Uterine Malformations

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.

Arcuate Uterus

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.

Bicornuate Uterus

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.

Didelphic Uterus

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.

Unicornuate Uterus

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.

Septate Uterus

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.

Absent Uterus

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.

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