Uterine Conditions That Could Impact Your Fertility
I’m here to answer your questions and dive into topics many people were never taught about—your reproductive health and anatomy. Understanding how your body works is empowering and essential, whether you're trying to conceive or simply want to make informed decisions about your health. Let’s dive in to some common uterine abnormalities and how they impact fertility.
The Basics: What Is a Septate Uterus?
A septate uterus is one of the most common congenital uterine anomalies. It occurs when the uterus fails to fully develop and reabsorb the tissue dividing it during fetal development. During embryogenesis, the uterus forms from two structures called Müllerian ducts. These ducts are supposed to fuse together, and the central wall (the septum) should then dissolve to create a single uterine cavity. If that last step doesn’t happen, a septum remains.
This condition is considered a birth defect and may go undiagnosed because it often can’t be detected during routine pelvic exams or standard vaginal ultrasounds. You need more specialized imaging, such as:
Hysterosalpingogram (HSG): An X-ray with contrast dye to visualize the uterus and fallopian tubes.
Saline sonogram: Uses saline to expand the uterus during an ultrasound.
MRI: Provides detailed imagery to distinguish between similar anomalies.
Septate vs. Bicornuate Uterus: What’s the Difference?
While both conditions affect the shape of the uterus, they originate from different developmental issues:
Septate Uterus: Fusion of the ducts occurred, but resorption didn’t. The outer shape of the uterus remains normal, but a fibrous wall divides the inner cavity.
Bicornuate Uterus: The ducts didn’t fuse completely, resulting in a true “heart-shaped” uterus with two horns.
This distinction matters because:
Septate uteri are linked to very high miscarriage rates (up to 80%), due to poor blood supply in the septum.
Bicornuate uteri typically have better vascularity, so while there’s a higher risk for complications like breech presentation and preterm birth, miscarriage rates are not as extreme.
If you’re diagnosed with a septate uterus and experiencing infertility or miscarriage, surgical correction (hysteroscopic septum resection) can normalize the cavity and significantly improve outcomes.
Why Didn’t My Doctor See It Earlier?
A septate uterus often isn't visible on standard transvaginal ultrasound unless saline is used to open the cavity. It also doesn’t show up during pelvic exams. So even if your doctor has “looked at your uterus for years,” specialized imaging might be necessary for diagnosis.
Delayed Period After D&C: Could It Be Asherman’s Syndrome?
Another important topic is Asherman’s Syndrome, a condition where scar tissue forms inside the uterus, often after a D&C (especially after a second-trimester loss), postpartum infection, or uterine surgery.
Symptoms can include:
No return of periods (amenorrhea)
Lighter-than-normal or irregular periods
Infertility
Diagnosis involves:
Vaginal ultrasound to assess endometrial lining
Hormonal bloodwork
Saline sonogram to detect scarring inside the cavity
I recommend evaluation if your period hasn’t returned by 8 weeks post-D&C—especially if you had regular cycles before. Early intervention is key; severe or longstanding cases can become untreatable and may require IVF with a gestational carrier.
This is also a powerful example of how restricted access to safe reproductive care can lead to preventable scarring and permanent infertility.
Unicornuate Uterus: What to Expect
A unicornuate uterus forms when only one Müllerian duct develops. You’ll have one fallopian tube and one half-sized uterus. While you still have two ovaries, conception may be more challenging:
Lower pregnancy rates
Increased risk of miscarriage
Implantation difficulties
Even if you ovulate on the side without the fallopian tube, the tube on the other side may reach over and “catch” the egg. I generally recommend continuing to try each cycle rather than skipping ovulation from the “wrong” side.
That said, patients with a unicornuate uterus often progress to IVF sooner. Why? Because it allows:
Genetic testing of embryos to minimize miscarriage
Optimal preparation of the uterine lining before transfer
Also, unicornuate uterus can be associated with kidney abnormalities and endometriosis, so a full health evaluation is recommended.
Tubal Blockage: IVF vs. Laparoscopy
If you’ve been told both fallopian tubes are blocked (or only partially open), you may be weighing options like IVF vs. laparoscopy.
HSG is a good screening test but sometimes gives false positives due to spasms or poor technique.
Laparoscopy with chromopertubation (using dye to check tube patency while watching with a camera) is the gold standard for diagnosis.
However, at age 38 and if you’re planning for more than one child, IVF is often more time-efficient and effective than trying to surgically “unblock” tubes.
Every case is unique, so the best next step depends on your full medical history, fertility goals, and how long you've been trying to conceive.
Final Thoughts
Understanding your reproductive anatomy gives you power to advocate for yourself, to make informed decisions, and to pursue the right treatments. Whether you're facing a uterine anomaly like a septum or unicornuate uterus, recovering from miscarriage, or weighing options after tubal blockage, there are paths forward.
