A normal uterus has a pear-shaped form and is located at the center of the pelvis. However, in the case of a bicornuate uterus, the uterine fundus collapses downward, resulting in a saddle-shaped configuration. This condition occurs due to incomplete fusion of the two Müllerian ducts during the developmental process, leading to the presence of saddle-shaped tissue at the top. Bicornuate uterus presents with two horns and not only exhibits abnormal external appearance but also has a smaller uterine cavity volume. This condition can cause reduced menstrual flow, irregular menstrual cycles, recurrent early and late miscarriages, and various pregnancy failures, including infertility, biochemical pregnancies, and ectopic pregnancies.
Bicornuate uterus can be visualized through laparoscopy or laparotomy as it relates to the external shape of the uterus. Clinically, it is classified into two types: the first type is the large uterine septum within the uterine cavity, which can be restored to normal by removing the septum; the other type is the bicornuate uterus (unfused bicornuate uterus), which can be normalized after surgical fusion.
Diagnosis usually relies on comprehensive techniques such as panoramic four-dimensional color Doppler ultrasound, dynamic digital hysterosalpingography, hysteroscopy, and laparoscopy. The treatment after a confirmed diagnosis is of utmost importance. However, for bicornuate uterus, undergoing in vitro fertilization (IVF) is not recommended. Despite normal eggs and sperm, the abnormal uterine shape decreases the success rate of IVF and imposes unnecessary financial and emotional burdens.
The most effective treatment approach is the hysteroscopic surgery. For the septate-type bicornuate uterus, the uterine septum is cut and a pear-shaped stent and bioresorbable adhesion barrier are placed under laparoscopic guidance. After the procedure, the endometrium can grow normally, the uterine shape returns to normal pear-shaped, and the uterine cavity volume becomes normal. This not only allows for normal pregnancies but also prevents miscarriages.
At Beijing Antai Hospital, a contracted treatment approach is taken for bicornuate uterus, with a full refund offered if the treatment goal is not achieved. Therefore, it is strongly recommended to avoid opting for IVF as a treatment for this uterine anomaly. The root cause lies within the uterus, not the ovaries, and certainly not the male partner’s sperm. The uterus serves as the cradle for fetal development; hence, if the uterus is abnormal, the outcome of IVF is often futile. IVF merely combines eggs and sperm and places them in the uterine cavity, without guaranteeing satisfactory pregnancy results. Thus, it not only incurs financial costs but also fails to achieve desired pregnancy outcomes.