Müllerian Anomalies

What causes mullerian anomalies (see figure 2)? Affects 2-4% in women with normal reproductive outcomes, 5-25% for women with adverse reproductive outcomes; NORMAL ovarian function with normal secondary sex characteristics 1) Errors in organogenesis – Mullerian agenesis (“MRKH” Mayer Rokitansky Küster Hauser), all or part of the mullerian tract fails to form or is underdeveloped: absent vagina, variable uterine development 2) Errors in fusion a. Uterine didelphys – “double uterus”, two mullerian ducts fail to fuse, duplication of the reproductive structures b. Bicornuate uterus – Fundus is indented, partial fusion of the mullerian ducts c. Unicornuate uterus – asymmetric lateral fusion defect – one cavity usually normal, while other duct poorly developed (+/rudimentary horn) 3) Errors in septal resorption a. Septate uterus (complete or partial) – Normal external surface of the fundus (compared to bicornuate), incomplete resorption of the midline septum between the 2 mullerian ducts b. Arcuate uterus – slight midline septum with minimal, and often broad, fundal cavity indentation