This complication is defined by the inability to bear any more children. It is seen in DES daughters and is a bit less common than the primary infertility noted elsewhere on this site. Although this complication has not garnered the same notoriety as primary DES infertility, it is equally frustrating to the DES daughter. In vitro fertilization may be an option for DES daughters with secondary infertility and an experienced fertility specialist can help you determine if IVF is right for you. Our DES attorneys have the experience and compassion to guide you through this difficult and traumatic experience. We have taken the liberty of summarizing some of the case studies of women who have a similar experience as you (14, 15).
Kaufman et al reported in 2000 on the long-term pregnancy experiences of DES daughters (14). This was also a cohort study based on the National Collaborative DES Adenosis cohort, the Chicago cohort and compared to a DES-unexposed control group. DES daughters were less likely than DES-unexposed women to have had full-term live births and more likely to have had premature births, spontaneous pregnancy losses or ectopic pregnancies. All could be associated with the later development of secondary infertility. DES daughters had a 24% reduced chance of delivering a full-term infant with their first pregnancy than unexposed women. Preterm delivery of first births occurred in 11.5% of DES-exposed and 4.1% of DES-unexposed women a risk of 2.8-fold.
In a comprehensive review paper, Probst and Hill described anatomic factors associated with recurrent pregnancy loss and characterized DES exposed women as Class VII. In their review, DES exposed women suffered from Mullerian abnormalities which resulted in recurrent pregnancy loss because of reduced vascularity or blood flow to the developing embryo and placenta, a smaller uterine volume or cervical hypoplasia with cervical incompetence.
In their review, 80% of women with Mullerian abnormalities suffered from reduced uterine blood flow (15). Reduced uterine volume clearly reduces the available space for a developing fetus but it is also hypothesized that this anomaly also increases intrauterine pressure, which, when coupled with cervical incompetence, sets the stage for preterm labor and fetal wastage. They also cited previous literature that suggested benefit from prophylactic cervical cerclage in cases of DES-associated cervical incompetence.
DES infertility may not always be recognized for what it is. A careful history by a gynecologist familiar with DES may provide a clue to the etiology and our DES attorneys are committed to assisting infertile DES-exposed women.
A recent report by Sher and Fisch suggested that sildenafil (Viagra) could be useful in patients with reduced uterine artery blood flow undergoing IVF so this option might be available to DES exposed women (16).
14. Kaufman R.H. et al. Continued Follow-up of Pregnancy Outcomes in Diethylstilbestrol-exposed Offspring. Obstetrics and Gynecology. 96;4: 483-9, October, 2000.
15. Probst A.M. and Hill J.A. Anatomic Factors Associated with Recurrent Pregnancy Loss. Seminars in Reproductive Medicine 18; 4: 341-50, 2000.
16. Sher G. and Fisch J.D. Vaginal Sildenafil (Viagra): A Preliminary Report of a Novel Method to Improve Uterine Artery Blood Flow and Endometrial Development in Patients Undergoing IVF. Human Reproduction 15; 4: 806-9, April 2000.