Premium
Prevalence of uterine anomalies and their impact on early pregnancy in women conceiving after assisted reproduction treatment
Author(s) -
Jayaprakasan K.,
Chan Y. Y.,
Sur S.,
Deb S.,
Clewes J. S.,
RaineFenning N. J.
Publication year - 2011
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.8968
Subject(s) - medicine , pregnancy , gynecology , bicornuate uterus , miscarriage , obstetrics , unicornuate uterus , uterus , follicular phase , septate , uterine cavity , gestation , paleontology , genetics , biology
Objective To estimate the prevalence of congenital uterine anomalies in subfertile women and to evaluate their influence on early pregnancy following assisted reproduction treatment (ART). Methods We prospectively recruited 1402 subjects undergoing ART over a period of 5 years from 2005 to 2009. Three‐dimensional transvaginal sonography was performed in the early follicular phase of the menstrual cycle (days 2–5) and repeated in the late follicular phase (days 10–14) if the shape of the uterine cavity could not be assessed at the first scan. All subjects who conceived following ART were followed up to 12 weeks' gestation. Chi‐square test was used to compare the pregnancy rates and miscarriage rates between women shown to have uterine anomalies and those with a normal uterus. Results One thousand three hundred and eighty‐five subjects were included for final analysis after excluding 17 subjects in whom a definitive diagnosis could not be made. While 1201 (86.7%) subjects had a normal uterine cavity, uterine anomalies were demonstrated in 184 (13.3%) subjects. Arcuate uteri represented the commonest anomaly ( n = 164 (11.8%)) followed by septate ( n = 7 (0.5%)), unicornuate ( n = 6 (0.4%)), subseptate ( n = 5 (0.4%)), bicornuate ( n = 1 (0.1%)) and T‐shaped uteri ( n = 1 (0.1%)). A total of 440 subjects who underwent ART were followed up. The pregnancy rates in women with arcuate uteri (36/66 (54.5%)) and major uterine anomalies (7/10 (70.0%)) were statistically similar ( P = 0.09 and P = 0.11, respectively) to that of the matched controls with normal uteri (158/364 (43.4%)). While first‐trimester miscarriage rates were similar ( P = 0.81) between the control group (20/158 (12.7%)) and women with arcuate uteri (5/36 (13.9%)), women with major uterine anomalies experienced a higher miscarriage rate (3/7 (42.9%); P = 0.05). Conclusions Women who are referred for ART have a high prevalence of congenital uterine anomalies, the most common anomaly being an arcuate uterus. These anomalies are not associated with a reduction in pregnancy rates following ART. However, while the arcuate uterus was not associated with an increase in first‐trimester miscarriage, major uterine anomalies seemed to increase the risk of first‐trimester miscarriage. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.