REPRODUCTIVE IMPACT OF CONGENITAL MULLERIAN ANOMALIES

This retrospective longitudinal study was undertaken in order to deter mine the incidence and reproductive impact of uterine malformations on women desiring to conceive during their reproductive years. A total o f 3181 patients in whom the morphology of the uterus was ascertained b y hysterosalpingography (HSG) and laparoscopy/laparotomy during the ye ars 1980-1995 was included in the study. The population analysed inclu ded fertile, infertile and sterile patients. The overall frequency of uterine malformations was 4.0%. Infertile patients (6.3%) had a signif icantly (P < 0.05) higher incidence of Mullerian anomalies, in compari son with fertile (3.8%) and sterile (2.4%) women. Septate (33.6%) and arcuate (32.8%) uteri were the most common malformations observed. Eac h malformation was individually analysed in fertile and infertile pati ents, in order to ascertain its actual reproductive impact. The perfor mance of the unicornuate and didelphys uteri was similar with a chance of having a living child of 37-40%. The reproductive potential of the bicornuate uterus showed a live birth rate of 62.5% and the septate u terus showed a live birth rate of 62%. In all these abnormalities, ear ly miscarriages (25-38%) and preterm deliveries (25-47%) were quite co mmon. The arcuate uterus presented a live birth rate of 82.7%. It is c oncluded that uterine anomalies are relatively frequent in fertile wom en, and more frequent in infertile patients. Nevertheless, fertile pat ients with normal reproductive performance do exist, and Mullerian def ects can permit an absolutely normal obstetric outcome. The reproducti ve performance of the unicornuate and didelphys uteri was poor, while that of the septate and bicornuate uteri was better than expected. The arcuate uterus had no impact on reproduction.