This web page includes abstract(s) of additional studies... A special thanks to Elizabeth Barrett, a fellow Uni, who did the research for these articles.

Barbara

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HSG X-ray of UU with case study: http://www.uhrad.com/mamarc/mam001.htm

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The following abstracts do not have Web addresses per se, but are accessible by doing a FREE Medline search at: http://igm-01.nlm.nih.gov/index.html

Unicornuate Uterus
Crowther, ME INT J Gynaecol Obstet 1991 Mar;34(3):281-4
"True unicornuate uterus is a rare anomaly which is often associated with renal tract anomalies, and may predispose to infertility and pregnancy complications."

Reproductive performance of women with unicornuate uterus
Fedele L, et al Fertil Steril 1987 Mar;47(3):416-9
19 women: 6 had primary infertility. The other 13 women had a total of 29 pregnancies. 1 ended in a ruptured uterine horn, 17 ended in miscarriage, 3 in premature labor, 8 were carried to term. The "live birth rate" was 38%. Of the 11 births, 6 were breech presentation, and 9 (breech and not breech) were C-section.

Hernia uterus inguinale associated with unicornuate uterus
Elliott, DC, et al Arch Surg 1989 Jul;124(7):872-3
A case of one woman with her uterus, fallopian tube and ovary located in an inguinal hernia.

Kallman syndrome and associated malformation of the uterus
Brandenberger, AW, et al Fertil Steril 1994 Feb;61(2):395-7
One patient with this disorder also had UU, suggesting that UU may be caused by an underlying genetic defect.

Hysteroscopically detected asymptomatic mullerian anomalies Prevalence and reproductive implications
Maneschi F, eta al J Reprod Med 1995 Oct;40(10):684-8
322 women with abnormal uterine bleeding were studied. 0.3% were found to have UU, 10.2% had other uterine anomalies. 24-month pregnancy rates were similar to women without anomalies, but 36-month cumulative live birth rate was significantly lower due to higher rate of miscarriage and lower term delivery rate.

Reproductive impact of congenital Mullerian anomalies
Raga F, et al Hum Reprod 1997 Oct;12(10):2277-81
This was a longitudinal study of 3181 women. 4% had uterine anomalies. The live birth rate for UU women was 37-40%, similar to the rate in women with didelphys uteri, but significantly worse than in women with septate or bincornuate uteri.

Polycystic ovaries in association with mullerian anomalies
Ugur M, et al Eur J Obstet Gynecol Reprod Biol 1995 Sep;62(1):57-9
A study of 167 women with mullerian anomalies, and 3165 women without them. Polycystic ovary syndrome was not more prevalent (than in the control subjects) in women with UU or uterus didelphys, although it was more prevalent in women with septate or bicornuate uteri.

Multiple gestation in a unicornuate uterus. A case report.
Nahra-Lynch M; Toffle RC J Reprod Med 1997 Jul;42(7): 451-4
Uterine anomalies occur in 0.1-3.2% of women studied. Out of those UU occurred in only 1-2% of the cases. A 35 year old woman with UU became pregnant with twins after controlled ovarian hyperstimulation and intrauterine insemination. She had a successful outcome, after a pregnancy complicated by cervical incompetence, premature labor, dysfunctional labor, the need for C-section and postpartum uterine atony. Their conclusion is that "the presence of this mullerian anomaly should not be considered an absolute contraindication to the use of superovulation when treating fertility."

Successful triplet pregnancy in a patient with unicornuate uterus with a cavitary communicating rudimentary horn
Gerris J, et al Hum Reprod 1993 Feb;8(2):338-41
The woman had primary infertility; ovulation was induced by monitored stimulation with HMG because of polycystic ovarian disease. The husband had a varicocele-related moderate oligo-asthenoteratozoospermia; triplet pregnancy occurred in the 3rd cycle, with IUI of the husband's washed semen. She had a C-section due to premature labor at 33 weeks and delivered three healthy babies.

Uterine rupture during a trial of labor in a case with a unicornuate uterus and a previous cesarean section
Sato K et al Gynecol Obstet Invest 1993;36(2):124-6
The title says it all. They conclude that after one c-section with a uterine anomaly, the next deliveries should probably be elective c-sections.

Urupture pregnancy in a heterotopic fallopian tube: evidence for transperitoneal sperm migration
Brown C Am J Obstet Gynecol 1987 Jan;156(1):88-90
You heard it here first!

A comparison of pelvic ultrasound and magnetic resonance imaging as diagnostic studies for mullerian tract abnormalities
Letterie GS, et al Int J Fertil Menopausal Stud 1995 Jan-Feb;40(1):34-8
Ultrasound was not able to identify either of the two UU in this study. MRI was able to identify and provide detailed images of UU. Statistics on other uterine malformation as well.

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The following abstracts are available by doing a FREE Medline search at http://www.healthgate.com/HealthGate/MEDLINE/search.shtml

Urinary tract anomalies associated with unicornuate uterus
Fedele L, et al J Urol 1996 Mar; 155(3):847-8
They studied 37 women with UU. 15 of the women had urinary tract abnormalities: ectopic kidney in 4, renal agenesis in 6, double renal pelvis in 2, horseshoe kidneys in 2 and unilateral medullary sponge kidney in 1.

Laparoscopic resection of a noncommunicating rudimentary uterine horn
Giatras K J Am Assoc Gynecol Laparosc 1997 Aug;4(4):491-3
Two women with UU with rudimentary contralateral horn had infertility, and both had successful pregnancies after laparoscopic resection of the horns.

Rudimentary uterine horn pregnancy: A case report on surviving twins delivered eight days apart
Nahum GG J Reprod Med 1997 Aug; 42(8):525-32 The first twin was delivered by c-section at 28 2/7 weeks due to intractable preterm labor with breech presentation. Arterial surgery was performed at that time to arrest myometrial hemorrhage. Continuing pretern contractions resulted in contralateral rudimentary horn rupture eight days later, allowing a successful vaginal delivery of the second twin. Now I've really heard everything! I think, although referred to as UU, this was a case of one of the other anomalies, with two uteri.

Unicornuate uterus and rudimentary horn
Heinonen PK Fertil Steril 1997 Aug; 68(2):224-30
42 women with UU, with or without rudimentary horn. 21 had the rudimentary horn removed surgically. Right UU with noncommunicating rudimentary horn was the most common subtype. Unilateral renal agenesis was found in 13 of 34 cases. 6 of the 42 women had primary infertility. 34 women produced 93 pregnancies: 20 were ectopic (tubal or rudimentary horn); The pregnant uterine horn ruptured in 3 of 7 cases. 8 of 14 women with infertility underwent IVF-ET; 4 conceived and 2 had term delivery. Fetal survival rate was 61%, prematurity 17%, fetal growth retardation 5%, and spontaneous intrauterine abortion rate was 16%.Surgical removal of the rudimentary horn is indicated. They also conclude that the prognosis of IU pregnancy is not impaired in the UU although prematurity threatens.

Obstetric outcome of in-vitro fertilization and embryo-transfer in women with congenital uterine malformation
Marcus S Am J Obstet Gynecol 1996 Jul; 175(1):85-9
24 women studied: 6 with UU, 9 bicornuate, 5 septate and 4 uterus didelphys. All underwent IVF-ET. 24 women achieved 19 pregnancies in 51 ET cycles. UU and didelphys had the highest rates of term delivery (66.7%), and the lowest rate of 1st trimester miscarriages (0.0%). The multiple pregnancy rate was 40% for women who had 3 embryos transfered, and 0.0% for women that had 1 or 2 embryos transfered. High rate of preterm delivery (46.2%), and c-section (76.9%).

Endometriosis and nonobstructive mullerian anomalies
Fedele L Obstet Gynecol 1992 Apr;79(4):515-7
748 records reviewed of women who underwent laparoscopy for infertility; 198 with anomalies and 545 without anomalies. The frequency of endometriosis was 30.8% in the women with anomalies, and 38.5 in the controls. Among the women with UU, the prevalence of endometriosis was 55%, not significanly greater than the controls, although significantly greater than the women with other uterine anomalies (28%). They conclude that there is not a common pathogenetic factor between the anomalies and endometriosis.

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Below is an article Elizabeth Barrett found on the Web at this address: http://www.asrm.abstracts.org/abstracts/19960347.htm

In Vitro Fertilization and Embryo Transfer (IVF-ET) in Women With Congenital Uterine Malformation

S. F. Marcus, N. K. Marcus, P. R. Brinsden. Bourn Hall Clinic, Cambridge, CB3 7TR, United Kingdom

Objectives: Analysis of IVF-ET outcome according to various types of uterine malformation.

Design: Retrospective analysis of data from 26 patients treated by IVF-ET known to have the following congenital uterine malformations: 2 with absent uterus, 6 with unicornuate uterus, 9 bicornuate uterus, 5 septate uterus and 4 uterus didelphys.

Materials and methods: Study of the outcome of treatment of 26 patients, with a mean age of 33.6 years and mean duration of infertility of 6.4 years. The indications for IVF were tubal infertility (n = 12), endometriosis (n = 3), male factor (n = 2), unexplained (n = 7) and 2 with congenital absence of the uterus. GnRh agonist combined with gonadotrophins was used for ovarian stimulation, all patients underwent transvaginal oocyte retrieval. The number of oocytes recovered per retrieval was 9.3 ± 0.8 (mean ± SEM) and number of embryos transferred per cycle was 2.8 ± 0.15 (mean ± SEM).

Results: The 26 women achieved 20 clinical pregnancies in 52 embryo transfer cycles, including one ongoing twin pregnancy in an IVF surrogacy case. The clinical pregnancy rate per embryo transfer was 20/52 (38.5%) and per patient 18/26 (69.2%) in a mean of 2 transfer cycles. There was no significant difference in the clinical pregnancy rate when the various forms of uterine malformation were compared. There was a trend that the group with unicornuate uterus and uterus didelphys had the highest term delivery (6/9) and lowest abortion rate (0/9) compared with the group with septate uterus and bicornuate uterus, in whom the term delivery rate was (1/10) and the abortion rate (3/10). The multiple pregnancy rate was 40% in women who had 3 embryos transferred compared to 0% in women who had _ 2 embryos transferred. There was a high rate of preterm delivery 6/13 (46.2%) and caesarean section 10/13 (76.9%).

Conclusions: Women with congenital uterine malformation treated with IVF-ET can achieve high pregnancy and live birth rates. Patients should be counselled about the risks involved, in particular the increased rate of preterm delivery and caesarean section.

Source: 1996 ASRM Meeting