It is difficult enough for millions of women to become pregnant. DES infertility makes this task much harder as our compilation of articles on this topic shows. Gynecologists have shown that the DES uterus is often misshapen, has increased resistance to blood flow and functions very abnormally just before and during pregnancy. Our firm has successfully represented women with DES infertility in the past and we will be happy to discuss your case with you. If you are a victim of DES infertility, please review the article summaries on this site to see if your situation is similar (4, 5, 6).
Haney et al reported on a spectrum of reduced uterine and endocervical dimensions in a cohort of 13 infertile, DES-exposed women in 1979 (9). They determined that the endometrial cavity area of these women was reduced by half, upper uterine segment length by one quarter and endocervical diameter by almost two thirds with P values for all three of < 0.01. In their commentary, Haney described the uterine hypoplasia (poor development), irregular endometrial contour, oligomenorrhea and dysmenorrhea that are known accompaniments of prenatal DES exposure. Given these findings, it is easy to see why DES exposed women suffer from primary infertility decades later. DES attorneys have the experience to partner with women who are DES daughters and find it difficult to conceive.
Palmer et al. studied 1,753 DES exposed and 1,050 DES unexposed women, and established a link between DES and infertility (10). The authors mailed out a detailed questionnaire to these DES exposed women in 1994 analyzed the responses and published this paper in 2001. The main questions centered on demographic factors, health outcomes and reproductive history. They drew the following conclusions:
1. DES exposed women are more likely to have difficulty becoming pregnant
2. DES is associated with primary and secondary infertility and never becoming pregnant
3. DES is most associated with uterine or tubal problems and least associated with hormonal/ovulatory factors.
4. The greatest infertility risk for women was before the 9th week of gestation but was still increased later in gestation
5. These findings are consistent with the results of some (DESAD) but not all earlier studies and cite possible selection bias and the nature of self-reporting for this.
Next, Salle et al. reported on transvaginal ultrasound studies of vascular and morphological changes in uteri exposed to DES in utero (11). The study group consisted of 28 women exposed to DES in utero and 60 control patients diagnosed with primary or secondary infertility unexposed to DES. A typical Doppler ultrasound was obtained with transverse (cut through the transverse plane) and sagittal (cut through a longitudinal plane) images. Patient groups were similar with respect to age and estradiol concentrations. Ultrasounds were done on the same days in the menstrual cycle for both groups. Parity was similar for both groups but duration of infertility and numbers of gestations and miscarriages were borderline significant for the DES exposed women at the P=.05 level.
1. A reduced cavity length (p < .0001) and uterine cavity surface area (P < .0001)
2. Reduced length, width, thickness and volume of the uterine body (P < .0001)
3. Shorter cervix (P < .05)
4. Reduced endometrial thickness in both follicular (day 5) and luteal (day 22) phases of the menstrual cycle, especially the latter
5. higher uterine artery resistance to blood flow
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.
9. Haney A.F. et al. Diethylstilbestrol-Induced Upper Genital Tract Abnormalities. Fertility and Sterility 31; 2: 142-6, Feb. 1979.
10. Palmer J.R. et al. Infertility among Women Exposed Prenatally to Diethylstilbestrol. Am. J. Epidemiology. 154; 4: 316-21, 2001.
11. Salle B. et al. Transvaginal Ultrasound Studies of Vascular and Morphological Changes in Uteri Exposed to Diethylstilbestrol In Utero. Human Reproduction. 11; 11: 2531-2536, 1996.