A woman is usually diagnosed with uterine factor infertility when there are abnormalities of the uterus. This can result in a significant impact on her ability to conceive as well as carry a successful pregnancy. Some women have an abnormally developed uterus from birth (congenital) while others may develop a uterine problem from surgery or a past infection.
There are a many different fertility problems that involve the uterus contributing to infertility and recurrent miscarriage including Uterine fibroids, Congenital abnormalities, Asherman’s syndrome, Adenomyosis, and DES.
In the case of a suspected congenital uterine factor, a hysterosalpingogram (HSG) test, is often used to help diagnose. Another type of test used is a sonohysterogram which is done by injecting a small amount of sterile water or saline and looking at the uterus by a transvaginal ultrasound. It is performed in the office and is not usually very uncomfortable. This particular ultrasound technique will often allow the physician to see separate uterine cavities and may also allow them to see if the uterine abnormality maybe from a septate uterus (SU) or a bicornuate uterus (BU). Either way, it’s important to know the differences between the two and that the professional who is testing for uterine factor is a fertility specialist or a perinatologist/MFM specialist who has experience in this specialty.
In women who are diagnosed with a septate or bicornuate uterus, surgical correction of the uterus (metroplasty) is the recommended treatment. If the surgeon is not absolutely confident of the diagnosis prior to surgery, then it is advised that a laparoscopy should be performed as the first step to confirm. During a septate uterus correction surgery, the septum can usually be removed by hysteroscopy while the patient is still under anesthesia. However, if the external appearance of the uterus is “rabbit-eared” suggesting a bicornuate uterus, surgical correction is performed by laparotomy (open abdominal surgery).
In the first case with a septate uterus, the woman can start trying to become pregnant relatively soon after surgery, and the typically outcome for a successful pregnancy is good. More specifically, the woman is allowed to have a normal labor and vaginal delivery. However, after surgery for a bicornuate uterus, it is generally recommended that patients wait at least three months before trying to conceive, and a cesarean section is recommended for delivery. This recommendation is based on an increased risk of uterine rupture during labor for women who have had surgical correction of a bicornuate uterus. No surgical procedure has been shown to be effective in the treatment of either unicornuate uterus or uterus didelphys.