Congenital abnormalities

surgical solution

Sometimes the cause of female infertility can be attributed to congenital anomalies or birth defects in the uterus. Other than infertility, these anomalies can cause recurrent miscarriages and create difficulties in carrying a pregnancy to term.

Around 10% of all cases of female infertility are caused by an abnormal uterus. Any defect in the development of uterus and fallopian tubes in utero is referred to as a Mullerian anomaly. For example, some women are born without a uterus, while some are born with two uteri, cervices and vaginas.

What is an abnormal uterus?

A uterus that is different from the normal in structure and contour rather than position is considered abnormal. However, this generally does not affect a woman’s ability to get pregnant. In fact, many a times, women don’t realise that they have an abnormality till they have repeated miscarriages or have a preterm delivery. Uterine anomalies can be diagnosed accurately, and can often be corrected, making it possible for a woman to have a healthy pregnancy. Abnormalities of the uterus may be classified into the following types:

Agenesis

This is a rare condition where there is an absence of vagina or uterus or both. This is usually picked up when a girl doesn't start menstruating by the age of 12 or 13. The condition can be treated with surgery, but women with both uterus and vaginal agenesis require counselling, as they can’t give birth to a baby. In such cases, surrogacy is the only option.

Uterus didelphys

In women with this anomaly, the uterus has two inner cavities. Each cavity may lead to its own cervix and vagina, so there are two cervices and two vaginas. A healthy pregnancy is still possible in such cases.

Unicornuate uterus

A unicornuate uterus is half of the normal uterus and has only one fallopian tube. Because of its shape, it is described as a uterus with one horn. If you have a unicornuate uterus, you probably have two ovaries, but only one will be connected to the uterus. As long as there is one, healthy, developed horn, it is perfectly possible to conceive. However, it does put you at greater risk of miscarriage and preterm delivery.

Bicornuate uterus

Women with this anomaly have two separate uterine cavities and two fallopian tubes. This shouldn’t affect fertility, but there is a higher risk of miscarriage and preterm delivery.

Septate uterus

In such cases, the uterus is divided by a wall. Partial septum is more common than a complete septum. A septate uterus may increase the chances of infertility as well as the risk of miscarriage if at all a woman conceives.

Common symptoms

In many cases, the abnormal uterus causes no problems and may remain undetected until pregnancy is attempted. If a uterine anomaly, such as in unicornuate uterus, is associated with  a rudimentary uterine horn with no outlet, menstrual flow will be obstructed. This can result in pain that gets worse during periods. If untreated, blood collects in the uterus and may become result in infection. Abnormalities in the uterus can be diagnosed through a pelvic exam, hysterosalpingogram, ultrasound or MRI scan, laparoscopy or hysteroscopy.

Treatment

Many uterine anomalies can be corrected surgically. Neovagina can be made in case of vaginal agenesis. Metroplasty is most often used to reshape the uterus. Hysteroscopic septal resection can be done in septate uterus. Cervical cerclage may be performed in some cases to prevent the cervix from dilating prematurely and to increase the fetal survival rate.

(The author is infertility and IVF specialist, ​Indira IVF, Bengaluru)