There are a variety of DES associated abnormalities of the cervix, uterus and Fallopian tubes (4). DES daughters may have an increased risk of life threatening ectopic pregnancy and preterm labor due to a markedly abnormal, mutated uterus. These DES tragedies should never have happened but the consequences of DES usage for decades are still being felt by American women today. We are committed to assisting women with DES abnormalities who have encountered difficulty becoming pregnant or delivering a healthy child. Our extensive research into this link between toxic drug and infertility is summarized on this site and the interested reader is invited to do so.
Swan reviewed the long-term effects of DES usage in humans in a comprehensive paper (4). In 1976, the National Cancer Institute organized the National Cooperative DES Adenosis Project (DESAD) to determine DES outcomes including vaginal adenosis, cervical ectropion, and transverse cervical and vaginal ridges. Another study of DES daughters showed similar findings of 73% with vaginal adenosis. In addition, uterine abnormalities were seen including hypoplastic uterus and "T-shaped" uterus. In 1979, autopsy reports of stillborn fetuses and neonates showed that vaginal adenosis was found in 70% of 43 DES-exposed but in only 4% of those without DES exposure. DES exposure was therefore found to be toxic, teratogenic and carcinogenic.
In 1980, Kaufman et al. described 267 women in the DESAD project who were investigated with hysterosalpingography (HSG) (5). One hundred and eighty-five of these 267 women, or 69% had abnormal HSG studies including T-shaped uterus, constrictions and reduced uterine cavity size. The authors noted a high correlation between abnormal cervical changes and abnormal HSG results (objective risk 4.5). Ninety-three of these women who had undergone HSG had 144 subsequent pregnancies with the following results: 25 elective abortions, 7 ectopic pregnancies (6%) and 54 term pregnancies (45%). Therefore, the overall pregnancy wastage in DES-exposed women was significantly higher than unexposed women. In addition, 44% of the women in the study had structural cervical anomalies. The DES attorneys in our firm are acutely aware of the difficulty that DES daughters face in achieving a term pregnancy.
A septated uterus has been associated with recurrent second trimester fetal loss. This vertical septum or division extends partially from the top of the uterus or fundus, down to the cervix, in effect creating 2 uterine compartments. The relative size of these two compartments determines when or if fetal loss will occur. A technique to cut the DES induced septum can be effective treatment. This recommendation was confirmed by Acien and Acien in 2004 (6). A more difficult anomaly associated with DES exposure called the bicornuate uterus where the uterus appears to have 2 horns is much less likely to result in a term pregnancy.
Cervical hypoplasia with incompetence is associated with DES exposure. During pregnancy, many women have experienced preterm labor in the second trimester and fetal loss due to this complication. Painless cervical dilation during the second trimester and bulging or ruptured membranes suggest incompetence of the cervix. With the next pregnancy, obstetricians have used serial transvaginal ultrasonography and cervical cerclage at 10 weeks of gestation in DES exposed pregnant women to salvage the pregnancy. Other investigators including Hricak demonstrated a short cervix (25mm as opposed to the normal of 33 mm) with normal os dimensions in 9 out of 10 DES exposed women using magnetic resonance imaging or MRI (7). Cervical narrowing has been reported as a complication of cryotherapy used to treat the abnormal mucus noted in DES daughters with cervical anomalies.
DES daughters have an increased incidence of endometriosis. Endometriosis is the presence of uterine type glandular tissue outside the uterus which retains its hormonal sensitivity and can result in cyclical bleeding, inflammation, anemia and scar tissue development outside the uterus which can be painful and debilitating. Missmer et al. described an 80% increased incidence of laparoscopically proven endometriosis in women exposed to DES in utero (8).
4. Swan S.H. Intrauterine Exposure to Diethylstilbestrol: Long-term Effects in Humans. APMIS 108:793-804, 2000.
5. Kaufman R.H. et al. Upper Genital Tract Changes and Pregnancy Outcome in Offspring Exposed in Utero to Diethylstilbestrol. Am J. Obstet. Gynecol. 137:3: 299-308, June 1980.
6. Acien P and Acien M. Evidence-based management of recurrent miscarriages. Surgical management. In: Advances in Fertility and Reproductive Medicine, Proceedings of the 18th World Congress on Fertility and Sterility. 1266: 335-342, April 2004.
7. Hricak H. et al. Cervical Incompetence: Preliminary Evaluation with MR Imaging. Radiology. 174:821-826, March 1990.
8. Missmer S.A. et al. In Utero Exposures and the Incidence of Endometriosis. Fertility and Sterility. 82; 6:1501-1507, December 2004.