Heart-shaped uterus, Bicornate uterus
Bicornuate uterus results from incomplete fusion of two uterine horns (Müllerian tubes) leading to varying degrees of separation between the cavities (Pic. 1.). As a result, the lower part of the uterus is unitary while the upper part is bifurcated. The condition is also called a heart-shaped uterus (Pic. 2). There are many degrees of a bicornuate uterus. There is a continuous range of the degree and location of the fusion of the paramesonephric ducts, and existence of a spectrum, rather than a fixed number of types corresponding to strict medical definitions. This degree of fusion and reabsorption can determine the likeliness of a pregnancy reaching full term.
A bicornuate uterus is estimated to occur in 0.1-0.5% of women in the U.S. It is possible that this figure is an underestimate, since subtle abnormalities often go undetected. Some intersex individuals whose external genitalia are perceived as being male may nonetheless have a variably shaped uterus.
Associated disease
Associated defects may affect the renal system, and less common, the skeleton or so called cloacal disease.
Complications
Risk factors
Uterine malformations are associated with genetic and teratogenic factors. Seen as problematic can be contact with any substance with teratogenic potential during pregnancy. Fetus is the most vulnerable in the period of 2 to 12 weeks.
Previously, a bicornuate uterus was thought to be associated with infertility, but recent studies have not confirmed such an association. Pregnancies in a bicornuate uterus are usually considered high risk and require extra monitoring because of association with poor reproduction potential.
None recognized, except for avoiding contact with teratogenic factors.
None possible.
Pharmacotherapy
Pharmacological treatment is mostly additional to deal with conception issues. Hormonal treatment is used for ovarian stimulation and ovulation induction. It is commonly combined with assisted reproduction techniques.
To prolong pregnancy time, to prevent preterm birth, maintaining uterine quiescence in the latter half of pregnancy is important. Limiting the production of stimulatory prostaglandins and inhibiting the expression of contraction-associated protein genes (ion channels, oxytocin and prostaglandin receptors, and gap junctions) within the myometrium seems to be helpful.
Surgical therapy
Usually, women with bicornuate uterus have relatively good reproductive outcomes. Therefore, the pure type rarely require treatment. In case of hybrid types hysteroscopic metroplasty is needed.
The most often method is IVF-ICSI in combination with surgical solution and pharmacotherapy. Own oocytes or donated ones may be used, depending on woman' age and quality of her eggs. Multiple pregnancies may have a negative impact on the likelihood of a full term pregnancy; therefore, a singleton pregnancy should be ensured by eSET (elective single embryo transfer) in these patients.
If all efforts to prevent pregnancy loss fail repeatedly, surrogate mother is needed to carry a baby.
A type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis.
Congenital uterine malformation where both Müllerian ducts develop but fail to fuse, thus the woman has a "double uterus".
The narrow inferior portion of the uterus that projects into the vagina.
Two very fine tubes that transport sperm toward the egg, and allow passage of the fertilized egg back to the uterus for implantation.
The uterus is the largest and major organ of the female reproductive tract that is the site of fetal growth and is hormonally responsive
Sex organ that is a part of the female genital tract having two primary functions: sexual intercourse and childbirth.
The process in which a human embryo or fetus gestates during pregnancy, from fertilization until birth.
The very early stage of pregnancy at which the embryo adheres to the wall of the uterus.
A pain that occurs between the chest and pelvic regions.
The absence of a menstrual period in a woman of reproductive age.
Longitudinal division of the vagina into two separate organs.
A condition that affects a woman's ability to engage in vaginal penetration.
Irregular menstruation is a menstrual disorder whose manifestations include irregular cycle lengths as well as metrorrhagia
A birth of the baby before 37 completed weeks of gestational age.
A disease distinct from infertility, defined by two or more failed pregnancies.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
The procedure of transfer one single good quality embryo in cleavage stage or in stage of blastocyst that was selected as the most appropriate.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.
The embryo is gestated in a third party's (surrogate) uterus.
