The number of women having difficulty getting pregnant or maintaining a pregnancy is increasing exponentially every year. There can be many reasons for this and they are not always easy to identify. Apart from hormonal or psychological problems, the issue of congenital anatomical abnormalities of the uterus is very important. What is their impact on a woman's fertility and do they really prevent her from having children?
Diagnosis of uterine malformations
Anatomical defects of the uterus are often undiagnosed until symptoms develop, the first visit to a gynaecologist or recurrent problems with pregnancy delivery. Symptoms in non-pregnant women are usually limited to menstrual disorders in the form of spotting or perimenstrual soreness. If a uterine defect is accompanied by a vaginal defect, additional symptoms such as pain during intercourse may be present. The diagnosis of a potential uterine defect is very important because of the need to assess the chances of reproductive success and to implement surgical treatment as necessary. Several basic methods are used in the diagnosis of defects. These are:
- basic two-handed gynaecological examination with speculum - already on the basis of this it is possible to assess, for example, the presence of two cervixes in the vaginal vault (double uterus).
- ultrasound examinations, e.g. contrast-enhanced sonohysterography and Medical US 3D - these allow an accurate picture of the uterus in its frontal cross-section and can therefore be used to diagnose, for example, the presence of a bicornuate or septate uterus. They are best performed during the first phase of the menstrual cycle.
- hysterosalpingography - one of the basic diagnostic methods, providing information on the dimensions, volume and shape of the uterine cavity and the patency of the fallopian tubes. However, in the case of uterine malformations, it does not allow a definite diagnosis.
- magnetic resonance imaging (MRI) - a highly sensitive and specific method - most effective for diagnosing congenital uterine malformations. In addition, it is non-invasive, painless and does not expose the patient to harmful radiation, which in practice means that it does not cause any complications.
photo: panthermedia
Treatment of uterine defects
The treatment of congenital uterine malformations must always be determined for each individual patient. The steps to be taken depend on the age of the woman diagnosed with the defect, the severity of any symptoms, her plans for reproduction and, of course, the type of defect itself. In the case of a unicornuate uterus with a vestigial horn, it is always necessary to remove the underdeveloped horn in order to eliminate the cause of the painful periods and to prevent embryo implantation in the horn. The septum, which can restrict fetal growth, is also removed surgically. In the case of other defects, surgical treatment may be waived and performed after any reproductive failures.
Explanations
*Muller's ducts - a.k.a. median ducts - a pair of ducts that develop during fetal development. In women, they develop into the fallopian tubes, uterus and part of the vagina. In men they disappear.
**This is the type of clinical trial with the highest value. The phrase 'randomised' means that the allocation of patients to the clinical trial was completely random and randomised.
***The endometrium.
