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All You Need to Know About Bicornuate Uterus

By Dr. Jesús Alberto Félix Atondo

It is believed that less than 0.5% of females at birth have a bicornuate uterus. As one of the most common uterine anomalies, it often goes undiagnosed. Learning all you need to know about bicornuate uterus could be very helpful if you choose to have a family with this anomaly.


Anatomy of a Uterus

A normal uterus is shaped like an upside-down pear. The fundus is the roundest part of the pear. The uterus is hollow until conception when the embryo grows there, and until birth.

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A bicornuate uterus is heart-shaped. This anomaly is created when the Mullerian ducts don’t fuse completely, splitting the top of the uterus in two and causing a cleft, which results in the heart shape. Currently, there is no explanation for why the ducts do not fuse.


Bicornuate Uterus Explained

A bicornuate uterus is a congenital anomaly caused by the incomplete merger of the Mullerian ducts while in utero, creating a bicornuate uterus. Since this is not inherited through birth, you will not pass it on to your daughters despite its diagnosis in four out of a thousand women.

Generally, there are no symptoms, but some women do endure painful periods. Diagnosis falls in two degrees: partial and complete, based on how large the dip in your uterus is.

A partial bicornuate uterus has a slight depression in the top of the uterus.

A complete bicornuate uterus has the most severe indentation in the top of the uterus.

Bicornuate uterus places you at a higher risk of repeat miscarriages and endometriosis (a disease causing uterine-like tissue to grow on the outside of the uterus, which causes severe pelvic pain). While women with a Bicornuate uterus generally have no problems conceiving and have successful pregnancies, this anomaly places women at a higher risk for preterm birth, miscarriage, and infertility.

Your chances of having twins with a bicornuate uterus are one in five hundred million.

Non-pregnant women and women who have no wish to conceive are at lower risk.


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Bicornuate Uterus Pregnancy Complications

Having a heart-shaped uterus doesn’t affect the implantation of the embryo, but it does place women at a higher risk for complications while pregnant.

Increased risk of complications during pregnancy include:

  • Low birth weight
  • High blood pressure induced by the pregnancy
  • Moderate vaginal bleeding caused by the loss of endometrium from both sides of the horns in the uterus
  • Preeclampsia (high protein levels in the urine and hypertension)
  • Repeat miscarriages
  • Infants presenting in a breech (buttocks first) or transverse (shoulders first or sideway position) position.
  • PPROM – Preterm labor and early rupture of membranes
  • Delivery by cesarean section
  • A baby that is small for its gestational age
  • Placenta Previa, where a low-lying placenta covers all or part of the cervix

Women with a bicornate uterus are 250% more likely to experience these than their peers with a healthy uterus. Unfortunately, you probably won’t know you have a bicornuate uterus until you are pregnant.


Bicornuate Uterus Symptoms

Symptoms are often hard to detect because the anomaly is congenital. Girls and women who have symptoms believe they are normal because they have had them since birth. If you are symptomatic, you may experience the following:

  • Pain during menstruation
  • Vaginal bleeding
  • Pelvic pain
  • Abdominal pain or discomfort
  • Pain during intercourse
  • Recurrent miscarriages


Diagnosing Bicornuate Uterus

It is not uncommon for a woman with a bicornuate uterus to be diagnosed unless they have painful periods, an ultrasound while pregnant, or several miscarriages. Tests run from non-invasive to very invasive. These tests include:

Pelvic Exam – A physical exam to inspect and diagnose disease or abnormalities of the reproductive organs, rectum, and bladder.

Ultrasound – Images of the uterus are created using high-frequency sound waves

MRI (magnetic resonance imaging) – Detailed images of the uterus generated by radio waves and strong magnetic fields

Hysterosalpingogram – Diagnostic images are produced using a contrast dye and x-rays of the uterus and fallopian tubes. It can help diagnose infertility and other uterine anomalies.


Treatment Options for Bicornuate Uterus

Women with no notable symptoms or fertility issues do not require treatment for their bicornuate uterus. Treatment is generally recommended for women who have given birth prematurely or have endured repeated miscarriages.

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Women suffering from painful intercourse and menstruation are treated based on the severity of their symptoms. Some women may need assistance for fertility issues depending on why they cannot conceive.

During pregnancy, high-risk obstetric care is beneficial because of the increased chance of premature delivery and the high rate of recurrent miscarriages.

There is a surgical option for a bicornuate uterus. Generally, it is done on women with a history of miscarriages.

The surgery is a Strassman metroplasty, which repairs the bicornuate uterus by removing the abnormal tissue that separates the top of the uterus and then stitching it into a proper uterine shape. The success rate is approximately 88% for viable births and pregnancy. This procedure is generally done laparoscopically under anesthesia but can also be done abdominally.

Most women leave the hospital the same day and can return to work a few days post-surgery. Post-surgically, some women experience abdominal pain and feel uncomfortable sitting for a few days. Most doctors encourage patients not to try and conceive for 2-3 months post-surgery to ensure the uterus is healed completely. Once you have conceived, you will deliver by cesarean section, attributed to an increased risk of uterine rupture during a vaginal birth.

Speaking to your healthcare provider with any concerns or questions is essential. Once properly diagnosed, your doctor can help you manage your symptoms and decide on the best bicornuate uterus treatment.

If you or someone you know is experiencing infertility and looking for treatment options, The Fertility Center Mexico, located in Tijuana, has fertility experts offering cutting-edge procedures at prices lower than the same procedures done in the US. An initial consultation is required. Contact our bilingual staff today and start your fertility journey with confidence!

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Dr. Jesús Alberto Félix Atondo

Gynecology, Obstetrics and Biology of Human Reproduction Surgeon at the Autonomous University of Guadalajara, specialist Biologist of Human Reproduction by the Mexican Institute of Infertility.

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