Can a Bicornuate Uterus (Double Uterus) Affect Fertility?

A bicornuate uterus is a rare congenital condition that can significantly impact a woman’s reproductive health and pregnancy outcomes. This uterine anomaly is characterised by a heart-shaped structure with a deep indentation at the top. The uterus is partially divided into two distinct cavities, which can affect pregnancy outcomes. This condition occurs due to the incomplete fusion of the Müllerian ducts during foetal development.

If you’ve been diagnosed with this uterine anomaly, it’s natural to feel concerned and overwhelmed. However, understanding what a bicornuate uterus is and how it can affect your fertility and pregnancy can help you navigate this journey with more confidence and clarity.

Many women with bicornuate uteri have gone on to have successful pregnancies with proper care and monitoring. Let’s explore its causes, symptoms, and potential impact on reproductive health, along with available treatment options and strategies.

Types of Bicornuate Uterus

A bicornuate uterus can be classified into two main types based on the degree of separation:

• Complete bicornuate uterus
• Partial bicornuate uterus

Cause of a Bicornuate Uterus

The exact cause of a bicornuate uterus is not entirely understood, but it is generally attributed to the incomplete fusion of the Mullerian ducts during foetal development. This usually happens between the 10th and 20th week of pregnancy.
It’s important to note that having a bicornuate uterus is not hereditary, and there are no known genetic or environmental factors that contribute to its development.

Symptoms of Bicornuate Uterus

Many women with a bicornuate uterus do not experience any noticeable symptoms. However, some common signs and symptoms may include:

• Repeated miscarriages

• Irregular vaginal bleeding

• Abdominal pain or discomfort

• Painful intercourse

• Painful periods

It’s important to note that these symptoms can also be associated with other gynaecological conditions, so it’s crucial to consult with your healthcare provider for an accurate diagnosis.

How does Bicornuate Uterus Affect Pregnancy?

Increased Risk of Miscarriage

The presence of a septum or division in the uterus can significantly impact implantation success. The irregular shape may lead to:

• Impaired blood supply: A divided uterus can affect blood flow to the developing foetus, which is critical for providing the necessary nutrients and oxygen for growth.

• Challenges in uterine expansion: The abnormal structure may restrict the uterus’s ability to stretch as the foetus grows, leading to potential complications and increasing the likelihood of miscarriage.

Preterm Labour and Delivery

The unique shape of a bicornuate uterus can limit the available space for foetal growth, potentially resulting in:

• Early contractions: The confined environment may trigger the uterus to contract prematurely, leading to preterm labour.

• Increased likelihood of premature delivery: Studies have shown that women with a bicornuate uterus have a higher rate of preterm births compared to those with a normal uterine shape, necessitating close monitoring throughout pregnancy.

Malpresentation of the Baby

The irregular uterine shape can affect foetal positioning, which may result in:

• Increased likelihood of breech presentation: The foetus may not have enough space to turn into the head-down position, leading to a breech birth where the baby is positioned feet-first.

• Transverse lie: In some cases, the baby may lie sideways in the uterus, which can complicate delivery and often requires a caesarean section for safe birth.

Foetal Growth Restriction

A bicornuate uterus can restrict the available space for foetal development, leading to:

• Intrauterine growth restriction (IUGR): This condition occurs when the foetus does not grow at the expected rate, often resulting in low birth weight.

• Compromised foetal health: Insufficient space can hinder normal growth patterns, which may lead to long-term developmental challenges or health issues for the baby.

Increased Monitoring and Care

Pregnancies in women with a bicornuate uterus are typically classified as high-risk, requiring:

• Regular ultrasounds: Close monitoring through frequent ultrasounds is essential to assess foetal growth, position, and overall health.

• More prenatal visits: Increased appointments with doctors to help ensure that both the mother and baby receive appropriate care and that any emerging complications are promptly addressed.

• Coordination of care: In some cases, a multidisciplinary approach involving obstetricians, maternal-foetal medicine specialists, and possibly surgeons may be necessary to manage the pregnancy effectively.

Treatment of Bicornuate Uterus

Effective management of a bicornuate uterus involves a comprehensive approach to ensure healthy pregnancy outcomes. This approach includes:

• Monitoring and surveillance: Women with a bicornuate uterus require closer monitoring during pregnancy, including regular ultrasounds and prenatal visits to monitor the baby’s growth and positioning.

• Cerclage placement: In cases of preterm labour or a short cervix, a cerclage may be placed to prevent premature birth and support the pregnancy.

• Foetal positioning techniques: Techniques such as the external cephalic version may be attempted to encourage the baby to assume the head-down position for a safe delivery.

• Surgical treatment (metroplasty): Bicornuate uterus treatment may involve metroplasty, a surgical procedure to unify the uterus, especially if the condition is causing significant fertility or pregnancy issues. This surgery can be done laparoscopically and requires a waiting period of at least three months before attempting to conceive again due to the risk of uterine rupture during labour.

• Individualised management: The management of a bicornuate uterus during pregnancy is tailored to each individual case, considering factors such as the severity of the uterine anomaly, previous pregnancy history, and any associated complications.

Success Rate of Bicornuate Uterus Pregnancy

Despite the challenges, many women with a bicornuate uterus can have successful pregnancies. The success rate is influenced by several factors, including:

1. Degree of uterine malformation: This will directly impact the success rate of the pregnancy.
   

   • Partial bicornuate uterus: Women with a partial bicornuate uterus typically have a larger, more functional uterine cavity, which can support foetal growth more effectively. The presence of a septum may be less pronounced, allowing for better blood supply and implantation, often translates to a higher likelihood of success.
     

   • Complete bicornuate uterus: Here the division of the uterus can limit space for the developing foetus, potentially leading to complications such as foetal growth restriction, increased risk of malpresentation, and a higher chance of miscarriage.
     

2. Timely Natal Care: Regular prenatal visits enable doctors to closely monitor both the mother and the foetus. Early detection of any complications can facilitate prompt interventions, significantly enhancing pregnancy outcomes. Additional ultrasounds and assessments help track foetal position and growth.
   

3. Individual health factors: A woman’s health plays a crucial role in her pregnancy outcomes. Some key factors are

   • Existing health problems: Conditions such as obesity, diabetes, or hypertension can complicate pregnancy, impacting success rates.

   • Age: Women under 35 typically have higher fertility rates and better outcomes compared to older women, as fertility declines with age. 

   • Lifestyle choices: Healthy lifestyle choices, such as maintaining a balanced diet, exercising regularly, avoiding smoking and excessive alcohol consumption, and managing stress, can positively impact fertility and pregnancy outcomes. 

A study published in the Journal of Minimally Invasive Gynecology found that women with bicornuate uterus who underwent laparoscopic metroplasty had a significant improvement in reproductive outcomes:

These findings highlight the potential benefits of surgical intervention in improving pregnancy outcomes for women with bicornuate uterus.