Monday, March 10, 2008

Müllerian anomaly myths

This section deals with misinformation. Many women with müllerian anomalies have been horrified by the predictions of doctors who have not had a lot of exposure to women with müllerian anomalies. Some have been told they will only have miscarriages and preemies. A few have even been told to consider adoption or surrogacy, and that trying to conceive would be foolish. If you have experienced this, request a referral to a Reproductive Endocrinologist (RE), who can better assess your prognosis. Please read on.

A. You Cannot Have Children
  1. You will not be able to get pregnant because of your MA — FALSE. In most women, having a müllerian anomaly alone does not affect their fertility. If there are other fertility concerns (e.g. damage to the single connecting fallopian tube in a Unicornuate uterus) an MA is one more factor to consider during fertility treatment.
  2. You will never carry a baby safely — FALSE. Many women find this web site after one or more devastating losses. The thing to remember is that with proper medical supervision, most women can carry their pregnancies to a safe, live birth. After conception, a woman with a müllerian anomaly should consult a high-risk OB/GYN (also called Perinatal Specialists or Maternal-Fetal Specialists) to discuss how their pregnancies will be monitored. A high-risk OB will monitor your cervix for signs of incompetence and preterm labor, your baby for signs of stress and your amniotic fluid for lower levels. These sound scary but can be managed, and if someone is watching you from the start, often prevented. Some of our mothers went overdue. Others have had twins. In fact, a number of mothers on this board have been discharged from their high-risk OBs because they were doing so well.
B.Your mother took DES (or was otherwise responsible) — Not always
  • It is true that some mothers who were given a drug called DES while they were pregnant gave birth to daughters who had distinctive T-shaped uteri. However these young women make up just a fraction of women who are diagnosed with müllerian anomalies. The fact is, the cause of MAs is simply not completely understood.
  • From time to time an ignorant person may assume that a müllerian anomaly is the result of venereal disease or abortion. The answer is always false; MAs are always a birth defect.
C. You can not have a vaginal birthNot always
Studies and anecdotal evidence support the notion that the uteri of women with müllerian anomalies may be prone to stretching differently than a normal uterus while a baby grows. This can result in a breech or transverse fetal lie towards the end of pregnancy. In these cases, a cesarean birth may be scheduled in advance. This is just a tendency, however, and a number of our members have had uncomplicated vaginal births. Many women on this board feel cheated and mourn the loss of the vaginal birth experience. If you feel this way, you aren’t alone.

D. One surgery can remove your septumSadly, this is not always true
While many of our members have had one surgery “do the trick”, quite a few have been shaken to find out a second, and perhaps even a third surgery may be necessary to remove as much septum as possible. In any case, most postoperative HSG's do reveal an arcuate-looking uterus, and a residual septum of less than 1 cm. apparently does not affect pregnancy outcomes. Some researchers even recommend leaving a residual "stump," to guard against rupture. Please read on:
“A surgeon could leave too much septum behind if he only cut the septum at the cervix end of the uterus, but stopped too soon, before he got anywhere near the fundus. If a surgeon does this, only some part of the septum snaps back, but some of it is left intact… This can happen if the surgeon is not experienced, or, if there is poor visibility in the scope due to too much blood or endometrial tissue.”

E. Your "tipped" or "tilted" uterus is causing your infertilityFalse
A tipped uterus refers to the very common condition of the uterine fundus' pointing somewhere besides slightly forward, toward the navel. Instead, it may be pointing straight up, backward, or may be flexed forward more than usual. This is almost never a problem, beyond the potential for causing painful intercourse. In short, the tipped uterus is not a müllerian anomaly, does not cause infertility, and usually "cures" itself by the 10th week of pregnancy.

1 comment:

Julie said...

This is an informative site thank you. I never knew that removal of a longitudinal vaginal septum (which I have considered)carried the risk of incompetent cervix.
Also a myth that is not addressed, I don't know how many times I've been asked if my UD meant that I absorbed a twin! NO!