Dear Dr Mitchell,

I am 35 years old and have been trying to get pregnant without success for the past three years. I was recently diagnosed as having a bicornuate uterus. What are my chances of getting pregnant and what is the success of carrying the baby to term? I have read up on this condition on the internet and it’s quite scary! I must add that I’m overweight and my partner has a four-year-old son.

A bicornuate uterus is a birth defect in which the body of the uterus is split into two so instead of one uterine body there now exists two. Usually each uterine body has a fallopian tube and one ovary is attached.

This condition can be associated with recurrent pregnancy losses and sometimes this is how it is detected in the first place. It is usually picked up on doing an ultrasound scan or by doing a hysterosalpingogram (HSG).

There is one cervix so when the dye is injected for the HSG it will outline both uterine bodies. In some instances, this may be linked to a weak cervix (cervical incompetence) which also causes recurrent pregnancy losses in the second trimester of pregnancy. A weak cervix can be managed by inserting a cervical suture at around 14 weeks of pregnancy then subsequently removing the stitch at 38 weeks of pregnancy.

However, having a bicornuate uterus does not usually prevent you from becoming pregnant. The fact that you have tried without success for three years is significant. You will need to have investigations done to determine if you ovulate regularly. This can be confirmed by doing a blood progesterone level 21 days from the start of the menstrual period. Other hormone tests such as prolactin level and thyroid function tests should also be done since abnormalities in these hormone levels can prevent ovulation.

It is also important for you to do a HSG (X-ray of the fallopian tubes and uterine cavity) to determine if the fallopian tubes are blocked. It is important to try to attain your ideal weight and height since this will improve your ovulation pattern and reduce your risk of developing diabetes and hypertension when you become pregnant later on.

Your partner also needs evaluation. It is usually advised that a semenanalysis be done if the youngest child is over two years old. He should get a physical examination and have his doctor write a request form for semenanalysis since the inability to conceive might not have anything to do with your bicornuate uterus and might be entirely a male factor.

The outcome with a bicornuate uterus is usually good but you will probably need a cervical cerclage and be monitored to prevent a pregnancy loss.

Consult your doctor who will advise you further.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.