Uterine anomalies are problems related to the uterus that have been present since birth or have formed later. Some can be considered normal. However, certain types can make pregnancy difficult or, more frequently, lead to miscarriage.
When a problem is detected in the uterus during the evaluation of a couple wanting a child, the infertility issue is generally attributed to it. Uterine anomalies are associated with problems such as infertility, recurrent miscarriages, and preterm birth in pregnancy. However, they most frequently lead to miscarriages.
A uterine anomaly may be suspected via ultrasonography during the evaluation of an infertile couple. In fact, a diagnosis can be clearly made with three-dimensional ultrasonography. On the other hand, the type of uterine anomaly can be understood through imaging tests such as a uterine film.
What Can Uterine Anomalies Be?
Congenital uterine anomalies result from the incomplete fusion or formation of the tissues that make up the uterus due to certain factors while still in the mother’s womb. The most common uterine anomaly is the septate uterus, which can be described as having a septum (curtain) in the uterus. This septum can extend down to the cervix or be shorter and descend to the middle of the uterus. It has been reported to occur in one in every 45 women. Another uterine anomaly is the heart-shaped uterus, called the bicornuate uterus. The uterus, which is normally pear-shaped, is heart-shaped in this anomaly. It is seen in one in every 200 women. In the anomaly called unicornuate uterus, half of the uterus is not developed and there is only one tube, but the ovaries are not affected and there are two of them. This single-horned uterine anomaly is rare, occurring in one in every 1000 women. In the didelphys uterus (double uterus) anomaly, there are two uteri and two cervices, and these women do not have difficulty in getting pregnant. However, it is necessary to be sure whether there is a septate uterus (a septum in the uterus). In women with a double uterus, the risk of preterm birth and miscarriage is higher. Double uterus is seen in one in every 350 women. Other uterine problems are not actually uterine anomalies. For example, the uterus being tilted backward, namely a retroverted uterus, is not an anomaly and does not lead to infertility.
Recently, the diagnosis of T-shaped uterus anomaly has been made frequently. In this uterine problem, the uterus is not pear-shaped, and its side walls are narrow; the uterus appears tunnel-shaped on ultrasonography or uterine film.
Among the uterine anomalies, the types that cause the most problems are the septate uterus (septum in the uterus) and the bicornuate uterus (heart-shaped uterus). These anomalies have been associated with infertility, miscarriage, preterm birth, and growth retardation in the baby.
A definitive diagnosis of uterine anomalies is made using imaging methods such as ultrasonography, uterine film, and occasionally MRI. The treatment of uterine anomalies is surgical. The surgical decision is made according to the woman’s problem and the type of anomaly. If a septum or heart-shaped uterus is detected while investigating infertility or the cause of miscarriage, surgical correction of the uterine anomaly is recommended. Generally, these problems are easily eliminated with a procedure called hysteroscopy, which is an endoscopic entry into the uterus and does not require stitches. When a T-shaped uterus is detected among other anomalies, its correction via hysteroscopy is also recommended. However, surgical treatment is not performed for a one-sided uterus (unicornuate uterus) or a double uterus.
Pregnancy can be achieved 2-3 months after the uterine anomaly is corrected with hysteroscopy, and pregnancies usually continue without problems. However, although rare, ruptures in the uterus can occur during pregnancy or during the follow-up of normal birth; therefore, careful monitoring of the pregnancy is recommended.
Some problems in the uterus are not congenital and may appear later. For example, intrauterine polyps, myomas, or adhesions are uterine anomalies that occur later. These problems can lead to issues such as painful menstruation, irregular periods or excessive menstrual bleeding, intermenstrual bleeding, decreased menstruation, or continuous bleeding. The diagnosis of these problems can be made by ultrasonography, uterine film, and by performing ultrasonography while fluid is being administered into the uterus, called saline infusion sonography. When these anomalies are detected during the evaluation of a couple coming due to infertility, they should first be treated with hysteroscopy, and then infertility treatment should be started.
Hysteroscopy is very useful in the evaluation and treatment of problems related to the uterus. It can be performed with local anesthesia or general anesthesia depending on the patient’s condition. Depending on the type of anomaly, it takes about 10-30 minutes. The patient can go home 2-4 hours after the procedure; hospitalization is not required. Sometimes, if the intrauterine problem is very serious, a balloon, catheter, or gel can be placed inside the uterus during hysteroscopy, and then some hormonal drugs may be recommended. Although its effectiveness is debated, such applications are performed according to the patient’s condition. The intrauterine balloon or catheter is removed after 2-7 days.
In conclusion, uterine anomalies are associated with infertility or miscarriages. Although uterine anomalies can lead to serious problems, the anomaly can be corrected easily and in a short time with the endoscopy performed into the uterus, which we call hysteroscopy; subsequently, the probability of pregnancy increases and pregnancies proceed normally.
