How does a unicornuate uterus affect fertility?

From the Research

A unicornuate uterus can significantly reduce fertility and increase pregnancy complications, but with proper management and care, women with this condition can still achieve successful pregnancies. Specifically, a unicornuate uterus:

• Reduces the space available for a growing fetus
• Increases risk of miscarriage, preterm birth, and ectopic pregnancy
• May cause irregular menstrual cycles or pain Women with a unicornuate uterus who want to conceive should:

1. Consult with a reproductive endocrinologist for personalized care
2. Consider fertility treatments like IVF if needed, as a study found that Han Chinese women with unicornuate uterus have a good chance to conceive and deliver healthy neonates despite increased risk of complications 1
3. Undergo close monitoring during pregnancy, as the risk of twin pregnancies should be minimized in patients with unicornuate uterine anomaly undergoing IVF-ET, due to increased risks of preterm delivery, perinatal mortality, and low birth weight 2

The most recent and highest quality study found that unicornuate uterus constitutes a small portion of all congenital uterine anomalies, and although increased ectopic pregnancy and malpresentation rates with diminished birth weights were found in the unicornuate group, live birth rates and preterm deliveries did not differ significantly between the two groups 3. Therefore, patients with a unicornuate uterus should be counseled on the potential risks and complications, and should be followed closely during pregnancy.

Key considerations for managing a unicornuate uterus include:

• Routine excision of the rudimentary horn should be undertaken during non-pregnant state laparoscopically, if present
• Serial ultrasound assessments of the estimated fetal weight and the cervix length should be performed to screen for the development of intrauterine growth retardation
• Cervical cerclage may be recommended to reduce the risk of preterm birth
• Close monitoring of the pregnancy is crucial to minimize the risks associated with a unicornuate uterus.