Unicornuate Uterus: Fertility Challenges and Options

Uterine anomalies

Hello Dr.
Jan, I have been married for over six months and have not become pregnant, so I went for a check-up at the obstetrics and gynecology department.
During the cervical examination, it was found that I have a uterus with only one fallopian tube.
The doctor mentioned a term that sounded like "unicornuate uterus." The doctor said that having only one fallopian tube would lower my chances of conception.
I would like to ask Dr.
Jan if I should undergo a hysterosalpingography to check the fallopian tube.
If it is confirmed that I only have one fallopian tube, does that mean my chances of natural conception are very low? My husband's semen analysis is normal; should we consider assisted reproductive techniques? Even if conception is successful, is there a higher risk of miscarriage? I look forward to your answers to these questions.
Thank you.

Ling, 30~39 year old female. Ask Date: 2004/03/03

Dr. Zhan Deqin reply Obstetrics and Gynecology

1.
A hysterosalpingography can be performed first, but a hysteroscopy is also an option.
2.
It is possible to conceive with only one functioning fallopian tube, and artificial insemination is not necessarily required if the tube is normal.
3.
The success rate of artificial insemination is approximately 35%, and the miscarriage rate may be slightly higher than that of natural conception.

Reply Date: 2004/03/03

More Info

Understanding a unicornuate uterus, which is a type of congenital uterine anomaly, is crucial for couples facing fertility challenges. A unicornuate uterus is characterized by the presence of a single horn or cavity, which can lead to various reproductive issues, including reduced fertility and an increased risk of complications during pregnancy.

Firstly, regarding your question about whether to undergo a hysterosalpingogram (HSG) or a laparoscopy to assess the condition of your remaining fallopian tube, it is indeed a reasonable step. An HSG can provide valuable information about the patency of the fallopian tube and the shape of the uterine cavity. If the remaining tube is open and functioning properly, there is still a possibility of natural conception, albeit with a potentially lower success rate compared to women with a normal uterus.

It’s important to note that while having a unicornuate uterus can complicate pregnancy, many women with this condition do conceive naturally. However, the chances of successful pregnancy can be influenced by several factors, including the health of the remaining fallopian tube, the presence of any other reproductive health issues, and the overall fertility of both partners. Since your husband’s semen analysis is normal, this is a positive factor in your fertility journey.

If it is confirmed that you have only one functioning fallopian tube, your chances of natural conception may be lower, but not impossible. The key is to monitor your ovulation closely and time intercourse appropriately. If you find that natural conception is not occurring after a reasonable period of trying (typically one year for women under 35), you may want to consider assisted reproductive technologies (ART), such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

Regarding the risk of miscarriage, studies indicate that women with a unicornuate uterus may have a higher risk of miscarriage and other complications, such as ectopic pregnancies or preterm labor. However, many women with this condition have successful pregnancies. Close monitoring by a healthcare provider throughout the pregnancy can help manage risks effectively.

In summary, while a unicornuate uterus presents unique challenges, it does not eliminate the possibility of pregnancy. It is advisable to consult with a reproductive endocrinologist or a fertility specialist who can provide personalized guidance based on your specific situation. They can help determine the best course of action, whether that involves further diagnostic testing, lifestyle modifications, or exploring ART options. Remember, each case is unique, and advancements in reproductive medicine continue to improve outcomes for women with various uterine anomalies.

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