Reproductive Outcomes in Women With Uterine Anomalies

Paul C. Lin, M.D.

In This Article

Uterine Anomalies and Art

Overall, data are limited in the reproductive outcome of uterine anomalies undergoing IVF because of the relative infrequency of such uterine anomalies. However, this situation may change in the near future as access to ART and IVF pregnancy rates improves.

Three studies have looked at uterine anomalies and IVF outcome. The first study looked at 38 subjects undergoing 119 oocyte retrievals and compared their pregnancy outcome with a French national database of 7677 IVF egg retrievals over the same time span.[31] Comparable numbers were obtained for number of transfers attempted per retrieval, number of oocytes obtained per retrieval, and mean number of embryos transferred. Nevertheless, pregnancy rates per retrieval (11.7% vs. 19.1%), pregnancy rates per transfer (13.6% vs. 24.9%), and implantation rate (pregnancy rate/embryo) (5.8% vs. 11.7%) were all lower than the French national IVF database. Surgically treated uterine septi had a non-statistically significant difference in implantation rate, but untreated septum and unicornuate uteri had a 50% reduction in pregnancy rate per transfer and implantation rate. Patients with a bicornuate uterus also had a 50% reduction in pregnancy rate per transfer and implantation rate.

The second study compared IVF rates with a historical control.[32] Looking at only 17 subjects with uterine anomalies undergoing 55 IVF cycles, this study found a lower delivery rate per embryo transfer compared with a historical database at the same hospital and facility (8.2% vs. 17.5%–19%). The study stated that unicornuate uterus had a reasonable pregnancy rate of 19.4% (no control data were provided) but an especially high ectopic rate of 33% (2 of 6 pregnancies). The didelphic uterus pregnancy rate per embryo transfer was 11.1%, but the single pregnancy resulted in a miscarriage. Because of its extremely low number of subjects, this study is difficult to interpret. This Finnish study did not consider subjects who had a bicornuate uterus or an arcuate uterus.

The third study looked at 24 subjects who underwent 47 IVF cycles.[33] Using their own historical data, the authors found that overall clinical pregnancy (37.3% in uterine malformations vs. 38.8% in controls) and implantation rates (17.5% in uterine malformations vs. 13.0% in controls) were similar. Subjects with a didelphic uterus had a 27.3% implantation rate (IR), those with a septate uterus had a 22.5% IR, those with a bicornuate uterus had an 11.6% IR, and a woman with a unicornuate uterus had a 13.2% IR. This study suggests also that specific anomalous uteri, such as bicornuate and unicornuate uteri, have lower IVF success rates, but these studies also suffer from small numbers.


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