DES daughters and sons appear to suffer from an increased incidence of fertility problems.
These problems are often related to the reproductive tract abnormalities caused by their
exposure, such as smaller than normal reproductive organs, T-shaped or constricted uterine
cavities, tubal irregularities and cervical deformities.
Hypoplasia of the cervix and/or uterus means that those organs are smaller (sometimes much
smaller) than normal. Cervical hypoplasia can result in the opening of the cervix being so
small that it does not allow sperm to pass through to the uterus or fallopian tubes,
thereby preventing conception. Uterine hypoplasia can prevent or hinder implantation of a
fertilized egg and can also prevent the fetus from growing normally. The decreased volume
of the uterine cavity can ultimately result in expulsion of the fetus, or miscarriage.
The cervix of a DES-exposed woman is also more prone to
inflammation and even to dysplasia (pre-cancerous cell growth). Dysplasia is typically
treated in non-exposed women by cryotherapy (freezing of the pre-cancerous cells).
However, this treatment in the DES-exposed can actually cause more harm than good. A very
high percentage of DES daughters suffer significant scarring and constriction of the
cervical canal after this therapy, thereby resulting in even greater problems with
conception. Cryotherapy can also disrupt the production of cervical mucus which is crucial
for transport of sperm into the uterus. If you are diagnosed with dysplasia or other
abnormalities of the cervical tissue, ask your doctor to discuss alternative treatments
with you. Many abnormal Pap smears are the result of benign cervical conditions which
should really not justify treatment in view of the potential hazards. If therapy is
absolutely necessary, focal cryosurgery of the outer part of the cervix (as opposed to the
internal canal) guided by colposcopy is advised by DES specialists.
The fallopian tubes of DES daughters may be distorted,
shortened or "withered" as a result of their exposure. This leads to a higher
incidence of ectopic or tubal pregnancies, which can be life-threatening if not discovered
early. These abnormalities also make it more difficult for the fertilized egg to be
transported to the uterus for implantation.
If you are or believe you may be DES-exposed, you should seek
out special medical help as soon as you are thinking of becoming pregnant. Reproductive
endocrinologists are OB/GYNs receiving additional specialized training in the causes and
treatment of infertility. Make sure your doctor knows of your exposure, since he or she
will likely want to perform special tests to determine the existence or extent of any
DES-caused abnormalities you may have. One such test is the hysterosalpingogram (HSG)
which is a dye-enhanced x-ray of the uterine cavity which reveals whether there is a
uterine abnormality ("T-shape", constriction bands, septum, hypoplasia) or tubal
blockage. Your infertility specialist can also discuss what all is involved in an
infertility workup, as well as assisted reproductive technologies, such as intrauterine
insemination, in vitro fertilization, and surrogacy. Since DES daughters should be handled
as high-risk pregnancy patients, he or she will likely refer you to a perinatologist or
other obstetrician with special training in pregnancy
complications if you do become pregnant.
