Congenital anomalies (birth defects) of the uterus are
occasionally found in infertile women. These uterine anomalies are
usually not a cause of infertility, but can be associated with
recurrent miscarriages and difficulty carrying a pregnancy to term.
With the exception of the arcuate uterus, these uterine
malformations can be associated with malformations of the kidneys.
Therefore, all women with uterine malformations should have an
x-ray or ultrasound of their kidneys. The physicians at Arkansas
Fertility & Gynecology are skilled in the diagnosis and treatment
of birth defects involving the female reproductive organs. A brief
discussion of the various uterine anomalies is provided below.
A slight indentation at the top of the uterine cavity (fundus)
characterizes an arcuate uterus. This is probably best considered a
variation of normal anatomy because it is not associated with any
adverse reproductive outcomes. No treatment is indicated.
This is the so called “heart shaped” uterus. There is a more
marked indentation at the top of the uterus and the upper half of
the uterus is separated into two separate cavities or “horns”. Most
women with a bicornuate uterus will not have difficulty getting
pregnant. They do have a higher risk of preterm labor and breech
presentation of the baby. Some women with a bicornuate uterus will
have recurrent miscarriages. Surgical correction of this uterine
malformation is possible, but is only indicated if the woman has
had adverse obstetrical outcomes in previous pregnancies.
There is complete duplication of the uterus and cervix with this
malformation. There are two separate uterine cavities, each with a
cervix. A vaginal septum extending from the upper vagina down to
the vaginal opening is frequently seen. Surgery to unite the two
uterine bodies is not recommended. The vaginal septum can sometimes
cause problems with intercourse. The vaginal septum can also
obstruct the outflow of blood from one of the uterine cavities.
Removal of the vaginal septum can be performed with a simple
outpatient surgical procedure. Women with this malformation
typically do not have any trouble conceiving. They are, however, at
higher risk for miscarriage, preterm delivery and breech
presentation of the baby.
Only half of the uterus forms in women with this malformation.
There is a single uterine cavity and cervix with a single fallopian
tube coming off the uterus. This anomaly can be thought of as
one-half of a didelphic uterus. There may be a small remnant of the
other half of the uterus that did not form properly. This remnant
usually does not cause any problems. Occasionally, the uterine
remnant may have functioning endometrial tissue that bleeds each
month. These women will have cyclic pelvic pain on the side of the
uterine remnant. Surgical removal of the uterine remnant can be
performed in symptomatic cases.
A partition or septum separates the uterine cavity into two
separate cavities in this malformation. The septum arises at the
top of the uterine cavity and extends for variable lengths,
sometimes all the way down to the cervix and vagina. This uterine
anomaly has the strongest association with adverse obstetrical
outcome. Surgical removal of the septum is recommended in these
women. Removal of the septum can be performed with a relatively
simple out-patient surgical procedure.
This anomaly is also called uterine agenesis. It also goes by
the name of Mayer-Rokitansky-Kuster-Hauser syndrome, or MRKH. This
is the most severe of the uterine anomalies. There is complete
failure of the uterus and cervix to develop. The vagina also does
not develop. These women will have only a small dimple where the
vaginal opening should be. Surgical creation of a sexually
functional vagina is possible in these women. Nonsurgical creation
of a functional vagina using progressive vaginal dilators can also
be performed. These women cannot carry a pregnancy, but they can
have their own biologic child with the use of in vitro
fertilization (IVF) and a gestational surrogate.
If you have been diagnosed with, or are suspected of having a
uterine anomaly, the physicians at Arkansas Fertility & Gynecology
and can provide you with the necessary information you need to help
you make treatment decisions. If surgery is indicated, we can
provide this for you.