Uterine Anomalies

The uterus is one of the most important organs in the female reproductive system. Thanks to its unique inner structure, it allows the implantation and development of a fertilized egg and facilitates childbirth through contractions during labor. The uterus plays a vital role in women’s health, but various anomalies or disorders can develop within it.

Uterine anomalies are congenital abnormalities that occur in the structural formation of the uterus. These conditions can lead to several complications, including infertility, recurrent miscarriages, preterm birth, and menstrual irregularities.

Uterine anomalies can be diagnosed using various imaging and surgical methods, and treatment is often performed through surgical procedures, depending on the type and severity of the anomaly.

What Are the Types of Uterus-Induced Infertility?

Since the uterus plays a key role in reproduction, any damage or abnormality can lead to infertility. Uterine factor infertility is typically divided into two categories:

• Congenital Uterine Factor Infertility:
  A condition in which a woman is born with an abnormally developed or non-functioning uterus. This may result from incomplete fetal development.
• Acquired Uterine Factor Infertility:
  This develops during a woman’s lifetime due to conditions such as:
  • Hysterectomy (surgical removal of the uterus)
  • Uterine fibroids
  • Uterine prolapse
  • Endometrial hyperplasia
  • Trauma or damage to the uterus

One of the most significant causes of acquired uterine infertility is Asherman’s Syndrome, in which scar tissue forms inside the uterus, creating blockages that prevent implantation. This may be caused by infections, radiation therapy, or procedures like dilation and curettage (D&C).

Why Do Uterine Anomalies Occur?

Uterine anomalies occur during the embryonic development of the baby in the womb. Structural abnormalities in the uterus may arise due to improper fusion or development of the Müllerian ducts.

Both genetic and environmental factors play a significant role in the formation of these anomalies. Additionally, hormonal imbalances can negatively affect the development of the uterus.

Factors That May Lead to Uterine Anomalies:

• Maternal health during pregnancy:
  Chronic illnesses and infections during pregnancy can adversely impact fetal development, including the formation of the uterus.
• Exposure to harmful substances:
  Exposure to radiation, chemicals, or certain medications during pregnancy can interfere with the proper development of the uterus.
• Nutritional deficiencies and unhealthy habits:
  Poor maternal nutrition, smoking, and alcohol consumption are also contributing factors that may lead to structural abnormalities in the uterus.

Common Types of Uterine Anomalies:

• Septate Uterus:
  A septum divides the uterine cavity, often leading to recurrent miscarriages.
• Bicornuate Uterus:
  The uterus has two distinct cavities, giving it a heart-shaped appearance.
• Arcuate Uterus:
  A mild anomaly with a small indentation at the top of the uterine cavity.
• Unicornuate Uterus:
  Only one side of the uterus forms, usually with a single fallopian tube.

Didelphys Uterus:
A rare condition in which the uterus is duplicated, resulting in two uterine cavities, two cervices, and sometimes two vaginas.

What Are the Symptoms of Uterine Anomalies?

While some women show no symptoms, others may experience:

• Pain before or during menstruation
• Irregular vaginal bleeding
• Pain during intercourse
• Recurrent miscarriages
• Preterm labor or premature birth

How Are Uterine Anomalies Diagnosed?

Diagnosis is typically made using imaging techniques, including:

• Ultrasound:
  Provides initial images of the uterus, cervix, and ovaries
• MRI:
  Offers a detailed view of complex cases when ultrasound results are unclear
• Laparoscopy:
  A minimally invasive surgery that uses a small camera inserted through the lower abdomen to inspect the uterus
• Hysterosalpingography (HSG):
  An X-ray procedure that uses dye to assess the shape of the uterine cavity and check for fallopian tube blockages
• Chromopertubation:
  Performed during laparoscopy using a colored dye to evaluate tubal patency

The choice of diagnostic method depends on the patient’s medical history and symptom severity. If you suspect any symptoms, consult a healthcare professional for an accurate diagnosis.

How Are Uterine Anomalies Treated?

Most uterine anomalies are not life-threatening and may not require treatment unless they interfere with fertility or cause pregnancy complications.

Common Treatments:

• Laparoscopy and Hysteroscopy:
  Minimally invasive techniques to correct abnormalities such as a septum

Metroplasty:
A surgical procedure used to treat bicornuate uterus in specific cases. This treatment remains controversial and is performed only when clearly indicated.

Do Uterine Anomalies Prevent Pregnancy?

Not all uterine anomalies cause infertility. However:

• Septate uterus, uterine agenesis, and hypoplasia can make conception more difficult
• Didelphys uterus may cause abnormal fetal positioning and delivery complications
• Bicornuate uterus is associated with higher miscarriage rates and preterm labor

Proper diagnosis and individualized treatment plans greatly increase the chances of a successful pregnancy in women with uterine anomalies.

Uterine Anomalies and IVF Treatment

For women with uterine anomalies, in vitro fertilization (IVF) is one of the most effective options when natural conception is not possible. Structural abnormalities in the uterus can interfere with embryo implantation and development. Therefore, surgical correction of the anomaly may be required before undergoing IVF treatment to improve the chances of a successful pregnancy.

When Is IVF Recommended for Uterine Anomalies?

IVF may be recommended in the following cases related to uterine anomalies:

• Septate Uterus:
  A septum dividing the uterine cavity can prevent embryo implantation. Hysteroscopic surgery to remove the septum can significantly increase the success rate of IVF.
• Bicornuate Uterus:
  A heart-shaped uterus with two cavities may not be suitable for pregnancy. Surgical correction may be needed before IVF can be considered.
• Unicornuate Uterus:
  A uterus that has developed only on one side can pose risks during pregnancy. IVF combined with close pregnancy monitoring is often recommended.
• Intrauterine Adhesions (Asherman’s Syndrome):
  Scar tissue within the uterine cavity can prevent embryo implantation. Hysteroscopic surgery is often performed to remove the adhesions before starting IVF.

Congenital Absence of the Uterus (MRKH Syndrome):
In this case, the woman is born without a uterus. Since carrying a pregnancy is not possible, gestational surrogacy is the recommended approach using the woman’s own eggs and IVF.