Reproductive Outcomes in Women With Uterine Anomalies

Paul C. Lin, M.D.

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In This Article

Discussion

In general, uterine anomalies present some difficulty in pregnancy retention and overall pregnancy outcome with natural conception and ART.

Arcuate uterus probably has no impact on reproductive capacity. The uterine septum is more definitively associated with recurrent miscarriage, and unlike the bicornuate uterus, surgical correction is technically easier and less morbid. Therefore, in the face of suspect data, surgical repair for the infertile couple with no previous pregnancies seems reasonable. The bicornuate uterus appears to cause an increased miscarriage rate and preterm delivery.

The didelphic uterus was originally thought to have no impact on reproductive outcome, but reevaluation of the literature shows that it does increase preterm deliveries and miscarriage rates. Like the unicornuate uterus, the didelphic uterus has an increased risk of malpresentation and cesarean section for dystocia. Patients with a unicornuate uterus have the poorest outcome: higher miscarriage rates, higher ectopic rates, higher preterm delivery rates, and lower live birth rates. Pregnancy for vaginal agenesis patients appears comparable with oocyte retrieval from the affected patient and IVF and embryo transfer into a gestational carrier. DES-exposed patients have increased miscarriage, ectopic pregnancies, and preterm delivery rates because of the multitude of associated genital anomalies, not only uterine.

In general, the role of IVF needs to be better evaluated, with studies including a larger number of subjects. IVF pregnancy rates appear to be decreased not because of decreased number or quality of eggs obtained but rather because of the uterine anomaly itself. Resulting implantation rates and clinical pregnancy rates are still uncertain but may be reduced by 50% compared with women undergoing IVF without anomalies.

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