaired, which can result in recurrent pregnancy loss or implantation failure. Testing the sperm DNA fragmentation index in men above 50 with a history of recurrent pregnancy loss or implantation failure would be worthwhile.
Frequently Asked Questions
For patients with PCOS, how long should metformin be taken before conception and after conception?▼
Metformin should be started at least 2 to 3 months before conception. It is safe to continue in pregnancy and is generally continued through the first trimester and sometimes beyond. It should be monitored with GTT as well as regular HbA1c and blood sugar checks throughout.
My question is about sperm collection. In my clinic I often see couples where the male is over 50 years old. What are the chances of getting good quality sperm, and what are the implications for implantation?▼
I will not be able to give you details about specific sperm selection procedures, as in our hospital this is a multidisciplinary process involving the IVF specialist and the andrology laboratory. But in terms of the genetic implications: above the age of 50, there is a high chance that sperm quality is reduced, and the sperm DNA fragmentation index is likely to be elevated. Unless we specifically test for it, we do not know the exact level, but even without testing, there is a significant chance that sperm DNA quality is impaired, which can result in recurrent pregnancy loss or implantation failure. Testing the sperm DNA fragmentation index in men above 50 with a history of recurrent pregnancy loss or implantation failure would be worthwhile.
Which uterine abnormalities are established causes of recurrent pregnancy loss?▼
A uterine septum is a well-established anatomical cause, while the role of an arcuate uterus remains unclear.
How do fibroids and intrauterine adhesions contribute to pregnancy loss?▼
Intrauterine adhesions and large uterine fibroids can cause loss, most likely by disrupting the vasculature and placentation of the embryo; endometrial polyps may contribute as well.
What clinical signs suggest cervical incompetence?▼
A history of recurrent spontaneous rupture of membranes with otherwise normal ultrasounds, bulging membranes through the cervix, or painless cervical dilatation.
How is cervical incompetence managed once suspected?▼
Management involves cervical surveillance from 14-16 weeks with ultrasound monitoring of cervical length, and cervical cerclage if length falls below 25mm before 24 weeks.
In This Series: Finding Answers in Recurrent Pregnancy Loss
- 1.Finding Answers in Recurrent Pregnancy Loss
- 2.Fetal Chromosomal Abnormalities: The Leading Cause of First-Trimester Loss
- 3.Balanced Translocation: When a Genetically Normal Parent Passes on Recurrent Loss
- 4.Single-Gene Causes: Why Second-Trimester Losses Need a Different Genetic Workup
- 5.Anatomical Causes: Uterine Septum, Fibroids, and Cervical Incompetence
- 6.Antiphospholipid Antibody Syndrome: Diagnosis and Treatment
- 7.Endocrine Causes: Thyroid, PCOS, and Diabetes in Recurrent Pregnancy Loss
- 8.Sperm DNA Fragmentation: The Male Factor in Recurrent Pregnancy Loss
- 9.The Immunological Debate: NK Cells, TNF-Alpha, and IVIG Therapy
- 10.What to Test For: A Practical Investigation Framework by Trimester
- 11.Pre-Implantation Genetic Testing: PGT-A, PGT-M, PGT-SR and PGT-HLA Explained
- 12.Prognosis After Recurrent Pregnancy Loss: Why the Outlook Is Better Than Most Couples Expect