The developing embryo implants into the lining of the uterus, known as the endometrium. The endometrium must be sufficiently ‘thickened’ and vascular to support the embryo and developing fetus.

The uterus must also be free of large obstructions such as polyps and fibroids and it must not have serious “congenital defects” such as seen in the bicornuate uterus. Some congenital defects can be corrected by a skilled reproductive surgeon.

Polyps and fibroids can be removed surgically usually using the laparoscope and it is very important that a reproductive surgeon perform this surgery. Sometimes the obstruction can be removed using the hysteroscope. Some surgeons still rely on the open incision to remove polyps and fibroids which dramatically increases recovery time and pain.

When the uterus is severely damaged it may be necessary to use a surrogate mother to carry the baby to term. Using surrogacy, an embryo created using the genetic material of the mother and father is transferred to the surrogate mother who carries the baby to term and delivery.