What’s a bicornuate uterus?

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A bicornuate uterus is when the uterus is dissected into two chambers, or horns, instead of one. Also called a “heart-shaped” uterus, this shape of organ forms during the embryonic stage of development. The Muller ducts, which become the ovaries and fallopian tubes, don’t fuse properly making the lower part of the uterus appear normal while the upper part bends inward causing a malformed heart-shaped uterus.

There are different severities of a bicornuate uterus from a partial bicornuate, in which only part of the upper portion dips into the chamber, to a complete bicornuate, in which the entire upper portion bends, creating two chambers.

Many women don’t even realize they have a bicornuate uterus until they try to get pregnant. While definitely not related to infertility, this shape of the uterus can make pregnancy difficult and place a woman in a high-risk category if she does conceive. These women are often told they will have difficulty conceiving, if at all, and are at high risk of miscarriage (63%) and premature birth (15-25%). Because a two-chambered uterus has less room than a normally shaped uterus, the chance of a baby being born breech increases in a partial bicornuate to 40-50%.

A bicornuate uterus is usually detected during an initial ultrasound during pregnancy if it hasn’t been detected previously. It can also be detected through an MRI.
It is estimated that the presence of a bicornuate uterus occurs in approximately 0.1-05% of women living in the United States. It should be noted that this is probably an understatement, as many cases go undetected.

Some symptoms experienced by women who have this type of uterus include abdominal pain, heavy or irregular menstrual periods, and painful ovulation. Women with these symptoms should alert their doctors and ask for an ultrasound to rule out the possibility of a bicornuate uterus.

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