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Dr. Eric Daiter

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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: Barriers to Implantation
Embryo implantation into a receptive uterine environment is necessary for the development of a successful pregnancy. Barriers to implantation certainly can exist for the preimplantation embryo (fertilized egg) that normally enters the uterine cavity following fertilization in the fallopian tube.

At the time of In Vitro Fertilization, 4 or 5 good quality embryos are often placed into the uterine cavity and there is usually a dramatic reduction in the number of embryos that actually will implant and develop into a pregnancy.

Research on natural conception suggests that a large percentage of fertilized eggs are lost both prior to implantation and also following implantation prior to the clinical detection of pregnancy. The reason for such a high loss rate remains unclear. Most researchers are just now beginning to study the molecular events that occur at the time of embryo implantation. There is an enormous complexity to these molecular interactions.

Research results on cell adhesion molecules (CAMs, sometimes referred to as "molecular glue" that allows the embryo to adhere to the uterine wall) that may be involved in the process of human embryo implantation include the "beta 3 integrin subunit" and "osteopontin." This research has been publicized, is fascinating, and yet none of the results have a widely accepted clinical role. Therefore, this testing is experimental.

Clinical attention has been predominantly directed at detection and correction of anatomic abnormalities associated with unsuccessful implantation. "Congenital abnormalities of the Mullerian ducts" are a relatively common group of uterine defects associated with reproductive difficulty. These abnormalities result from problems in development in female offspring that occur at an embryonic stage. Normally two "tubes" known as Mullerian ducts fuse at about 8 weeks of gestation (when the mother is in the 8th week of pregnancy) in embryos that are destined to become girls, and these fused ducts then go through changes that result in the formation of the uterus and fallopian tubes. This process is complete by about the 20th week of pregnancy. When there is a problem in the normal development of the uterus and tubes then anatomic abnormalities with reproductive impact can occur.

Mullerian duct abnormalities include

* (1) septate uterus:

this is a partial lack of resorption of the poorly vascularized tissue within the uterine cavity. The remaining tissue creates a wedge shaped septum in the fundus (top) of the uterine cavity.

Implantation of an embryo onto this septum, and within a septate uterus, has a markedly greater chance of spontaneous abortion (miscarriage) compared with a normally developed uterus. There is also an increase in preterm labor and delivery as well as abnormal fetal lie or presentation (such as breech).

Fortunately, the repair of the septate uterus is fairly straightforward and usually very effective, requiring only an outpatient surgical procedure. Reportedly, repair of a septate uterus will improve the miscarriage rate from about 90% if untreated to about 10-15% if treated.

* (2) unicornuate uterus:

this is the failure in development of 1 of the Mullerian ducts, most likely due to a failure in migration (movement) of the duct to its proper location resulting in its total loss. The resulting unicornuate or half uterus has connection to only 1 fallopian tube since the other tube was to be formed from the "lost" Mullerian duct.

The caliber (size) of the cavity in the unicornuate uterus is very important in determining the likelihood of reproductive success. Unfortunately there is no accepted benefit for the treatment of these uterine defects.

The unicornuate uterus is associated with renal abnormalities (renal agenesis or lack of a kidney on the side of the missing Mullerian structures) and reproductive problems (abnormal lie or presentation, intrauterine growth retardation, preterm labor and delivery, incompetent cervix).

* (3) bicornuate uterus:

occurs with a partial lack of fusion of the Mullerian ducts, resulting in a single cervix and two uterine cavities in a heart shaped partially unified uterus. Reproductive outcome may be normal so no treatment is indicated unless reproductive problems are identified.

Reports suggest an increase in spontaneous abortion (miscarriage), preterm labor and delivery, and abnormal presentation (breech). The patient with recurrent pregnancy loss, a bicornuate uterus, and treatment for all other identified causes for the losses may reasonably consider repair of the uterus.

The treatment is surgical repair requiring a laparotomy with unification of the uterine cavities. The laparotomy requires a lengthy postoperative recovery period.

Success with this surgery is generally quite good, improving the miscarriage rate from about 90-95% if untreated (and the cause for the recurrent losses) to about 25-30% if treated.

* (4) didelphic uterus:

This results from a complete lack in fusion of the Mullerian ducts with duplication of the uterus and cervix so that the patient has 2 cervices and two uteruses (each smaller than normal). This is commonly also associated with a vaginal septum so that there are 2 vaginal canals at the top of the vaginal vault.

Occasionally, one of the sides will become obstructed and result in pain as blood accumulates in the obstructed region.

These are associated with abnormal lie or presentation as well as preterm labor and delivery.

* (5) rare abnormalities:

there are an entire host of intermediate or somewhat unique problems associated with abnormal development of the Mullerian structures. Isolated endometrial (lining of the uterus) or cervical (mouth of the uterus) agenesis (lack of development) are rare. Communicating and noncommunicating uterine horns that failed to fuse and canulate properly are possible.


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

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