Candid Patient Reviews of
Dr. Eric Daiter

Click here for more video reviews

How Can I help You?

Dr Eric Daiter has served Monmouth and Middlesex Counties of New Jersey as an infertility expert for the past 20 years. Dr. Daiter is happy to offer second opinions (at the office or over the telephone) or new patient appointments. It is easy, just call us at 908 226 0250 to set up an appointment (leave a message with your name and number if we are unable to get to the phone and someone will call you back).


"I always try to be available for my patients since I do understand the pain and frustration associated with fertility problems or endometriosis."


"I understand that the economy is very tough and insurance companies do not cover a lot of the services that might help you. I always try to minimize your out of pocket cost while encouraging the most successful and effective treatments available."

NJ Center for Fertility and Reproductive Medicine - Infertility Tutorials

Pelvic Factor Infertility: Uterine Cavity Abnormalities

An abnormal uterine cavity can result in infertility. Sperm that enters the uterine cavity through the cervical mucus must then traverse this cavity and enter the fallopian tube to reach the egg. These structures should be confirmed to be normal early in the infertility evaluation. The most popular, safest and most cost effective way of doing this appears to be the hysterosalpingogram (HSG).

The HSG is a radiologic test performed under fluoroscopy by a radiologist and/or possibly by the infertility specialist. The test requires that a radioopaque distending media is used, which is seen by xray on film and fluoroscopy. During the performance of the test, the physicians can watch a monitor which normally shows the dye entering and filling the uterine cavity and then entering and spilling from the fallopian tubes.

There are two major types of HSG distending media, water soluble dye and oil based dye. Essentially, the water based dye is more rapidly absorbed yet is associated with a higher incidence of muscle spasm and discomfort. The oil based dye is much more slowly absorbed over possibly days to weeks (versus minutes to hours for the water based equivalent) and is associated with more serious complications (including granulomas) that are potentially fatal (oil emboli) if infused directly into the blood stream under pressure through an open channel.

There are anecdotal reports of increased pregnancy following HSG, possibly due to the opening of the tubes with the dye (commonly referred to as "blowing out the tubes"). The use of oil based media is associated with a somewhat higher subsequent pregnancy rate than water based HSGs. The HSG currently remains a diagnostic and not a therapeutic test.

The oil based dye has many supporters, and yet, I prefer use of the water based dye since there are less complications of a serious nature. Also, if oil based dye is used then ideally (for the quality of the study) the patient must return to the radiologic suite the day after initial injection for another xray of the pelvis to determine the location of the dye (to see whether there is free spillage or loculation of dye), which is inconvenient.

About 3-6 milliliters is normally required to fill the uterus and tubes. Image intensification with fluoroscopy allows direct viewing of the procedure on a monitor and limits the number of films that must be taken (consequently reducing the total amount of radiation used).

I recommend that an antibiotic, Doxycycline (when there is no history of allergy to Tetracycline or Doxycycline), be given around the time of the HSG since the flushing of these spaces (cavity and tubes) can reactivate a dormant infection to result in a clinically apparent infection (pelvic inflammatory disease). Research has indicated that there is up to an 11% risk of developing pelvic inflammatory disease (PID) in dilated or distally blocked tubes following an HSG if no antibiotics are used, a 3% risk of serious infection after HSG if there is a history suggestive of prior tubal infection or damage, and less than a 1% chance of infection if the patient is pretreated with Doxycycline regardless of history or findings of distal tubal disease. I give Doxycycline as 100 mg by mouth twice a day for a total of 4 tablets starting the evening prior to the test.

With water based dye, the patient often experiences what appears to be a large uterine cramp or contraction. This is thought to be a reaction of the uterine muscles to the rapid expansion and decompression of the uterine cavity with dye. The discomfort associated with this cramp may be largely prevented or relieved by taking a nonsteroidal antiinflamatory agent like Motrin or Alleve 30-60 minutes prior to the test.

* (1) Ashermann's syndrome

Ashermann's syndrome is the occlusion or obliteration of the uterine cavity due to damage to the endometrium (lining of the cavity). This is not common but is important to recognize if present. When the endometrium is destroyed beyond a certain depth (believed to be the basalis level which is the level that promotes subsequent growth) in the context of hypoestrogenism (a low circulating estrogen concentration) then permanent scar tissue can form within the cavity. Clinical situations that increase the chance of Ashermann's Syndrome include

  • overzealous dilatation and curettage (especially for a missed abortion, postpartum bleeding, or septic abortion),
  • intrauterine surgery to remove fibroid tumors or uterine structural defects (septum, bicornuate uterus, large polyps),
  • infections related to IUD use (or the placement of any foreign object within the uterine cavity),
  • some uncommon infections in the uterus (Tuberculosis, Schistosomiasis), or
  • radium insertion into the uterus for the treatment of a gynecologic cancer

The finding on HSG exam for Ashermann's Syndrome is intrauterine filling defects These are irregular areas within the normally triangular shaped cavity where the distending media is excluded due to the presence of the adhesions (scar tissue). Thin adhesions may be primarily composed of fibroconnective tissue with little blood supply. The thicker the adhesions, the greater the likelihood that they are vascular and possibly also partially muscular. Vascular and muscular adhesions are much more difficult to repair and seemingly pose a greater problem for fertility.

Repair of intrauterine adhesions is most easily and safely performed by hysteroscopy. Operating scissors can be used through some hysteroscopes but tend to be flimsy for any but very thin filmy adhesions. A type of operating hysteroscope called a resectoscope allows the surgeon to apply electrical current through a monopolar cutting instrument attached as the operating element of the hysteroscope and lysis (cutting) of the adhesions can then be performed. In more complex cases of adhesions, repeated procedures may be required. After each hysteroscopic repair in which cautery is used or extensive lysis of adhesions is accomplished, the patient is typically placed on higher dose estrogen replacement (say, Premarin 1.25 or 2.5 mg by mouth each day for 30-60 days, with a Provera withdrawal flow brought on at the end of this time) to promote the regrowth of endometrium (lining) over the repaired sites. Occasionally, a stent (such as an IUD or pediatric foley balloon) is also placed within the cavity to keep the sides of the uterus apart during the repair period.

For mild to moderate adhesions, you might expect a 60-80% chance of successful pregnancy after repair. For more extensive adhesions the chance of a successful pregnancy is lower. If a pregnancy does occur after repair of Ashermann's Syndrome there is a greater chance of preterm labor and delivery (delivery of a premature baby), placenta accreta (where the placenta invades the uterine wall into the muscular component of the wall and becomes difficult to impossible to remove) and postpartum hemorrhage (heavy bleeding after the delivery of a baby).

* (2) Uterine fibroids

Uterine fibroids, known as leiomyoma uteri, are tumors of the smooth muscle of the uterus. Fibroid tumors of the uterus are common, with about 75% (3 of 4) of uterine specimens removed at the time of abdominal hysterectomy having fibroids (many are quite small) and about 15-20% of hysterectomies are performed for problems involving fibroids.

The uterine wall is primarily composed of smooth muscle (the myometrium). A uterine fibroid is thought to originate as a gene mutation within one of these myometrial (smooth muscle) cells that leads to the progressive loss of its own growth regulation. Each fibroid tumor grows from a single progenitor cell (each tumor arises from one single cell) and all the cells within a particular fibroid contain the same abnormal DNA that favors growth. Different fibroid tumor originate from different muscle cells, each with their own genetic (DNA) abnormality so that each tumor may grow at its own rate (some faster and some slower). Fibroid tumors are not malignant (cancer) yet there is an uncommon cancer called "leiomyosarcoma" that is composed of malignant smooth muscle cells. It is not clear whether these cancers develop from benign fibroids or whether they arise independently.

The role of uterine fibroids in reproduction is usually not clear. If the fibroid is presenting (bulging) into the uterine cavity (submucosal) then it may obstruct one of the fallopian tube entrances or it may present a mechanical or other barrier to implantation. If the fibroid is throughout an entire wall of the uterus, then it might interfere with the blood supply to the uterine structures around it or an embryo implanting near it. If the fibroid is predominantly on the outside of the uterus with projection into the pelvis and abdomen then it may outgrow its own blood supply and degenerate or become infected, resulting in pain and irritability (contractions) of the uterus that can be associated with complications of pregnancy (preterm labor, severe pain).

Most fibroids do not seem to interfere with fertility. Fibroids should not be removed unless a reproductive problem is identified and all other treatable causes for the problem have been evaluated and either treated or excluded. One exception is the presence of a large intrauterine filling defect seen on HSG, which should be removed. Another exception is a fibroid compressing the fallopian tubes or creating a tremendous distortion of the uterine cavity.

More information on the Hysterosalpingogram is available here.


| About this web page | Basic Infertility | Ovulation | The Sperm | Pelvic Factor |

Eric Daiter, M.D. - Edison, NJ - E-Mail: - Phone: (908)226-0250

Design & Hosting by BLAZE inter.NET