Mullerian Anomalies

Welcome: An Introduction to Mullerian Anomalies

2010-11-10T21:57:00.000-08:00

This is a blog dedicated to informing people about Mullerian Anomalies - what they are, how they are diagnosed, treatments, and the personal stories of the women who have them. The information you read here has been compiled by a group of courageous women who have a wide variety of Mullerian Anomalies. They are not doctors, but are experienced and pro-active patients of a medical system that rarely seems to have a grasp of this very special condition.

If you have recently been diagnosed with a Mullerian Anomaly, please consider joining the MA Support Group on Yahoo forums. The women who write the boards there are the same women who have contributed here. Their knowledge and expertise can be a great help to you as you navigate through your diagnosis and treatment.

Good Luck on your journey!

Advice for after a loss

2008-08-30T18:09:00.000-07:00

If I can give you any advice right now, it would be to take time for yourself and let yourself grieve and lean on others.

Seek counseling if you think you need it.

Everyone grieves differently and at a different pace, so be gentle with yourself and have patience. It will hurt intensely all the time for awhile, and then you'll get some times of peace in between times of sadness. Gather all the memories you can now, while they're fresh--save everything.

You'll always miss your baby, but it does get better, and your memories will become more comforting.

By K, who lost her first baby at 18 weeks.

Your questions about MA answered here!

2008-06-28T06:31:00.000-07:00

Have a specific question about Müllerian Anomalies? Chances are your question may have already been answered by the the Müllerian Anomalies Yahoo Group volunteer consulting physician. Below are a list of questions you can read the answer to by clicking HERE:

1. Miscarriage causes
2. Incompetent cervix, Labor induction
3. Predicting incompetent cervix in the MA patient
4. UU and placing a cerclage
5. Bicollis: septate cervix versus true duplication
6. When in the cycle to have a laparoscopy/hysteroscopy
7. MA complications and the type of physician to see
8. Post-resection pregnancy monitoring in the septate uterus
9. Leaving lower septum segment intact; Resection techniques
10. Distinguishing between SU and BU using Doppler ultrasound
11. Diagnosing and resecting a vascular septum
12. Monitoring septum resection
13. UU and L-shaped cervix: cerclage?
14. Small cervix—is it a MA?
15. Treating endometriosis
16. When to measure cervical length in pregnancy?
17. Length of septum: absolute vs. relative measurement
18. Monitoring for incompetent cervix
19. Can HSG fail to show a septum?
20. Transabdominal versus transcervical resection
21. “Regrowth” of septum, effect of pregnancy on septum
22. C-section techniques for MA, Resection during birth?
23. Infertility questions
24. Late ovulation
25. Polycystic ovarian syndrome (PCOS)
26. Incompetent cervix guidelines
27. Ectopic pregnancy
28. Use of Clomid
29. Balloon catheters and progesterone following resection of SU

What does müllerian mean and what causes these anomalies?

2008-04-08T19:46:00.000-07:00

What does müllerian mean?
The uterus, fallopian tubes and upper vagina are made up of two partially fused tubes, which, in the embryo, are known as müllerian ducts, named for physiologist Johannes Peter Müller, who first described them in 1830. They are also known as the paramesonephric ducts, and are at first present in embryos of both sexes.

Normally, these ducts run down vertically from flank to pelvic floor in the young embryo and eventually fuse into a double-barreled tube with two loose ends, known as the uterovaginal primordium, or UVP. The double UVP will eventually merge into a single-barreled uterus, cervix and upper vagina, while the loose ends develop into the fallopian tubes. In adulthood, these organs are referred to as the müllerian tract and congenital malformations of this tract are called müllerian anomalies, or MAs.

In the male embryo, in the presence of anti-müllerian hormone (AMH), the müllerian structures disintegrate during early development. They persist in the female because she does not produce AMH.

In the embryo, the müllerian ducts act as scaffolding for the mesonephric ducts, which give rise to the kidneys. Because of this parallel structural relationship, it is common for a kidney or other urinary anomaly to be present with a müllerian anomaly.

What causes müllerian anomalies?
To date, there is no singular cause for müllerian anomalies. Some may be hereditary , others result from an insult to the fetus while in the womb (the T-shaped uterus of fetuses exposed to DES, for example), and still others may be attributed to random mutation. It is important to remember that in our grandmothers and mothers’ generations, many women with this problem were not diagnosed; while up to 4% of women may have a müllerian anomaly, it may be far more common than physicians realize. Only as diagnostic technology improves and women become more aware of their reproductive health will science get a better understanding as to how common these differences really are. In future years, our honest communication with our children will help build a larger base for understanding the causes of this uniqueness.

What are the different types of müllerian anomalies?

2008-04-05T19:49:00.000-07:00

a. Agenesis & hypoplasia: Mayer-Rokitansky-Kuster-Hauser syndrome is most common. All or part of the müllerian tract fails to form, or is extremely underdeveloped. For example, a cervix may be a tissue-thin membrane rather than a tough, fibrous "donut" several centimeters thick. Most women suffering from agenesis or extreme hypoplasia have severe fertility problems, simply by lacking sufficient tissue to support a growing pregnancy. A common diagnosis used to be "infantile uterus," but it simply means a smaller-than-average uterus and does not refer to the MA described above. The old "infantile uterus" is typically capable of supporting a pregnancy very well, since a uterus easily grows during pregnancy. The "infantile" term has fallen by the wayside in recent years.

b. Unicornuate uterus (UU): When one müllerian duct is underdeveloped or fails to develop, a banana-shaped half-uterus is formed. It may or may not be accompanied by a rudimentary horn, and that other horn may or may not have an endometrial cavity or communicate with the main uterine cavity. A missing kidney or other kidney problems accompany this asymmetric anomaly more than they do other MAs. Frequently, the ovary on the rudimentary side is found in an odd place, further up by the ribs. Adverse pregnancy outcomes are common with UU. SEE FIGURE BELOW.

Unicornuate uterus

c. Uterus didelphys (UD): The müllerian tract fails to fuse along all or most of its length. There may be complete duplication of the vagina, cervix and uterus, and the two halves may be divided by a ligament of connective tissue. UD is reported to have the best pregnancy outcomes of all the MAs. SEE IMAGE BELOW.

Uterus didelphys

d. Bicornuate uterus (BU): The uterine fundus fails to fuse and a myometrial division extends down to the cervix in a complete bicornuate uterus, or part way to the cervix in a partial bicornuate uterus. The division is visible on the outside of the uterus, evidenced by a groove or cleft in the uterine dome exceeding 1.5 centimeters. Cervix and vagina are usually single but may be septate or duplicate. BU has relatively few pregnancy complications when compared to SU or UU, with breech presentation being one of the most common. SEE IMAGE BELOW.

Bicornuate uterus

e. Septate uterus (SU): The müllerian tract has fused properly and the uterus looks single from the outside, but the inner duct wall (i.e. the median septum) has failed to dissolve around 20 weeks of gestation, and the uterus retains a double cavity. There may or may not be a shallow groove of 1.5 centimeters or less on the outer uterine dome, and sometimes even a whitish triangle of tissue, the septum itself, is visible. The somewhat fibrous inner septum extends to the internal cervical opening or beyond in a complete septate uterus, and extends only part of the way down in a partial septate or subseptate uterus. The inadequate blood supply and progesterone receptors of the median septum may cause problems in pregnancy, giving the SU the worst pregnancy outcomes of all the MAs. SEE IMAGE BELOW.

Septate uterus

f. Arcuate uterus (AU): The fundus of the uterus may be indented slightly both inside and outside. This shape has been variously defined as slightly bicornuate and slightly septate (and may be either one), and is so slight that it is considered a variation of normal. However, a few studies suggest that increased incidence of adverse pregnancy outcomes are associated with an arcuate uterus.

g. DES-related uterus: A T-shaped uterine cavity, dilated horns and malformed cervix and upper vagina may characterize this anomaly. Unlike the other anomalies, a T-shaped uterus is sometimes caused by maternal ingestion of DES, although sometimes the cause is unknown. When caused by DES, there are often other problems, such as incompetent cervix, infertility and abnormal tissue in the cervix and vagina. DES use is associated with high rates of female cancers, including cancer of the vagina.

Diagnostic Methods

2008-04-01T00:59:00.000-07:00

First of all, in an infertility work-up, a hysterosalpingogram (HSG) should be done to either rule out or assess the presence of a two-chambered uterus, the depth of the division, as well as tubal patency. But an HSG alone cannot differentiate between septate and bicornuate uterus. Misdiagnoses of BU by HSG are very common.
Other methods have better levels of reliability:

Transvaginal ultrasound is nearly 100% successful in detecting a bifid uterus, but only 80% successful in differentiating between SU and BU. It can be a helpful tool in the diagnostic process, but should not be relied upon alone.
Three-dimensional ultrasound (3DUS), is 92% accurate in differentiation of BU from SU, according to one 1997 study, but not widely available at the time of this writing. It should not be relied upon alone, with an 8% margin of error.
MRI - According to two studies done in 1994 and 1995, MRI can reliably differentiate between BU from SU, with an accuracy of 100% in comparison with laparoscopy/hysteroscopy. More recent studies cast some doubt on this. Proceed with caution after an MRI.
Concurrent laparoscopy and hysteroscopy are considered the "gold standard” of BU/SU differentiation. This test is invasive, but if needed, corrective hysteroscopic metroplasty can be done at the same time.

Surgeries associated with MA's (preconception and in pregnancy)

2008-03-29T20:08:00.000-07:00

Hysteroscopic metroplasty, abdominal metroplasty, hemihysterectomy, vaginoplasty
The quick, reflexive party line here is that if you have a septate uterus, yes, you should have it fixed. Studies tend to show a poor pregnancy outcome in the uncorrected SU, but a near-normal pregnancy outcome in the surgically corrected SU. Of course there are exceptions, and we should not forget that most women with a septate uterus are never diagnosed, and may indeed have no trouble with reproduction.

In deciding whether or not to have it repaired, take into account your own pregnancy history, your complications, your age, and, possibly, your investment. Are you spending thousands per cycle on IVF treatments? Then you may want to get the septum out of the way. If you have no trouble getting pregnant and have had only one miscarriage, some doctors recommend a more conservative approach, treating with surgery only if another miscarriage happens. Resecting a septum, although not without risks, is a relatively minor surgery compared to the open, abdominal metroplasty once performed.

If you have a septate uterus and suffer from painful menstrual periods, there is a good chance that having your septum resected will cure the painful periods.

Bicornuate, arcuate and didelphic uteri are generally thought to do well in pregnancy, but some studies show correlation to miscarriage and other problems. Again, take your history into account, first and foremost, and weigh the benefits versus the risks. Surgical correction of a bicornuate uterus involves an open (laparotomy) procedure in which the surgeon cuts through the uterine wall of each horn and then sews them together. Unlike most septum surgeries, abdominal metroplasty is a major procedure and carries greater risks of bleeding, infection, adhesions, infertility and rupture during pregnancy. Recuperation takes at least twice as long, and greater pain control is required.

Sometimes a well developed unicornuate uterus has a rudimentary bud (anlage) that is capable of supporting a pregnancy for time, but then ruptures, because of its tiny size. This tiny half-uterus may need to be removed in what is known as a “hemihysterectomy.” The surgery eliminates the possibily of an ectopic pregnancy in the rudimenary horn, lessens pain during menses and reduces the possiility of endometroisis caused by retrograde menstruation. The surgery is not common, but a few members have had it done.

Women with UD or with a completely septate uterus may also have a vaginal septum, sometimes expending to the perineum, creating two vaginal openings. This may make intercourse difficult or painful, or using tampons impractical, and surgery to lyse the vaginal septum is fairly simple. There is some controversy about severing the septum within a septate cervix, since there is a possibility of creating an incompetent cervix. Some surgeons prefer to spare the cervical segment of a septum.

How long to wait to TTC following surgery?
The standard advice is to wait either two cycles or 8–10 weeks following hysteroscopic metroplasty surgery, to allow time for the inflammatory response at the wound site to go away. Local inflammation is a normal response to an injury, but may increase miscarriage or hinder conception—opinions and studies vary. Sometimes, the hormones prescribed before or after surgery can interfere with conception as well.

Sometimes a surgeon will shorten the recuperation time to one cycle, depending in part on the scale of the surgery. Some list members have become pregnant even without an intervening menstrual period and the pregnancies have gone well.

Recuperation time for an abdominal metroplasty will be longer; 3–6 months' waiting is a common recommendation, because of the full-thickness wound in the uterine wall.

It is prudent to have a follow-up HSG to confirm the results of surgery before trying to conceive. An HSG can be done after the first menstruation, ideally before the next ovulation, while the lining is thin and compact. It will show not only the changed configuration of the uterine cavity, but may reveal perforations.

What is surgery like?
Hysteroscopic metroplasty (uterine septum resection via the vagina) ; a.k.a. septoplasty, septotomy
During this procedure, a uterine (and also a vaginal septum, if applicable) can be incised to open the uterus up for a better pregnancy result. This surgery is usually done at the same time as a laparoscopy (see below) and is often referred to on the board as a “lap/hyst.” It can be done with scissors, an electrocautery tool or a laser tool, depending on what the surgeon is most experienced with.

"Resection" is not an accurate term for what happens, since no tissue is removed from the uterus; instead, the surgeon parts the septum, like cutting a swatch of material in half. On parting, the septum retracts close to the normal uterine wall on each side, where it is covered with endometrium within days or weeks.

It is a day surgery in most cases. Recovery is different from woman to woman, but most agree that 3–5 days are required. It is important to know that some women require more than one surgery to adequately resect a septum.

Laparoscopy
You prepare for laparoscopy by fasting and discontinuing meds as ordered (aspirin or metformin, for example). You may or may not be ordered to do a bowel prep (laxative, enema, clear liquids), and wash your abdomen with special soap such as Phisoderm for a period of time preceding the surgery, as well as trim back or shave the pubic hair.

When you are under anesthesia (usually general), you’ll be put in the lithotomy position (a lot like a Pap smear), draped and prepped. The surgeon will make two to four puncture wounds in your abdominal wall—one inside the navel (for the laparoscope) and one to three in the bikini line fold just above the pubic hair, for other implements. Sometimes a minilaparotomy incision, about an inch wide, is made on the bikini line at the midline, though this is not usually the case. The surgeon will then inflate your abdominal cavity with carbon dioxide to improve visibility, and have a look with the lighted scope at your pelvic organs.

The main purpose of a laparoscopy is to monitor the outside of the uterus for imminent or actual perforations as the surgery goes on inside the uterus, but other fertility-related surgery may be done as needed: lysing adhesions, removing fibroids or endometriosis, or ovarian laser drilling.

After the surgery, you can expect to feel sleepy, forgetful and possibly nauseated from the anesthesia and the pain medication, and that may last over 24 hours. You may feel pain in your abdomen, under the ribcage and even referred to your shoulders from remaining carbon dioxide within your abdomen. Expect to have a sore abdomen for the next week or so. Many women compare the feeling to that of having done too many sit-ups.

Hysteroscopy (HSC)
A hysteroscopy involves distending the uterus with a fluid or gas, inserting a scope and then doing one of two things: either operating (e.g. removing a polyp or fibroid, resecting a septum) or just documenting any abnormality and then withdrawing the instrument. You prepare for laparoscopy by fasting and discontinuing meds as ordered (aspirin or metformin, for example). You may or may not be ordered to do a bowel prep (laxative, enema, clear liquids), and you may be on progestins, danazol or GnRH analogs in order to thin the uterine lining prior to surgery. Surgeons' preferences vary widely. It seems to be most useful in improving visibility with a wide septum or a complete septum (one that extends to the cervical os or beyond).

While it is a minor surgery, any instrumentation of the uterus creates the risk of injury or infection, and HSC carries with it about a 1% risk of perforating the uterine wall. Most perforations are minor in nature, but if the wound is large or bloody, or injures other abdominal structures, such as the intestines, complications can be serious. Perforation also increases the likelihood of rupture during pregnancy or childbirth. HSC also creates a risk of fluid overload and serious electrolyte imbalance as the distending medium enters the bloodstream, although fluid status is continually monitored during surgery. There is also the risk that the surgery will not accomplish its purpose and may need to be repeated.

The advantage of HSC, of course, is avoiding abdominal metroplasty, a major surgery with all the attendant risks.

Hysteroscopy itself does not seem to cause pain during recuperation, although the accompanying laparoscopy tends to give a sore abdomen. Expect to bleed for a day or two, then to see the flow lighten to a watery pink. After a few days, the flow should change to a watery, slightly yellowish serous fluid, and disappear at roughly two weeks post surgery. Foul-smelling discharge or a fever warrants an immediate call to the surgeon because of possible infection.

Some surgeons like to leave an inflated Foley catheter in place to hold the sides of the uterus apart, or to leave some other adhesion barrier in there. Barriers tend to increase bleeding and cramping beyond a few days, and some surgeons believe that barriers increase the risk for intrauterine adhesions and ascending infections.

An experienced surgeon may choose to waive the laparoscopy during HSC, but this is the exception, not the rule.

As often as not, an operative HSC is followed up with a course of conjugated estrogens to help promote regrowth and proper healing of the endometrium, especially if the patient has taken premedication to thin the uterine lining. Studies increasingly show postoperative estrogen to make little difference in re-epithelialization of the cut septum.

Antibiotics during or after surgery are also commonly given, although risk of endometritis is low.

An exploratory (rather than operative) hysteroscopy is an office procedure, frequently done while the patient is awake. Since the uterus needs to be expanded with saline, glycine or carbon dioxide, this can be quite painful, similar to having a hysterosalpingogram (HSG).

Cerclage
Cerclage is a stitch placed around the opening of the uterus, usually the cervix, to hold the uterus closed as pregnancy advances, and is done in cases where there has been a loss due to painless prolapse of the membranes in the second trimester of pregnancy. The McDonald stitch is the most common form of cerclage done. It is a suture done with mersilene or proline suture material, under local anesthesia (usually a low, short-acting spinal block). It takes only a few minutes to place, and recovery and monitoring following the procedure take only a few hours. Bedrest for 48 hours after the procedure is recommended

The patient is placed in the lithotomy position following the spinal or epidural anesthesia, and the area is draped and swabbed with antiseptic. A kind of caliper called a tenaculum is used to pull the cervix closer to the mouth of the vagina and manipulate the cervix as the surgeon makes the sutures. The patient may feel a painless tugging sensation as this is done. Sedation is optional; some surgeons feel that tranquilizers or general anesthesia pose an unnecessary risk to the developing fetus.

The patient is monitored closely for signs of bleeding, contractions and ruptured membranes and then usually discharged the same day, after she is able to void her bladder into the toilet. Sometimes an overnight stay is needed. The surgeon may or may not prescribe bed rest beyond 2–3 days, depending on individual circumstances. "Pelvic rest," or refraining from intercourse and orgasm, is also frequently advised, because of the infection risk and tendency for a cerclaged uterus to be irritable. At minimum, pelvic rest is advised for one wekk prior to and one week following surgery.

Cerclages work well (up to 90% success rate), but some do fail. In that case, a second stitch can be placed, and the patient is put on strict bed rest, which involves taking meals lying down and using a bedpan. One alternative to cerclage is strict bed rest by itself, beginning in the early second trimester; some studies show it to be just as effective as cerclage. The advantage of cerclage is, of course, avoiding the health risks of lying in bed for several months.

One contraindication for having a cerclage is active labor, since this may cause the stitch to tear through the cervix. Consequently, most cerclages are removed around 37 weeks, to allow effacement and dilation to occur naturally. Some women with very weak cervices experience labor and birth almost immediately after cerclage removal, but not always. Sometimes the cervix develops scar tissue from the cerclage and does not thin out or open up easily (cervical dystocia), which may necessitate a c-section.

Opinions vary as to when it is appropriate to place a cerclage. Current trends point to earlier placement—at 10 weeks or as soon as the embryo looks viable on ultrasound. Prior conventional wisdom indicated placement at 12–14 weeks, after it becomes 97% certain that the pregnancy will continue. However, ultrasound technology can predict a positive outcome with 95% certainty at 10 weeks, LMP.

A cerclage done to salvage a threatened pregnancy, after the membranes have begun to prolapse, is called an emergent or rescue cerclage. A rescue cerclage requires bed rest, and the prognosis is not as good as that of a cerclage done well before cervical shortening begins.

For patients with underdeveloped cervices or repeated cerclage failures, an abdominal cerclage promises some success. Prior to conception, the suture is placed around the lower segment of the uterus, deep to the uterine arteries, and is done through a laparotomy. Delivery must be by c-section, and the cerclage can be left in place for the next pregnancy.

C-section
If your c-section is planned, you will be asked to take nothing by mouth for several hours prior to surgery. At the hospital, you will be hooked up to a fetal monitor for a time and an IV of normal saline or Ringer's lactate will be started in your non-dominant hand. You may be shaved, prepped (enemas are passé!) and catheterized prior to the spinal anesthesia. The nurses will put tight anti-embolic stockings on your legs to reduce the risk of blood clotting while you are immobile.

Regional anesthesia is increasingly the method of choice for controlling pain. Shortly before surgery, the nurse anesthetist or anesthesiologist will start a spinal anesthetic of a fairly short-acting substance, such as lidocaine. You will be asked to lean forward and "shove" your back towards the anesthetist, to make room for the needle to enter the spinal space. You will feel a small prick right about at kidney-level, slightly off-center. When the anesthetic is introduced, you will lose a sense of having a lower body from the nipple line on down, and a warm, not unpleasant feeling may overtake you. Assistants help you lie back on the operating table and one or both arms are strapped at 90° angles to your body. Someone will apply a pulse oximeter, EKG leads and an oxygen mask or nasal cannula. You may begin to feel tingling or numbness in your thumbs and a difficulty swallowing, and while disconcerting, this is seldom a problem. A medication may be introduced into your IV to help with any feelings of anxiety.

Meanwhile, nurses expose your abdomen, scrub it with antiseptics and drape it with sterile drapes. Your surgeon will probably make a 10-cm. horizontal incision just superior to the pubic bone, above the hair line—a pfannensteil incision. Working very quickly, the surgeon will part and retract the underlying tissues, exposing the uterus. The uterus is opened with (usually) a horizontal incision, and the amniotic sac incised. Amniotic fluid is allowed to drain away. In many cases, the patient may not even have realized that surgery has begun.

While an assistant presses downward on the fundus, the surgeon reaches into the uterus and delivers the fetus' head. Taking gentle traction on the head, he or she delivers the baby rapidly. You may feel a pressure or rocking as they work.

Then comes the joyful part, as the baby is assessed and begins to cry. You may be able to touch, kiss or hold the baby, or even nurse the baby immediately following birth (this is something to work out beforehand in your birth plan with your obstetrician).

Meanwhile, the uterus itself is often delivered outside the laparotomy incision, inspected, suctioned, massaged and sutured, then replaced into the pevlic/abdominal cavity. This may be a good time to have a tubal ligation performed, if you do not want any more children. And your surgeon may ask if you want any septum present to be resected. One school of thought holds that childbirth is a risky time for a metroplasty because of increased vascularity and risk of infections and adhesions, but there are two documented cases of septa being successfully resected during a c-section.

Expect to spend an hour or two in recovery, being assessed and reassessed, and having your fundus massaged. With luck, you will be able to bond with your baby during this time. You will remain in bed, catheterized, until the anesthesia wears off, possibly with pneumatic sleeves on your feet or lower legs that periodically inflate to stimulate circulation in your legs. Once the catheter is out and you are able to void, you will be encouraged to stand, sit and walk around as soon as possible.

The level of discomfort following a c-section varies widely, and you may or may not require much pain medication. If it is painful to nurse your baby, a pillow over the incision may distribute pressure more comfortably. You will have lochia (postpartum flow), but it tends to be lighter than that of a vaginal birth. A typical hospital stay following a c-section is 2-5 days. Following hospital discharge, you will be asked not to lift anything heavier than your baby, or to drive, to minimize the risk of adhesion fomration immediately following the surgery. The stitches or staples closing the incision usually come out within a few days following surgery, and are replaced with steri-strips or other dressing. The scar gradually thins and fades in color.

Vaginal birth following a lower segment incision is definitely possible, with the right provider.

An emergency c-section is done after the mother goes into labor and it becomes apparent that she needs a section. A crash c-section is done when the fetus is at risk of hypoxia or death. In both these cases, anesthesia may be by epidural block or general.

What are some of the pregnancy complications associated with MA's?

2008-03-20T20:01:00.000-07:00

Before reading this list of possible complications, it is important to remember that most babies born to women suffering from MAs encounter none of these problems. These are simply possibilities to keep in mind, and most of them come from the potential poor attachment/blood supply of the placenta, or the lack of space.

a. Miscarriage: Spontaneous abortion is very common, especially with the septate uterus, because of blood flow disruptions and possibly hormonal receptor abnormalities. The normal miscarriage rate for a woman with no fertility or anatomical problems is 20%, or 1 out of 5 pregnancies lost. In the septate uterus, which has the worst pregnancy outcomes, some studies show a miscarriage rate approaching 90%.

b. Incompetent cervix: As many as 20% of anomalous uteri may have additional problems, such as incompetent or weak cervix. Such cervices tend to give way between 16 and 22 weeks’ gestation. A woman with a known MA should ask her OB to check for this possibility. Cerclage—sewing a purse stitch around the cervix to keep it closed—is the most common remedy.

c. Placenta previa: Because of the tight quarters in an abnormal uterus, it is a little more common for the placenta to ride low and cover the inner cervical os. This condition poses a bleeding risk, but may correct itself as the pregnancy advances and the uterus stretches upward.

d. Abruptio placenta: Because of the abnormal configuration, contractions and vasculature within an abnormal uterus, problems with its attachment to the uterine wall may arise.

e. Premature labor: Although no one knows all the causes of premature labor, expansion restrictions may be one reason why an anomalous uterus is more prone to it. Another may be disorganized contractions of the abnormal muscle in a septum.

f. Abnormal fetal lie: Breech position is very common in an abnormally shaped uterus, possibly because there is more room for limbs at the bottom, or because the fetus loses its ability to roll 180° earlier than a fetus in a normal uterus.

g. Intrauterine growth restriction (IUGR): Again, because of the possible placental vascular insufficiency, the fetus may not get all the nutrients it needs, and may be small for dates. One form of IUGR tends to spare the brain, and the fetus, if born prematurely, does quite well despite the small size.

Should I see a regular OB-GYN during pregnancy?
While it should be remembered that many women with uterine anomalies have no trouble at all during pregnancy, one can never go wrong erring on the side of caution. If the MA is a severe one (a deep SU or BU, or any UU), it might be wise to at least consult with a high-risk specialist (perinatologist) early in the pregnancy, or have one co-manage your case along with your OB-GYN. Or you might simply interview your OB-GYN and find out how much MA experience he or she has, what his or her philosophy of care is, and whether or not you feel comfortable with it.

Expect to have your cervix length evaluated (sometimes a cervix weakens when the baby is crowded) and possibly treated with a purse stitch (cerclage) if it begins to open up in the second trimester. You may also expect to be monitored for premature labor, intrauterine growth retardation and abnormal fetal lie during your pregnancy; these pregnancy complications are more common with müllerian anomalies.

Müllerian anomaly myths

2008-03-10T09:42:00.000-07:00

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

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.
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 birth— Not 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 septum— Sadly, 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 infertility—False
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.

A list of Terms and Abbreviations

2008-03-05T19:44:00.000-08:00

Müllerian Anomalies: Terms
This is a short list of abbreviations and specialized terms used when discussing Müllerian Anomalies on this site.

AF: "Aunt Flow" or menstrual period.
Anlage: The name for the undeveloped or rudimentary müllerian duct.
Arcuate: AU A variation of normal uterine development in which the top of the uterus has a slight dip. Rarely a problem.
AU: "Arcuate uterus"
BD: "Baby-dancing," or sex intended for conception.
BFN: "Big Fat Negative," on a home pregnancy test. "Fat" may be substituted by the F-word of one's choice.
Bicollis: Meaning "2 cervices." Many septate, bicornuate and didelphys uteri can have a double cervix. Eg. "uterus bicornis bicollis."
Bicornuate: BU Meaning "two horns," it describes a uterus with a distinct division (> 1 cm.) visible from the outside, caused by incomplete fusion of the two müllerian ducts. A.k.a. "uterus bicornis."
BMS: "Baby-making sex"
BU: See: Bicornuate uterus.
CC: See: Clomid
Clomid: Brand name of "clomiphene citrate," an oral fertility drug. A.k.a. CC.
Cornua: Term for the two horns of a uterus, normally united to form a cavity shaped like an upside-down triangle. The cornua are more separate and pronounced in müllerian anomalies.
DD: "Dear daughter."
DES: See: Diethylstilbestrol.
DH: "Dear husband."
Diethylstilbestrol: DES. Artificial hormone given to pregnant women in cases of threatened abortion, especially during the 1960s and early 1970s. DES was found to cause many reproductive abnormalities in the fetus, including a small uterus with a T-shaped cavity in the female.
DS: "Dear son."
DW: "Dear wife."
Dysmenorrhea: Painful menstrual cramps. Women with uterine anomalies frequently have painful menstruation, typically from associated endometriosis, outlet obstruction, retrograde menstruation and the disorganized muscle contractions caused by an intrauterine septum.
hCG: "Human chorionic gonadotropin." This is the hormone made by the embryo's placenta. The pregnancy hormone.
Hemihysterectomy: Removal of one uterine horn, commonly done for the tiny, undeveloped horn opposite a unicornuate uterus.
Horn: Common term for the hemi-uterine cavities found in bicornuate and septate uteri.
HPT: Abbreviation for "home pregnancy test."
HSC: "See: "Hysteroscopy"
HSG: See: "Hysterosalpingogram"
Hypoplastic: Term meaning small, or underdeveloped. The small uterus of a DES daughter is said to be hypoplastic.
Hysterosalpingogram: The x-ray "dye test" good for showing the shape of the uterine cavity and whether or not the oviducts are open.
Hysteroscopy: A minimally invasive surgery in which a lighted scope is inserted through the cervix of the uterus. It can be done just to check the uterine cavity ("diagnostic hysteroscopy") or to correct polyps, septa, adhesions, etc. ("operative hysteroscopy"). General anesthesia is used for the latter.
IC: See: incompetent cervix.
Incompetent cervix: IC. A condition in which the cervix opens up under the weight of a growing pregnancy, and and very common in women with müllerian anomalies. Sometimes the lack of uterine volume forces open an otherwise normal, competent cervix, but it is also the case that a cervix can be malformed or congenitally weakened, as in the case of DES daughters.
Intrauterine insemination: Placement of live, washed sperm inside the uterine cavity with a catheter. A.k.a. IUI.
Intravenous pyelogram: "IVP." This is an x-ray dye test of the kidneys, done in women with müllerian defects, most especially those with asymmetrical defects, such as uterus unicornis. Since the urinary and reproductive tracts form at the same time, it is not unusual for a woman with only one uterine horn to lack a kidney or ureter on the opposing side. Likewise, it is sometimes possible to have a "horseshoe kidney," that is a single large kidney extending from one side to the other, caused, much as a septum is, by the failure of some embryonic structure to deteriorate at the right time.
IUGR: "Intrauterine growth retardation," a condition common when uterine volume is diminished, in which the fetus does not obtain sufficient nutrition from a rapidly aging placenta and is small for gestational age. The placenta deteriorates more rapidly because it is overly compressed as the pregnancy progresses. IUGR also has other causes, such as autoimmune disorders and diabetes.
IUI: See: Intrauterine insemination.
IVP: See: "Intravenous pyelogram"
Jones & Jones metroplasty: A type of alteration of the uterus done through a laparotomy.
Lap/hyst: Abbreviation "Laparoscopy/hysteroscopy"—a combination of two operations in which the uterus is inspected inside and out, to determine the extent of the malformation. A lap/hyst is the `gold standard' of diagnoses in differentiating between a septate or bicornuate uterus. It is also commonly done during hysteroscopic septoplasty to monitor the operation and verify whether or not a uterine perforation has occurred in the course of the hysteroscopy.
Laparoscopy: The inflation of the abdomen with carbon dioxide gas and the insertion of a lighted scope through the navel, through a half-inch incision. Additional incisions for manipulating instruments may be made at the pubic hairline. Laparoscopy may be done to diagnose a uterine anomaly, to operate within the abdomen, or to monitor a hysteroscopic procedure. A laparoscopy is classified as major surgery, but recovery time is considerably shorter than that of a laparotomy. "Keyhole surgery."
Laparotomy: a surgical incision in the wall of the abdomen large enough to admit conventional surgical instruments.
MA: See: Müllerian anomaly. A.k.a.: Müllerian duct anomaly.
Magnetic resonance imaging: MRI A noninvasive test useful in seeing the contours of the uterus and differentiating between a septate and bicornuate uterus.
Malpresentation: Common in women with decreased uterine volume, malpresentation is the position of a fetus in the uterus such that some other part besides the head will be coming out first. "Breech presentation," in which the feet or buttocks present first, is the most common malpresentation in women with uterine anomalies, and a common reason for birth by c-section.
M/c: "Miscarriage."
Metroplasty: A general term for the surgical alteration of the uterus, be it surgery to remove a septum or to unite the two horns of a bicornuate uterus. A subset of metroplasty is septoplasty.
MDA: Abbreviation for müllerian duct anomaly. a.k.a. müllerian anomaly.
MRI: See: Magnetic resonance imaging
Müllerian anomaly: A developmental abnormality of the internal female sex organs resulting from the failure of the müllerian ducts to either fuse and/or resorb properly. Müllerian anomalies include hypoplastic uterus, arcuate uterus, septate uterus, bicornuate uterus, unicornuate uterus, T-shaped (DES) uterus, uterus didelphys, Rokitansky Syndrome, and others.
Müllerian ducts: Two long tubular structures found in both the male and the female embryo. In the male, these ducts dissolve, but in the female, they unite to form the uterus and oviducts.
OPK: Abbreviation for the home test kit that predicts ovulation.
Retrograde menstruation: The reversal of menstrual flow; it goes from within the uterus to the pelvic cavity by way of the Fallopian tubes. It is thought to be one cause of endometriosis, which is more common in women with MAs. Retrograde menstruation is also more common in cases of MA.
Rokitansky Syndrome: The congenital absence of a uterus and upper vagina—the most severe form of Müllerian defect. Also known as "müllerian agenesis."
Rudimentary horn: the small, undeveloped horn of a unicornuate, didelphic or bicornuate uterus. A.k.a. anlagen.
Septate: SU. Adjective describing a uterus with an extra fibrous/muscular band in the middle of its cavity, giving it two horn shaped hemi-uterine cavities. This is the most common müllerian anomaly, and results from the partial or total failure of the wall between the united müllerian ducts to dissolve. A.k.a. "uterus septus." Subcategories of the septate uterus include "total," or "complete," in which the septum involves the cervical canal and even the vagina, and "subseptate," in which the septum's lower end stops short of the cervical canal.
Septoplasty: Surgery to remove a uterine septum, usually done by operative hysteroscopy.
Septum: The name for the fibrous wall dividing the cavity of a septate uterus.
SHG: See: Sonohysterogram
Sonohysterogram: SHG. Ultrasound of the uterus and its cavity, aided by the distention of the uterine cavity with saline solution.
SSU: "Subseptate uterus"
Strassman metroplasty: A type of alteration of the uterus done through a laparotomy.
SU: See: Septate uterus.
Subseptate: SSU. A form of septate uterus in which there has been a partial dissolution of the embryonic structure dividing the uterine cavity in two. The septum does not run the full length of the uterus.
T-shaped uterus: The characteristic shape of the cavity of a uterus affected by diethylstilbestrol.
Tompkins metroplasty: A type of alteration of the uterus done through a laparotomy.
TTC: "Trying to conceive"
UD: See: Uterus didelphys
Ultrasound: "US." A tool which can reveal the inner and outer contours of solid bodily organs such as the uterus and kidneys. Sometimes useful in distinguishing between septate and bicornuate uteri. Synonymous with "sonogram."
Unicollis: Term meaning "one cervix." Most müllerian anomalies involve the presence of only one cervix. Two cervices are most commonly associated with uterus didelphys, but not always. E.g.: "uterus didelphys unicollis."
Unicornuate: UU. An asymmetrical uterine anomaly in which one of the two müllerian ducts has failed to form properly. The hemiuterus is a small, banana-shaped organ frequently accompanied by an anlage, or rudimentary uterine horn or bud, which may or may not have an open endometrial cavity. Pregnancies in the smaller horn almost invariably rupture, and to prevent this, a hemihysterectomy may be recommended. Women with UU usually have bilateral ovaries, and may have an associated kidney anomaly on the side with the anlage.
US: Abbreviation for "ultrasound."
Uterus Didelphys: Term for the existence in a woman of two separate hemi-uteri, usually each with its own cervix. Some degree of vaginal duplication may also be present. Literally means "two wombs."
UU: Abbreviation for unicornuate uterus, a.k.a. "uterus unicornis."
Vaginoplasty: Any surgery done to alter the shape of the vagina. With some müllerian anomalies, especially UD and total SU, there may be a septum present in the upper end of the vagina.

Pregnancy Successes!

2008-03-01T10:08:00.000-08:00

From carrying twins in one horn of a complete BU to having two children despite lacking a cervix, we have success stories in the archives for every kind of uterus.

Unicornuate

"At around 18 weeks, I began having some spotting and strange cramping that went across the left side of my pelvis and toward my thigh. The monitor actually showed uterine irritability which stopped after a shot of terbutaline. At that point, I was put on bed rest and various meds (over the next months, I was given: brethine, nifedipine, indocin, betamethasone steroids, and several high doses of mag sulfate.)
By 24 weeks, I was having pretty frequent contractions (which are hard to feel early in pregnancy, but I think particularly hard to feel with a UU. Only half of your stomach gets hard and it feels very much like the baby's movements.) My contractions would start very easily, even when I was talking on the phone for extended periods of time. By 26 weeks, we raced into the hospital with contractions that were 2 minutes apart. This became our routine for the next several months. It got to the point where all I had to do was call and tell the L&D nurses my name, and they would ask "How close are they?" I was fortunate that my cervix was pretty stubborn and I did not actually start to dilate until I was 31 weeks. They also did FFN testing which always came back negative.
All in all, I spent 18 weeks on bed rest. During that time, I made countless trips to L&D and was admitted several times. It was difficult, but paid off. DS was not born until 36 weeks...I even had a vaginal delivery. They used the vacuum (UU couldn't really push very well) and needed pitocin b/c contractions basically got "stuck." Otherwise, delivery was very easy. He was 6 lbs 7 ounces and other than jaundice and reflux, his health was perfect. I'm still in awe when I look at him!"

Uterus didelphys

When I was 15 I was diagnosed with UD. The doctors removed the v septum but left everything else alone; seeing as there really is nothing one can do to 'fix' UD. I was told then that I would probably never be able to have children. Which of course totally devastated me.

I could bore you with the details of my life story but to cut a long story short my third IVF cycle eventuated in a successful pregnancy (I was 38 at the time). The doctors warned me that the baby could come early due to 'lack of room' etc and I was put on limited activity at 30 weeks.

My baby boy was born via csection at 41 weeks pregnancy! I went to bed that night; my waters broke at 10.30 pm and he was born at 12.40 am weighing 8 pounds and 51 cm long. I wish now I had faith in my body to give birth naturally as my labour was very quick and the doctor said afterwards that the baby was already 'engaged' in the birth canal. Which one could tell immediately by looking at Jake as he had a bruise around his head from the cervix! Anyhow I did not want to risk a dangerous labour hence went the csection route.

So there in a nutshell is a UD success story! My darling boy will be 4 on July 27. I still marvel that he is actually here!!

Bicornuate

"I have a bicornuate uterus with a septum and 2 cervices. So the joke was that the baby could pick the exit when the time came. But that never happened because my daughter was, of course, breech presentation."
The beginning of the pregnancy was really bumpy; first they thought I was a tubal because I was having a lot of pain and just had my first positive prego test. After many ultrasounds in the ER, they saw no evidence of a tubal, but instead saw fluid (probably from a ruptured ovarian cyst) and the smallest of gestational sacs...with no fetal pole. So I was sent home and told to wait...and to see an OB/GYN which I did. I did not know that I had a bicornuate uterus until I got pregnant.
I had bleeding (nothing major but definitely not normal) for the first 20 weeks of my pregnancy along with intermittent cramping. I had a lot of ultrasounds, including 2 level 2 ultrasounds, to make sure she was growing normally (and she was even BIG, 8 pounds, 12 ounces at birth, which shocked everyone). She lived on my right side throughout most of the pregnancy, practically in my rib cage. We knew about the bicornuate uterus, but did not know about the septum until they were performing my c-section...at 38 weeks!!!
In the end I was so fortunate to have carried such a beautiful daughter to term, fully knowing that things very well may not have gone so well...and all the problems that might happen in the meantime."

Septate

"Inaccurately dx by HSG in 1995 (I think?) with BU. In 2001, got pregnant twice, miscarried at 12 and then 8 weeks. Finally correctly dx with SU bicollis. Found the MA group (my lifesaver!) and decided the lap/hyst to resect the septum was the choice for me. Had one surgery in January, 2002.
It was very successful, and I am left with a slight residual septum, making me somewhat BU — still have 2 cervices and vaginal septum (and one kidney). Post surgery had long, wacky cycles. Got pregnant on day 34 ovulation in July, 2002. Great pregnancy (although paranoid) and I was able to keep active throughout. No bed rest, no preterm labour. My son was breech from the start, and didn't turn despite lots of mellow encouragement (didn't even attempt a version). Went into labour at 39 weeks, and he was born by c-section.
And hopefully I will have a second success story to share in November, as I am currently 6 weeks pregnant and saw the HB today (despite a few days of spotting last week). Still nursing my almost 2 year-old son (who needs to be weaned otherwise he will BF until he is a teenager)."

Septate

"After 4 miscarriages, including one involving incompetent cervix, I was diagnosed as having a complete SU in 2000. A resection was partially successful, although the surgeon perforated my uterus high up on the fundus. Had a second resection 6 months later, leaving me with segments of the septum intact, but a window between the two horns.
I miscarried once more and then conceived my DS. had a cerclage at 11 weeks and had some slight trouble with bleeding and contractions during the pregnancy. I was worried about possible rupture, so we planned on a c-section at 37 weeks, before prodromal labor got vigorous. All in all, I spent 23 weeks on modified bed rest and had a lot of cervical monitoring. The cervix held up splendidly, although my uterus was irritable. I took terbutaline for that up until about 21 or 22 weeks, and in retrospect, I would have taken far less of it.
The septum resurrected itself during the early part of the pregnancy, and I was worried about that, but by 20 weeks, the fetus had squashed it back into the uterine walls. He was still able to flip from vertex to transverse and back again at 36 weeks, and was born by planned c-section at 37 weeks on the dot, weighing 7 lbs., 3 oz., and in perfect health."

Shock Diagnosis of Unicornuate Uterus

2008-02-18T00:33:00.000-08:00

After more than 2 miserable years of infertility in spite of good sperm, normal hormone levels, and good timing I was, at my request and my reproductive endocrinologist’s agreement, booked to have an investigative laparoscopy, dye studies and hysteroscopy. With this being my first real surgery and having a fear of needles I was terrified. I also feared the worst – that my doctor would open me up to find horrible deformities. One never actually expects these “irrational” fears to actually happen.

When I woke in recovery my reproductive endocrinologist’s assistant broke the news to me as gently as she could – I had severe endometriosis and only half of my reproductive organs. I especially remember the reference to my half-uterus. I sobbed, absolutely sobbed, and the doctor told me that she was sorry. Then my reproductive endocrinologist came to see me, something he doesn’t usually do, so I knew I was special. He repeated the news, and I cried again. He told me the nurses would arrange for an MRI to be done to try to get a better idea of what was going on in there. I was devastated, absolutely devastated, and asked him about my chances for pregnancy. He was confident that I could get there with IVF.

I had the nurses call my friend who lived nearby. She had told me she’d be available for me should I need anything, and I was grateful for that. She arrived after I had been moved to the recovery lounge, and sat with me for several hours while I waited for the MRI appointment.

Knowing how afraid and upset I was, the staff left my drip in so that I could be sedated for the MRI if needed. However, by the time of my appointment it was too late for a doctor to come down to do that, so I was left to attempt to allow an MRI to be done on my extremely claustrophobic self. I tried to relax as I lay on the MRI table and was strapped in, with a heavy plate across my recently-operated-upon abdomen. As soon as they put me into the machine I panicked and had to be let out. They tried again, and I barely got my head in before panicking. It was decided that I would get a Valium prescription from my GP and come back the following week.

I did this, and after taking the maximum 4 tablets the pharmacist would allow, I made it through the MRI, and a few days later had my follow up appointment with my reproductive endocrinologist.

He made me look at photos from the surgery, in spite of my squeamishness. I have a Mullerian Anomaly – a random birth defect occurring when the Mullerian Ducts (which become the female reproductive system) are forming at around 6 weeks gestation. I have a right unicornuate uterus, a right ovary, a patent right tube, and a very crooked cervix that made the hysteroscopy impossible. The endometriosis was probably caused by retrograde menstruation due to my crooked cervix.

I was sent for a renal ultrasound as kidney anomalies are often seen with Mullerian Anomalies, due to them forming at the same time. I was not the least bit surprised to learn that my left kidney, ureter and adrenal gland were completely absent.

My reproductive endocrinologist was confident that I could fall pregnant via IVF and carry almost to term. The biggest challenge would be to try to straighten up my cervix enough for a normal embryo transfer. This was successfully attempted, along with resection of the endometriosis, in August 2006.

I have been fortunate in finding a wonderful internet support group for women with Mullerian Anomalies. I have received and continue to receive such wonderful support and information there. I have even become friends with a woman with uterus didelphys (double uterus) who lives nearby.

The group has been most helpful in learning about my condition, as there is so little good information available. I certainly didn’t receive a Mullerian Anomalies handout at the hospital.

Receiving my unicornuate uterus diagnosis has been a crushing blow, and very difficult emotionally. It is an unusual condition, so I feel like something of a freak. I feel defective, deformed, as though I am half a woman, and the infertility side of things certainly doesn’t help alleviate these feelings. The impact on my self esteem and body image has also been awful, I feel so ashamed to have this imperfect “half-woman” body. I am so lucky to have the girls in the internet support group to rely upon, as they really understand.

I am shocked that it has taken 29 years to receive this diagnosis. I have ultrasound pictures from over a decade ago that show a “left renal area” and “right kidney” but make no mention of the absent left kidney. I also have many pelvic ultrasounds that proclaim my uterus to be “of normal volume and contour”, which, of course, simply is not true. I even have an ultrasound report counting the follicles on my left ovary – the one that does not exist!

If I am lucky enough to get pregnant in the future, I know that I will face risks due to my unicornuate uterus such as increased risks of premature labour, incompetent cervix, breech presentation, caesarean section, intra-uterine growth retardation, and late trimester loss. While I’m not glad to have these risks, I am very glad to know about them so that I can insist on being monitored closely.

I encourage anyone with a Mullerian Anomaly to educate themselves and seek support from other women with similar conditions.

K77

Kristina's Story, UU

2007-12-18T15:00:00.000-08:00

I learned I had an MA in April 2005. After a month-long stint ofspotting, I had a transvaginal ultrasound that showed two cavities,and the radiologist let me know I had a bicornuate uterus but told menot to be alarmed by what I read on the internet. I immediately lookedit up and was of course frightened.

We followed that up with an HSG, which only showed one cavity filling,a UU they said. Of course, I was freaked out since I knew there werereally two cavities, but the ob-gyn said there was no need for furthertests, since with one open tube I could get pregnant. I promptly"fired" this dr. and saw another ob-gyn referred to me by a teachinghospital, who ordered an MRI. I had also booked an appt. with an RE,and this ob-gyn suggested I keep it. I had to wait a couple of months,so I was glad I made the appointment so far in advance.

The MRI showed a UU with a noncommunicating horn of about symmetricalsize. The RE then performed a laparoscopy and discovered that the sizewas a bit smaller, but basically this diagnosis was correct. She alsotreated me for mild endometriosis at that time. I wanted to have theunderdeveloped horn taken out to prevent a pregnancy in it (it didhave some endometrium), but we had to wait another 6 months for alaparotomy because the RE didn't feel safe doing it laparoscopically, and I was writing a PhD dissertation and couldn't afford the recovery time.

6 mos. later (April 2006) we did the laparotomy and things went fine.I got my first epidural and bikini incision. One month later I was ina car accident that fractured my pelvis, so that delayed our TTC acouple of months, but the orthopedist felt there should be no complications to pregnancy as a result, thankfully.

We conceived my son Christian last October (due date July 1), my first BFP ever after 18 months of TTC. I started spotting in late Jan. atabout 17.5 weeks, and I went into preterm labor at 18 weeks. After oneday of bedrest at home and one day of bedrest in the hospital, theychecked my cervix again via u/s and found everything fine. (I had beenabout 1.5 cm dilated when I arrived, according to the ER staff.) They discharged me, and an hour or two later, my water broke. They took meoff the anti-contraction drugs, and after about 24 hours of worsening(veering into life-threatening) infection, labor started again, and the baby died sometime that night. It was the most terrifying week of my life.

The drs. are hopeful that a cerclage may help next time, but we've been TTC for about 8 cycles now with no luck yet. In fact, I've hadsome more spotting and just had a saline u/s that showed anendometrial polyp. I had another D&C with a hysteroscope to remove it, and we're back to TTC again.

Zachary's NICU Story

2007-12-13T22:31:00.001-08:00

By Stephanie, UU

My son, Zachary Nathaniel, was born at 28 weeks, weighing only 2 1/2 pounds (1170 grams). At that time, we had no idea that I had a unicornuate uterus. It wasn’t until my delivery that we had a suspicion that something was wrong – my OB did an internal exam and felt only one horn of a uterus. We confirmed it 6 weeks later.

The Delivery

I had been feeling what I thought were Braxton Hicks contractions for a while. On Monday September 18th, I went to the bathroom and saw a small amount of blood on the toilet paper. We went to the OB, she did a manual exam and my cervix was long and closed. I was put on a monitor only to realize that I was having contractions, about 8 in a half hour. She did a fetal fibronectin test, which was negative (a negative result means there is little or no danger of preterm labor for at least a week or two). She sent me home and put me on bedrest until further notice. The next day, I went back to her office and was still contracting at the same rate. She did another manual exam and felt that my cervix had softened a bit since the day before. She urgently admitted me to the hospital to be monitored more closely. Everyone (the residents, the OB hospital attendings, my husband and I) thought it was overkill, especially given that my cervix was closed and the fetal fibronectin was negative. Nobody thought this baby was coming. But my doctor stuck to her gun and insisted we go. If it weren’t for her, things may not have turned out as well for us.

Over the next few days, I received magnesium to stop the contractions in order to buy us some time to get two days of steroids, which help to mature the baby's lungs. The contractions stopped and they moved me off the labor and delivery floor on Thursday afternoon. The plan was for me to go home Friday afternoon. But Thursday night the contractions started again and Friday morning I lost my cervical plug. That was when things started to feel very real. We realized at that time that this baby wasn’t going to wait. I was moved back to the Labor and Delivery floor immediately, and Friday night my water broke. My son was delivered on Saturday night at 9:35 pm. I delivered vaginally, at 8 centimeters. Zach was 2 ½ lbs. My husband jokes that I had an easy delivery because I only pushed for about 5 minutes.

Knowing that he was going to be small, the Neonatal Intensive Care Unit (NICU or unit) doctors were in the delivery room and intubated (put a tube down his throat to help him breathe) him immediately after he was born. We heard a small cry, which was a huge relief. Outside of the quick glance I got when looking below, the next time I saw him was a few hours later in the NICU. My husband was able to see him and touch him (we got a couple of pictures, all of which are too upsetting to really look at anymore -in one picture, my husband’s finger is the length of my son’s body). My son was then rushed right up to the unit. I always choke up when I see pictures of women holding their babies immediately after they are born. I feel robbed of that experience. I didn't hold my son until he was about 5 days old. But when I held him, the joy in the room was palpable.

My husband and I are both doctors. So when Zachary was born, my husband said to the NICU attending - "tell us honestly, how is he". What we were looking for was - “he’s breathing” or “he’s intubated and stable”. However, the first words we heard about our son were, "well he looks a bit chromosomal". Because of the UU, there was a lack of space in my uterus, thus when my son was born his face was very disfigured. His nose was on the right side of his face and flat, his ears were low, his feet were both clubbed. The day after he was born, his nose shifted to the center. The next day, it popped out. Then his feet straightened out. Eventually, everything settled into place and we realized that it was positional - that he was just smushed. At that time we didn't know why, but we made our appointment with the RE for 6 weeks later, once everything shrunk back down to size.

I feel deprived of the normal, exciting delivery. The delivery of my son was frightening. I didn’t smile when he was born, didn’t cry with joy. I was silent, waiting to hear whether or not he was breathing. It was not what I wanted. I wanted him in me, not in an incubator. I remember hearing my husband yell out in joy when Zachary was out, and remember thinking, ‘what is he joyful about?’ The only emotion I could feel was fear.

The NICU

The first thing they tell you is that it’s a roller coaster in the NICU, and that couldn't be more accurate. The other thing they tell you is not to watch the monitors. Your life becomes a routine of sitting and staring at a blinking and beeping monitor. And pumping.

As you read this, keep in mind that all babies are different. But from what we were told, our experience was pretty typical for a 28 weeker. We were fortunate to have no real surprises along the way. For the most part, Zach improved steadily throughout his 8 week stay. There were setbacks, but there are setbacks for every baby - hence the roller coaster analogy. They told us that we should expect for Zachary to be in the NICU until our due date (however, many babies do go home before their due date). We actually went home about a month before ours. But, if it weren’t for our medical backgrounds, we would have probably stayed another couple of weeks. I’ll expand on that later.

The NICU is divided into several sections – 1) the acute part of the unit that holds all of the really small and critical babies and babies on ventilators, 2) the main part of the unit that holds babies that still need respiratory support but are not on a ventilator, and then 3) a step down unit, where babies go if they are close to going home. Zach spent the first week in the acute part of the unit because he was intubated and on a ventilator. We could touch him through the openings of his isolette -but only for a few minutes at a time, so that he didn't lose too much body heat. The NICU nurses actually discourage touching the babies early on- not only do they lose heat (and if you don’t wash your hands thoroughly, are exposed to who knows what), touch is thought to overstimulate them and cause them to desaturate (desat; periods where the babies blood oxygen concentration drops below a certain number because the baby is not taking adequate breathes).

We spent almost all day long watching the monitor for desats. In the beginning the preemies do it all the time, all day long. Very often, the numbers would go back up on their own, which showed that he was learning to take a good deep breath. However, sometimes he would need a little help. The nurses taught us to rub his hands or feet very strongly, so that he would cry and take a deep breath. Then somehow, he stopped doing it as frequently. He got to a point where he was only really desating during feeds – he didn’t know how to pace himself, and would forget to take a breath while eating. And, eventually all of the preemie babies stop desating. The nurses tell you that your baby will outgrow it, but it’s so hard to believe when they are desating so frequently. The first week or two, each desat was terrifying. We would stare at the monitor, waiting for the numbers to go up, screaming inside, wondering why the nurses and doctors weren’t rushing over. I would find myself holding my breath until the numbers would go back to normal. But eventually we realized that it happens to every baby, the nurses and doctors are in total control and know when they need to be there, and the babies do outgrow them.

Zach was extubated (they took him off the respirator) after about 6 days and put on CPAP (continuous positive airway pressure) which is another respiratory device that allowed him to breathe on his own but provided some additional pressure to help keep his airways open and make it a little easier. CPAP is a horrible looking device. It covered at least half of his face, and had two prongs that were far too big for those tiny little nostrils. While it’s a step in the right direction, it was so hard to watch him look so uncomfortable. I was constantly readjusting the prongs, terrified that his nose would be all misshapen (it’s totally fine). Outside of the small peep we heard when Zachary was first born, this was the first time we actually heard him cry (when babies are intubated, you can’t hear them when they cry). It was music to my ears. After about a week or so on CPAP, he was moved to something called high flow nasal cannula, where he received oxygen via a regular nasal cannula, as well as additional pressure to help keep his airways open and make breathing easier. This was a great change, b/c we were finally able to really see Zach’s face. But a couple of days later we faced one of our first dips in the roller coaster. We came back one morning to find him back on CPAP – he was having too many desats and wasn’t ready for high flow nasal cannula. He stayed on CPAP another 2 ½ - 3 weeks and was finally moved to high flow nasal cannula successfully. He stayed on that for about 1 ½ - 2 weeks until he was weaned off oxygen support entirely. That was an amazing feeling.

Like most premature babies (and many full term babies), Zach became jaundiced a few days after he was born. He spent a total of about 7 days under “the lights”. While it was frustrating because we couldn’t take him out to hold him during this time, it was pretty uneventful and eventually his lab tests came back normal.

The NICU nurses are AMAZING. I can’t stress that enough. They are the ones responsible for the day-to-day care of the babies. It’s important to know who your baby’s nurse is each day and night shift– this way, you can call them when you are gone to in order to check in. I came in one day to find a card that one of our nurses made for me, with Polaroid pictures of my son the first time his face was free of breathing and feeding tubes. She had given him a bath at night and removed everything for it. Knowing how much it would mean to me, she took pictures to capture the moment. It was the first unobstructed view I had of him. Another time, I came in to find a beautifully knitted blanket draped over his isolette, with a matching knitted hat. One of the nurses brought it for him, to protect him from the harsh lights of the NICU. In return, we made sure to bring them lots of snacks and goodies. And we’d leave them our People and Us Weekly magazines to read once we were done with them. Anything to get on their good side;) But it’s impossible to repay them for the work that they do.

We were very lucky to have nurses who weren’t scared to challenge our son – they tried to wean his oxygen support as much as he could tolerate. The less oxygen support babies get the better, because too much oxygen can lead to vision problems, which is why every baby that receives oxygen support while in the NICU needs to get eye exams. Zach had two while in the NICU and one 6 months after we were discharged home. These were pretty traumatic. They use these little metal speculums to force the babies eyes open - Zach’s eyes were swollen for two days after each exam. Fortunately, when we were home we saw a pediatric ophthalmologist who was able to dilate and examine Zachary’s eyes without a speculum. With all of the oxygen support he had received, Zach’s eyes are totally fine.

Pumping becomes a very important part of the day for most mothers with a baby in the NICU. It was the only thing I could really do for my son, so I became a bit obsessed with it. I think this is totally normal. I rented a hospital pump, because according to the lactation specialists, the run of the mill breast pumps would not be adequate for the frequency with which I would have to pump. I remember sitting in the lactation office, crying as she was explaining why I needed to have this special equipment, envious of the woman next to me who was able to go home with her store bought breast pump. While Zachary was in the NICU, I pumped about every 2-3 hours. The NICU has a special fridge to store breastmilk – each mom was given a large Tupperware container to store the bottles. There was also a pumping room (we liked to call it the “lactation station”) - I probably spent more time there than my own home in the 8 weeks Zach was in the hospital. Most days, there were even lines for the pumping room. It got to the point that my friend and I would pump together –misery loves company, I guess. Even though I didn’t produce that much milk, I still had filled my Tupperware container as well as my freezer at home. It was always funny to see people’s reactions when you asked them to get something out of the freezer. Many moms had to buy an additional freezer for their homes for storage. I was not that lucky. That being said, once we stopped nursing (at about 7 months), I still had plenty of breastmilk to feed my son or to mix with cereal.

Every baby, whether preterm or full term, loses weight after they are born. Zach weighed 1170g when he was born, but got down to 1050g during his first week. He was so small that even the preemie diapers covered his whole body – in fact, he wore a doctor’s face mask as a diaper for some time. However, the nurses in the acute room would call him a bruiser, because he was actually one of the biggest babies in that area. We watched Zach’s weight gain as closely as we watched his desats. It was the most important news of the day. On our way home from the hospital, we would call every member of our family with the daily weight gain.

Before the preemie babies really start to put on weight, they need to get up to full feeds, whether it’s with breastmilk or formula. They start out getting continuous feeds through a feeding tube, either in their nose or their mouth, depending on their means of respiratory support. But the feeds start out very slowly (1 mL, 1/30th of an ounce, at a time), so as not to overwhelm the digestive system. The next step is bolus feeds, where they get fed through their feeding tube every 2-3 hours. After they have successfully tolerated the bolus feeds, it’s time to start bottle and/or breastfeeding. We opted for both – I breastfed when I was there and let them bottle feed him at night. Some parents (and the lactation specialists) worried about nipple confusion, but I just wanted him out of there. We figured that the sooner he could figure out how to eat on his own, the faster we would get him home. It took a few times for Zach to figure out how to breastfeed, but we were persistent and he finally caught on. For some it took longer, but a lot of the babies eventually got it. It could be frustrating nursing in the NICU - the lack of privacy can be an issue, for those that are shy about nursing in public. We would use these folding dividers, but it wasn’t the perfect solution.

Once the babies get up to full feeds, they really start to put on the weight. For the most part, gaining weight was a steady process for Zach. Once Zach started gaining, most days he would gain about 20-30grams (30 grams is about one ounce). Obviously some days would be less, and some days he wouldn’t gain at all. He rarely lost weight. Another huge triumph for us was the first time Zach gained weight after breastfeeding exclusively for the entire day -we knew he was getting enough from my breasts. All that pumping was finally worth it! I think our obsession over weight gain that originated during Zach’s few months of life will stay with me for a long time. I still watch his weight very closely, even though he is well within the normal weight range for his real age (not his adjusted or corrected age, which is three months younger). He’s a great eater, yet still, every meal is a triumph and I relish in the ounces that he is gaining.

I will never forget the first time I held my son. He was 5 days old, still in the acute room on a ventilator. The nurse said the 8 words I had been waiting to hear – “Mommy, do you want to hold your baby?” I burst into tears. Holding Zachary in the NICU was always an event. Whenever I wanted to hold him, I would have to put on a hospital gown, strip him naked, and we would sit bare chest to bare chest, the heat of my body keeping him warm. The nurses in the NICU called it “kangaroo care”. I called it “bliss”. It was always wonderful, but in the beginning, it was also very frustrating. It was difficult to manipulate him with all of the tubes and wires connected to his body and face. We would have to call a respiratory therapist to come disconnect his tubing while we removed him from the isolette, and then to hook him back up once he was settled on my chest. For a while, we could only take him out of his isolette once a day, and my husband and I would take turns every other day holding him. Once he was more stable, we were able to take him out a few times a day for 10-15 minutes at a time (so he didn’t get too cold). Once he started maintaining his body temperature outside of the isolette, I don’t think we ever put him down. Kangaroo care allowed us to bond with our son.

Visitors would drive me crazy. I felt like I had to entertain them, which was added stress and pressure that neither my husband nor I needed. We felt the need to make others feel better about the situation, when we weren’t feeling so great about it ourselves. I would often hide in the pumping room, just to escape the casual (or not so casual) conversation. Watching people’s reactions to our son was hard. One set of visitors came and started crying when they saw Zachary; the husband actually stayed in the waiting room because he “couldn’t handle it”. Then don’t come!! Watching our visitors insensitively stare at other babies in the NICU was beyond aggravating. “Why is that baby here, he doesn’t look small?” “What’s wrong with that baby?” I wanted to scream, “It’s none of your damn business”. I’d have similar frustration (and anger) when other people’s visitors would stare at my son – I was known to blatantly say, “Stop staring”. People would get very embarrassed. Every time the monitor would beep, our visitors would watch me watching the monitor, waiting for my reaction. I wanted to scream at them (and sometimes did), “stop staring at me”. And because we could only have two visitors at Zach’s bedside at a time, it meant that every time someone came to visit, one of Zach’s parents couldn’t be with him.

In order for us to leave the NICU for home, the goal was to have Zachary breathing and eating on his own, weighing at least 4 lbs (he actually went home at 5 ½ lbs), and at least 3 days without any desats. He also needed to be able to maintain his body temperature outside of his incubator. Obviously, some babies don’t achieve these goals entirely – but the hospital will make provisions to get the babies home with assistance if necessary. For example, some babies that still desat but are otherwise eating, breathing and gaining weight will go home with a respiratory monitor.

Very few people understand what it is like to have a preemie. If one more person told me that I was actually lucky, because his being born early meant that I had him with me for an extra 3 months – the stupidity!! The day after Zachary was born, my closest friend, who I have known since nursery school, asked me if he had that “new baby smell”. She didn’t realize that I hadn’t smelled him, let alone touched him or kissed him. It was a hard question to answer. How was she to know? During the two months we were there, we developed a strong support system within the NICU. We became friends with other parents, who are truly the only people who understand what you are going through. We would become almost surrogate parents for each other; if one of us needed to step out or couldn’t come visit one afternoon, we would keep a close eye on their babies and let them know what they missed. We became very attached to these other children, and invested in their futures. I don’t know what I would have done without our NICU friends. They know how you feel every time your baby’s monitor beeps. They know how you feel each time you have to put your baby back in the isolette. They know how hard it is to leave your child every night, which was by far the hardest part of this whole experience. They know how you feel not being able to care for your own child. The first time I changed Zachary’s diaper was a huge triumph for me. I felt like a mommy for the first time. It was a long time before I let anyone change one of his diapers – I felt so deprived of caring for him for so long.

It wasn’t weight gain, maintaining his body temperature or even the need for oxygen that kept Zach from leaving the hospital, though. It was those damn desats. This is the case for most babies. As I mentioned, in order to leave the NICU we needed to have 3 days without any desats. This means that if your child goes 2 ½ days without one, but has one in those last 12 hours, you are back to ground zero. For some, this could go on for weeks until the baby would finally stop having them. For Zach, it got to the point where he would have them only when eating. The little guy would just forget to breathe. And he would do it with every feed. The doctors just weren’t comfortable sending us home knowing that he would desat with every feed. We would have to pace him, and pull the bottle out of his mouth after every two sucks– suck suck breathe, suck suck breath, suck suck breathe. But eventually, he got down to doing them only sporadically during feeds. I could tell by looking at him when he was desating, and knew to take the bottle out of his mouth and give him a break.

After a few days with minimal desats during feeds, we knew we were close to going home. The nurses offered to let me have a sleepover with Zachary. Many NICUs have a room called the “nesting room”, which has a bed, crib, television, etc. that parents can stay in with their baby right before the baby is ready to go home. It’s like a practice run. The nurses will check in with you, but for the most part, you are on your own. I was waiting for that day for a long time, to actually have the opportunity to care for my baby overnight. It was wonderful (although the scabies I caught from the dirty bed were not!). After nesting with my son (and a refresher CPR course), the doctors and nurses both felt comfortable discharging him home. This is where our medical background really helped us – most parents would have probably stayed until there were no desats during feeds, but we felt confident in our ability to handle the situation. And so did the hospital staff. Goodbye NICU, hello life! HOME

HOME

Zachary was born on September 23, 2006 and discharged home from the NICU on November 22, 2006, the day before Thanksgiving.

A big part of going home is about what you can do to avoid going back. This meant Zach not getting sick, since he came home from the hospital in the middle of the winter. Zach spent the entire winter in our home, except for a few trips to the pediatrician where he was always rushed into a room instead of having to wait in the waiting room with all of those runny noses. He also received monthly Synagis injections, which is a medication that protects preemies against a respiratory virus called RSV, which is known to be problematic for small babies. We accepted visitors, but had 3 simple rules: 1. Purell before you touch him, 2. If you’re sick, getting sick, or live with someone who is sick, don’t come over, and 3. Don’t touch his hands or his face. And it worked – Zachary made it through the winter without a single sniffle. Since then, we’ve become a lot more relaxed.

While it was difficult to let go of our NICU experience in the beginning, I sometimes forget now that he was even a preemie. It’s hard to believe that it all happened. But at that time, I never thought I would get over it. I never thought I would want to try again. But here we are, talking about trying to conceive again, meeting with a perinatologist about what to expect in a future pregnancy. So for those of you have a premature baby or who are anticipating a premature delivery, please know that you do get past it. It takes time, but eventually you do heal from the experience. And the time spent away from your child, while devastating to a new parent, does not impact your ability to bond to your child. I feel incredibly close to my son, and he is very much so attached to his mom. In fact, I truly believe he is tougher for it. He was a fighter in the NICU (he was constantly pulling the CPAP and nasal cannula off his face, or his feeding tube out of his nose), and he is a fighter as a 14 month old. The terrible two’s should be interesting. But I wouldn’t change it for a second.

The older he gets, the less difference I see between him and other babies his age. All babies do things at different rates, and this becomes more apparent as they get a bit bigger. Zach is 14 months old and finally walking – our good friends have a boy who was full term and didn’t walk until he was 15 months. While I still have to stop myself when I start comparing Zach to other children his age, I find myself doing it less and less. We now live our life no different than families with full-term babies. We are very blessed.

Thoughts on Surrogacy, Miscarriage, Diagnosis & Courage

2007-12-07T21:07:00.000-08:00

By Lisa G, 36, BU

I've thought about it, as in if it comes to that I'll at least entertain it. But I'm not there yet, even with 2 m/c behind me. I'm not sure what your reproductive history is, and certainly each person's experience is unique. Having said that, m/c absolutely positively suck, there's no two ways about it. They break your heart, they pull the rug out from under you, they take you to some pretty ugly places (at least mine did). But I know too many people who have had miscarriages and gone on to have healthy, beautiful babies. And I haven't yet been knocked out for the count by them (fortunately).

As someone who always thought I had a normal uterus (as I'm sure every single one of us on here did), it does come as a shock to realize that your parts aren't what you thought they were. It does suck that you have to take a crash course on reproductive medicine and know enough to weed out idiot doctors. I've been to more docs in the past 5 years than I have in my entire 31 years prior to that.

But, it isn't by any means hopeless. And the good news is you have an amazing group of wise, savvy women here who are glad to help.

If you truly want to go the surrogate route and feel that's what's best for you then by all means do it. But if you're making that decision out of panic and anxiety and fear, may I gently suggest that you let the dust settle a bit. Just because no doc you've seen has yet given a clear answer doesn't mean there isn't one to be found and it may be a bit early yet to throw in the towel. You might find that after you feel sorry for yourself, and kick and scream and wonder "why me???!!!" that you decide to pick yourself up and put one foot in front of the other and continue looking for answers. You are not alone. Many women have gone before you.

When I first met with my ob/gyn after we'd decided to jump on the ttc bandwagon, he found I had a thyroid that was 2-3 times the size of normal. I was shocked. Then he ordered a pelvic MRI (we already knew I had large fibroids) to see more clearly where my fibroids were and whether or not surgery was indicated. From that they suspected that in addition to large fibroids I also had what looked like a bicornuate uterus. I couldn't believe they'd found one more thing wrong with me. It totally knocked the wind out of me.

I was told by my ob/gyn during my first HSG that "I've seen bicornuate before, but I've never seen a bicornuate like that before." (he'd been in practice a long time). The diganosis by the radiologist was that I had a UU. Even I knew that wasn't right. I consulted with an RE locally who told me that it could be bicornuate or it could be a septum but that a septum only slightly increased the chances of miscarriage. Fired him. Then I went to "mecca" at Cleveland Clinic and realized again that I knew more than the "specialist" I was seeing. I lucked out on my 3rd try and travelled 10 hours to Philly to undergo a myomectomy and a Strassman to reunify my bicornuate (not typically done).

All of this to say that you may be stronger than you think and you may want to gather a little more info before making your decision (or you may already know it's the right decision for you). I will say that on this journey, I've met the most incredible, brave, courageous women. And if I could offer anything to you it would be to know that while life can pull the rug out from you at times, there are the most amazing gifts that come from unexpected detours, twists, turns and crashes. I've never been able to outrun my pain, or eat enough ice cream to drown it, but when I finally was willing to look it in the face, it wasn't nearly as scary as I thought. And in a strange, unexpected way it has made me a better human being.