The Bicornuate Uterus: What You Should Know

A bicornuate uterus is a rare congenital condition that affects 3% of women worldwide. In this uterine anomaly, the child-bearing organ resembles the shape of a heart. That’s because the uterus is split into two cavities by a tissue called the septum.

Why and when does the shape of your uterus matter?

The answer is pregnancy. Most women with the condition don’t experience any bicornuate uterus symptoms. This is why many don’t even know they have a bicornuate uterus until and unless they undergo an imaging test or ultrasound.

But the shape of your uterus does affect your pregnancy.

Let’s understand more about bicornuate uterus complications.

What is a bicornuate uterus? 

A typical uterus has an upside-down pear shape with a single cavity. The round, wide part of a regular uterus is called the fundus. In a bicornuate uterus, however, the top portion dips in the middle, separated by the septum.

Therefore, one hollow cavity is divided into two hollow cavities. The pregnancy requires your uterus to expand as the baby develops. A typical uterus has enough space for the baby to grow and later move around.

However, a bicornuate uterus pregnancy poses many challenges. Although research suggests that it doesn’t affect your ability to get pregnant, it can cause complications if the uterus doesn’t expand enough during the later months of the pregnancy.

This, in turn, may lead to preterm labour or miscarriage.

Types of bicornuate uterus

Now that you understand the bicornuate uterus a little better, let’s discuss the two types:

• Bicornuate unicollis: The partial fusion of Mullerian ducts can result in separate uterine cavities, a separate cervix, but a solitary vagina. This anomaly is referred to as bicornuate unicollis.
• Bicornuate bicollis: When the partial fusion of Mullerian ducts forms two separate uterine cavities but a single vagina and cervix, it’s called bicornuate bicollis.

Bicornuate uterus symptoms

Most women with a bicornuate uterus don’t experience any noticeable symptoms.

Some, however, may report:

• painful periods
• irregular vaginal bleeding
• pain during intercourse
• repeated miscarriages
• abdominal discomfort

If you experience any of these symptoms, it’s wise to consult a doctor. The subsequent imaging tests and ultrasound can confirm the diagnosis.

Bicornuate uterus Causes

The bicornuate uterus causes are congenital, which means it’s something you are born with. Therefore, you can’t stop or prevent this uterine anomaly. When a baby girl develops inside the mother’s womb, the two ducts merge together to form a typical uterus.

In a bicornuate uterus, they don’t fully merge due to unknown reasons or due to a medication called diethylstilbestrol (DES) taken by the mother during pregnancy. DES is synthetic estrogen prescribed to pregnant women back in the 1940s.

However, its usage was discontinued after 1971.

Bicornuate uterus diagnosis

A gynaecologist may use the following diagnostic tools to detect the condition accurately:

– Hysterosalpingogram (HSG test)

This bicornuate uterus diagnostic test involves injecting a special dye and taking an X-ray image of your uterus. The dye makes the uterus shape more apparent. However, it may still look like a separate uterus, which is a different uterine anomaly.

The other condition is known as uterus didelphys. In that, the two uterus ducts or horns, as well as the cervix, are completely separated. Some women with uterus didelphys may also have two vaginal canals.

Bicornuate uterus and uterus didelphys require different treatment options.

Thus, if the HSG doesn’t fully determine which type of uterine anomaly you may have, the gynaecologist will likely use other diagnostic methods such as ultrasound and MRI.

– Ultrasound

In this method, high-frequency sound waves are utilised to obtain your uterus’s image. A doctor will most likely use the ultrasound technique and an HSG test to detect any kidney problems. Those are consistent in many women with uterine abnormalities.

The doctor may use laparoscopy or three-dimensional (3D) ultrasound for a clearer image. In laparoscopy, a thin, lighted tube with a video camera is inserted into the belly using a small incision. It’s a minimally invasive surgery with a fast recovery period.

– Magnetic Resonance Imaging (MRI)

This diagnostic method uses radio waves and strong magnetic fields to get the most detailed image of your uterus. Doctors may recommend an MRI if you experience abnormal bleeding to rule out endometrial cancer.

However, the risk of endometrial cancer is not associated with uterine anomalies. In fact, endometrial cancer in both ducts is rarely ever reported. Even so, if you experience severe bicornuate uterus symptoms such as excessive bleeding, it’s crucial to get an MRI to rule out cancer.

Bicornuate uterus pregnancy complications

Research indicates that congenital uterine anomalies such as bicornuate uterus don’t reduce your ability to conceive. However, older studies establish the correlation between uterine anomalies and infertility.

What’s known is that a bicornuate uterus increases the risk of preterm delivery and miscarriage because of reduced uterine capacity or irregular uterine contractions. If a woman with a bicornuate uterus successfully carries the baby full-term, a caesarean delivery is most likely – especially if the baby is breech.

However, having a healthy bicornuate uterus pregnancy and a normal delivery is not uncommon. You might want to consider other options if you have a history of miscarriages.

Does Bicornuate Uterus Affect Fertility?

It is generally reported in various types of research that the bicornuate uterus doesn’t really impact the ability of conception. In fact, any type of variation in the womb does not really affect when a female is trying for pregnancy. 

It is reported in some research, however, that women who have not been able to conceive a child are more likely to have uterine abnormalities.

In addition, a bicornuate uterus increases a woman’s chances of having a miscarriage later in pregnancy and of giving birth to an early baby.

The irregular shape of the uterus is believed to contribute to these problems by causing irregular contractions or reducing uterine capacity.

Bicornuate uterus treatment options

A woman with a bicornuate uterus may never require treatment, especially if no debilitating symptoms are present. But if someone has suffered repeated miscarriages, she may be recommended a surgical treatment called Strassman Metroplasty.

The two cavities are unified in this method to form a single uterus. It might improve your reproductive outcome, but the procedure is controversial as it may lead to life-threatening conditions such as uterine rupture during labour.

If you have a bicornuate uterus and are diagnosed with infertility, In vitro fertilization (IVF) is a great treatment option for you.

In this method, the fertilisation of your egg with your partner’s sperm occurs outside the uterus, in a lab. After embryo transfer, however, you may still require caesarian delivery later on.

Conclusion

A bicornuate uterus is a uterine anomaly that is characterised by the presence of two uterine horns (or cavities). The uterus is typically shaped like a heart with two lobes. Since it’s a congenital condition, it cannot be stopped or prevented.

The two major risk factors associated with bicornuate uterus pregnancy are preterm birth and miscarriage.

To get an accurate bicornuate uterus diagnosis and treatment for infertility with state-of-the-art facilities, visit Birla Fertility & IVF or book an appointment with Dr. Prachi Benara.

FAQs:

1. Is a bicornuate uterus high risk?

If you have a bicornuate uterus, your pregnancy will be considered high risk. You will require more prenatal ultrasounds to observe the position and growth of your baby and the shape and size of your uterus.

2. Can you give birth naturally with a bicornuate uterus?

In some cases, women with bicornuate uterus pregnancy can give birth naturally.

3. What to do if you have a bicornuate uterus?

If you’re not planning to become pregnant or don’t experience any symptoms, you won’t require any bicornuate uterus treatment. Otherwise, you may either need surgery (less likely) or IVF.