Congenital Uterine Anomalies: How a Septate or Bicornuate Uterus Can Affect Pregnancy

Congenital Uterine Anomalies: How a Septate or Bicornuate Uterus Can Affect Pregnancy

For many women struggling with infertility or recurrent pregnancy loss, the shape of the uterus may be an unexpected but critical factor. Congenital uterine anomalies—structural differences present from birth—can impact the ability to conceive, carry a pregnancy to term, or deliver without complications. Two of the most common anomalies are the septate uterus and the bicornuate uterus.

What Are Congenital Uterine Anomalies?

Congenital uterine anomalies occur during fetal development when the uterus fails to form correctly. Instead of developing into a single, unified cavity, the uterus may form with a wall (septum) dividing it, or with a heart-shaped appearance due to partial duplication.

These anomalies often go undiagnosed until a woman experiences fertility issues, miscarriages, or preterm labor.

Septate Uterus

A septate uterus is the most common congenital uterine anomaly. It occurs when a band of fibrous tissue divides the uterine cavity. This tissue has poor blood supply, which can prevent proper embryo implantation or increase the risk of miscarriage.

Common issues associated with a septate uterus:

• Infertility
• Recurrent miscarriage
• Early preterm birth
• Malpresentation (e.g., breech position)

The good news is that a septate uterus can usually be treated with a minimally invasive procedure called hysteroscopic metroplasty, which removes the septum and improves pregnancy outcomes.

Bicornuate Uterus

A bicornuate uterus has two distinct horns or cavities, giving it a heart-shaped appearance. This condition results from incomplete fusion of the two ducts that form the uterus.

Potential complications include:

• Increased risk of miscarriage
• Preterm delivery
• Abnormal fetal positioning
• Need for cesarean delivery

Unlike a septate uterus, surgical correction of a bicornuate uterus is less common and often depends on the severity of the anomaly and the woman’s pregnancy history.

Diagnosis

Uterine anomalies can be detected through imaging studies, such as:

• 3D transvaginal ultrasound
• Sonohysterogram (saline infusion ultrasound)
• MRI
• Hysteroscopy or laparoscopy (in some cases)

A correct diagnosis is essential to determine whether surgical intervention is necessary and what steps can be taken to support a successful pregnancy.

Treatment Options and Fertility Planning

Treatment depends on the specific anomaly and how it's affecting fertility or pregnancy outcomes. Women with a septate uterus often see improved fertility after surgery. Those with a bicornuate uterus may require closer monitoring during pregnancy and delivery, but many go on to have healthy babies without surgical intervention.

Partner With Experts in Reproductive Medicine

If you’ve experienced unexplained infertility or multiple pregnancy losses, a uterine anomaly may be a contributing factor. At University Reproductive Associates, we provide thorough diagnostic evaluations and customized treatment plans to help you build your family with confidence.

Contact URA today to schedule a consultation and explore how we can help you navigate fertility challenges related to uterine anomalies.