Reproductive Outcomes in Women With Uterine Anomalies

Paul C. Lin, M.D.

In This Article

T-Shaped Uterus

Exposure in utero to diethylstilbestrol (DES) is commonly associated with a T-shaped uterus. The spontaneous incidence of the T-shaped uterus is not known in the general population. DES was first introduced in 1948 as an agent that reduced early pregnancy loss, intrauterine fetal demise, preeclampsia, and preterm delivery. This was eventually refuted, and DES was eventually banned in 1971. Therefore, its true clinical significance in reproductive medicine is rapidly diminishing as those affected women pass their reproductive years. DES has been known to be associated with benign vaginal adenosis, such structural cervical changes as collars, hoods, septae, T-shaped uteri, constriction bands, wide lower uterine segments, and irregular endometrial cavity borders.

In a meta-analysis study of DES-exposed subjects, the authors found a 9-fold increase in ectopic pregnancy, a 2-fold increase in miscarriage rate, and a 2-fold increase in preterm delivery compared with a matched control population.[30] Pregnancy rates were similar between DES-exposed women and controls, 72% vs. 79%, respectively. Such outcomes are caused not only by the uterine anomaly but also by the antiestrogenic effect at the endometrium. The resulting insufficient endometrial environment for the early conceptus leads to ectopic pregnancy, preterm labor, and miscarriage, but not necessarily infertility.


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