Congenital Uterine Anomalies – Their Impact On Fertility

Malfunctions of the uterus which develop when the development of the baby begins in the womb or during the embryonic life are known as congenital uterine anomalies. During the embryonic stage, the baby begins its development as two halves. These fuse together to form the entire body later during further development in the womb. A woman is said to have congenital uterine anomaly, when her uterus develops in a different way than what is considered usual. This article discusses about the condition in detail.

Congenital uterine anomalies are seen more in women who have had a miscarriage or have delivered premature babies.

Some of the commonest types of congenital uterine anomalies include:

• Septate uterus
• Bicornuate uterus
• Arcuate uterus
• Unicornuate uterus
• Didelphys uterus

Septate and the bicornuate uterus is the most common types of congenital anomalies.

Impact of Congenital Uterine Anomalies on Fertility

Congenital uterine anomalies although do not play much of a role in causing difficulty in getting pregnant, but these malformations are often discovered during the evaluation of infertility and pregnancy loss.¹ However, it is important to understand the impact of congenital uterine anomalies on fertility to be able to deal with the condition better.

It is a common uterine anomaly. In this condition, there is a normal surface of the uterus on the exterior but two cavities in the endometrium. In this anomaly, a membrane called septum divides the inner portion of the uterus at its middle. The septum can be a fibrous tissue or a muscular tissue band (thick or thin).

Though its role in infertility is controversial, some experts propose its contribution in unexplained fertility, maybe due to, it, adversely affecting the implantation. There might be a difference between the endometrium of the overlying septum and the neighboring endometrium within the uterine cavity.

One of the ways in which a septate uterus can impact fertility is that it can be a reason for miscarriage or recurrent miscarriage. The pregnancy that occurs in this type of uterus may be at risk of premature labor, breech positions, cesarean delivery, and bleeding complications after delivery.

When a woman has a heart shaped uterus it is known as a bicornuate uterus. It occurs due to the abnormal development of the paramesonephric ducts. When the ducts fail to fuse correctly, the uterus is divided into two parts. Just like a septate uterus, it is also a very common congenital uterine anomaly. It has an abnormal intended external uterine cavity.

The bicornuate uterus does not affect the embryo implantation, and there are no clear studies depicting its role in affecting fertility. A womb variation does not make a difference when a female is trying to get pregnant, but surely has a role in miscarriage and premature delivery. However, studies report that women who have not managed to conceive sometimes have one or the other uterine abnormality. This could be one of the ways in which congenital uterine anomalies show their impact on fertility.
Other symptoms associated with this condition are:

• Period pain
• Irregular vaginal bleeding
• Painful intercourse
• Pain or discomfort in the abdomen

An arcuate uterus is a type of uterine anomaly, where the uterine cavity shows a concave contour towards the fundus. The external uterine surface is normal with a slight indentation into the endometrial cavity.

This condition does not affect fertility, and neither does it affect the birth rate. This is a very common congenital anomaly and does not affect pregnancy. Thus, an arcuate uterus does not have a negative impact on fertility.

This is a rare congenital anomaly, in which only one half of the uterus develops. A unicornuate uterus is smaller in size than a normal uterus with only one fallopian tube. This condition can have an impact on fertility owing to the presence of just one half.

The symptoms associated with this condition are,

• Pain in the abdomen
• Infertility
• Complicated pregnancy such as miscarriage, preterm labor, or breech delivery.

Didelphys uterus is a condition in which there are two inner cavities, each having its separate vagina and cervix. It is a very rare condition and is also known as a double uterus. It occurs due to the failure of the fusion of the Mullerian ducts. This does have an impact on fertility and can affect women in many ways.

This condition is associated with infertility, preterm delivery, and miscarriage. Other symptoms associated are,

• Painful intercourse
• Dysmenorrhea
• Breech presentation
• Cesarean section

The diagnosis of congenital uterine anomalies is based on medical history and clinical examination. The gynecologist might further recommend tests if a congenital anomaly are suspected. The imaging tests which can help detect the condition are an ultrasound, hysterosalpingogram, and an MRI. The scans help to view the uterus, which can confirm the presence of a congenital anomaly.

Women with congenital uterine anomalies have no medical or reproductive problem. However, in some cases, these conditions have their impact on fertility. Hence timely diagnosis and treatment is necessary to improve the health of the woman and plan a family.

There are surgical treatments depending on the anomaly and history of pregnancy and reproductive function. As a treatment of septate uterus, which can be diagnosed when dealing with infertility or miscarriage, surgery may be advised. This will help to improve the reproductive function and have positive impact on fertility. Bicornuate, unicornuate, or a didelphic uteri does not require any surgical treatment.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/20426609

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