Fertility in women with uterine malformations

Abstract

Aims: The aim of this chapter is to critically review the potential impact of congenital uterine anomalies (CUA) on the fertility potential of the woman. Evidence is based on: (1) the analysis of their prevalence in the general and infertile population, (2) the achievement of pregnancy in patients having CUA and, (3) treatment results. Brief description of the reviewed data: The presence of CUA might be associated with a detrimental effect on patient’s fertility; the probability of conception, assisted or spontaneous, is decreased by ˜15 % (Recommendation Class IIb). It is not still clear what is the impact of the different types of CUA on woman’s fecundity.Based mainly on indirect evidence, it could be supported that the more severe the malformation of the uterine cavity is, the more the possibility to play a role for the achievement and evolution of pregnancy; septate uterus and more severe forms of uterine anomalies could adversely affect the reproductive potential of the woman whereas this does not seem to be the case for arcuate uterus.Clinical implications: In view of this evidence, infertile patients should be investigated for the presence of CUA with high accuracy non-invasive diagnostic methods. This, also, support the notion that surgical treatment is indicated in infertile patients. Open issues for further research: There is a need of prospective well-designed studies to improve the level of the existing evidence and to draw definite conclusions. The accumulation of further relevant epidemiological data might elucidate the exact role of each type of uterine anomaly on reproductive potential of the woman, and enhance our understanding of the pathophysiology. The new ESHRE/ESGE classification system should be the working basis for the design of those studies offering the crucial additional advantages of accurate diagnostic criteria and precise categorization of the anomaly type.