Uterus and Fertility

Dr Richa Sharma Dr Amit Basnotra
Shape of the womb can be one of the factors in having difficulty in pregnancy or in having difficulty to carry till full term and it can be an absolute or relative factor. Before we discuss further,its important to know as how does a normal womb look like.
The womb (uterus) is generally a pear shaped structure with measurements of about 7.5cm long, 4.5cm wide and 3cm deep and its size is affected by various chnages which happen in the body of a female over a period of lifetime starting from puberty to adolsecence adolesence age group to menopausal phase till post menopausal phase both physiological and pathological.Its not just an organ to carry baby but has many other functions to do
Parts of a normal womb –
Normally a womb has three main parts
* Fundus – It is the upper part and rounded in shape and lies between the fallopian tubes one either end.
* Corpus-It is the middle part also called as body
* Cervix-It is the bottom part of the womb which dips down (Invaginates) into the vagina
How Common It is to see variation in shape of Uterus ?
One woman in 13 for infertility treatment may turn out to have a womb abnormailty and this incidence may rise to 1 in 8 in those with recurrent pregnancy losses.
Various Queries In Mind of Patients-
How will I know if I have an abnormal womb?
You may not know until you have difficulty in getting pregnant or can be an incidental finding in ultrasound scan
Will I be able to have a baby if I have an abnormal womb?
Generally speaking, a uterine abnormality won’t affect your ability to become pregnant. But depending on the abnormality, it may be more difficult for you to carry your baby for the full nine months of pregnancy. So you may need extra monitoring during pregnancy to give you the best chance of having a baby at term.
Some uterine abnormalities are more common in women who’ve suffered recurrent miscarriage.
However, in most cases, it’s possible to have a baby if you have one of these uterine abnormalities:
Retroverted Uterus-
Womb position is generally anteverted but sometimes it may be tilted backwards towards your spine called as Retroverted but that is not an abnormality and has no affect on your chances to have baby and also in your pregnancy phase as such so don’t panic if your hear about any such incidental or coincidental finding from your treating doctor or radiologist.
Arcuate Uterus- It a condition which is one of the type of Mullerian anomalies which may be detected during investigation where your womb has a dip, or a slight indentation at the top. Having an arcuate uterus should not affect your ability to get pregnant or lead to pregnancy complications.
Septate uterus- This is where the inside of the womb is divided by a muscular wall, called the septum. It’s the most common uterine abnormality, with around one woman in 45 being affected. The septum may extend only part way into the womb (partial septate uterus or subseptate uterus) or it may reach as far as the cervix (complete septate uterus). Complete septates are more common than partial septates.
A septate uterus may make it more difficult for you to conceive and carry a baby to term, and you’re more likely to have problems with your pregnancy if you have complete septate.
Bicornuate uterus- Womb looks more like a heart, with a deep indentation at the top so called as womb with two horns or cornu.Seen one in 250 women and often have history of miscarriage.
Uterus didelphys- In this case there are two wombs, each with its own cervix and its rare affecting about one in 350 women and it may lead to pregnancy complications, breech presentation of the baby and premature labour.
Unicornuate uterus- A unicornuate womb is half the size of a normal womb and there is only one fallopian tube. It is a rare abnormality, affecting about one woman in 1,000.
Mullerian Anomalies or what we call as variation in shape of uterus are congenital(by birth) and it may go unnoticed with normal reproductive life or it may present in different ways depending on many factors as discussed. It really depends on the type and extent of the abnormality. How many pregnancies you’ve had can make a difference too.So don’t panic if you fall into one as that’s not going to work. Better to see concerned doctor for timely action in right direction as not all need correction and not beneficial in all types of variations in shape of uterus.
(The author are SeniorIVF Consultant Delhi NCR and Senior Gastroentrologist)