What is a bicornuate uterus? Is it possible to achieve pregnancy?

By (gynaecologist), (embryologist) and (embryologist).
Last Update: 03/06/2024

A bicornuate uterus is a uterine malformation characterized by the presence of two symmetrical uterine cavities, although the horns are not fully developed.

The cause of this type of uterus is an alteration in the fusion of the Müllerian ducts and a heart-shaped cleft is formed in the upper part of the uterus. For this reason, the bicornuate uterus is also known as a heart-shaped uterus.

Depending on whether the cleft reaches the internal and external cervical os, or only extends inside the uterus, there are two modalities: complete bicornuate uterus and partial bicornuate uterus respectively.

Depending on the severity of the severity of this uterine anomaly, the risk of miscarriage and premature delivery may be increased.

What is the bicornuate uterus?

A bicornuate uterus is a congenital uterine malformation characterized by a heart-shaped uterus divided by two partially developed horns. Therefore, the lower or caudal part of the uterus is normal; while the upper part is double.

Although bicornuate uterus is a malformation from birth, it is not hereditary. The cause of this uterine malformation is an incomplete fusion of the Müllerian ducts during embryonic development.

There are different degrees of bicornuate uterus according to the separation of the uterine necks:

  • Mild: abnormal uterine shape, but without duplicity of cervix or vagina. It is the most common uterine malformation.
  • Intermediate: there is duplication of the cervix, but not of the vagina.
  • Severe: on rare occasions, uterine duplicity occurs, so there are two uteri, two cervixes and two vaginas.

In addition, a distinction can be made between partial or complete bicornuate uterus depending on whether the cleft affects only the inside of the uterus or also the outside.

Sometimes the bicornuate uterus can be confused with the didelphic uterus, but they are different uterine malformations. The difference between a bicornuate uterus and a didelphic uterus is that the horns are not fully developed and are smaller in size.

Symptoms of bicornuate uterus

Most women with a bicornuate uterus are asymptomatic, although some of them may have painful menstruation and sexual intercourse. However, many women are not aware that they have this uterine malformation until they try to become pregnant.

Depending on the severity of the uterine cleft, some of the following problems may arise in women with a bicornuate uterus:

  • Increased risk of miscarriage.
  • Premature delivery.
  • Intrauterine growth retardation
  • Abnormality in fetal position such as breech presentation.

However, there are women with a bicornuate uterus who manage to get pregnant and deliver without any complications.

Diagnosis and treatment

As mentioned above, the bicornuate uterus is generally asymptomatic. Therefore, this uterine malformation can be difficult to diagnose without specific tests.

On most occasions, the bicornuate uterus is discovered during an ultrasound performed for other reasons. In addition, other complementary studies may be performed to confirm the diagnosis:

  • Pelvic MRI: provides detailed images of the uterus and other pelvic organs.
  • Hysteroscopy: to observe the inside of the uterus.

Women with bicornuate uterus without any symptoms do not require specific treatment. On the other hand, if there is pelvic pain, menstrual problems or difficulty in achieving pregnancy, then it would be necessary to establish a treatment.

Bicornuate uterus and possibility of pregnancy

Problems in achieving pregnancy due to the presence of a bicornuate uterus can be solved in some cases by assisted reproductive techniques. Specifically, in vitro fertilization (IVF) is a viable option for many women with this type of uterine malformation.

Given this situation, the IVF process would consist of stimulating the woman's ovaries to produce several eggs, which will be collected after ovarian puncture and fertilized in the laboratory with a seminal sample. The resulting embryos are then transferred into the uterus, with the hope that they will implant in the endometrium.

In the most severe cases of bicornuate uterus, recurrent miscarriages and gestational complications may occur. Therefore, it would be necessary to consider the option of correcting the uterine anomaly by surgery. This type of surgical procedure is known as metroplasty or hysteroplastyalthough it is rarely performed.

In any case, it is essential to perform a personalized evaluation and establish the best therapeutic option for each woman.

FAQs from users

Is it possible to get pregnant through IVF with a bicornuate uterus?

By Katharina Spies M.D. (gynaecologist).

Yes, women with a bicornuate uterus can become pregnant naturally or after assisted reproduction techniques. In both cases, closer monitoring is recommended because of the risk of miscarriage, premature birth or other complications during pregnancy.
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Is twin pregnancy possible in a bicornuate uterus?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

It would be possible for two embryos to be implanted in a bicornuate uterus, that is, each one in a uterine cavity. However, this could result in a high-risk pregnancy, with a high risk of miscarriage and premature delivery.

In the case of in vitro fertilization (IVF) treatment, it is not advisable to transfer two embryos if the woman has a uterine malformation with these characteristics.

What are the consequences of a bicornuate uterus?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

The main complications associated with this uterine malformation are related to pregnancy. Depending on the severity of the bicornuate uterus, the woman may have difficulty becoming pregnant.

In addition, the bicornuate uterus is associated with an increased risk of miscarriage, premature delivery and breech fetal presentation.

Is vaginal or cesarean delivery more frequent in women with bicornuate uterus?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

There are studies that indicate that cesarean delivery is more common in women with a bicornuate uterus. This is because there is a greater tendency for the baby to be breech, always looking for the position with more space for the head and the risk of premature delivery.

Can an IUD be inserted if the uterus is bicornuate?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

No. One of the contraindications of the intrauterine device or IUD is uterine malformations. Therefore, it is not possible to insert an IUD in women who have a bicornuate uterus.

Suggested for you

If you would like to know more information about other alterations in the shape of the uterus, we recommend you visit the following article: Uterine malformations in women: can they cause infertility?

In addition, uterine malformations can be a cause of female infertility. However, there are other reasons at the uterine level that can also cause problems conceiving. Here you have more information about it: Female infertility due to uterine factor: causes and treatment.

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Chengyan Zhang, Xiaoxin Wang, Haili Jiang, Lei Hou, Liying Zou. Placenta percreta after Strassman metroplasty of complete bicornuate uterus: a case report. BMC Pregnancy Childbirth. 2021 Jan 29;21(1):95 (View)

Hamidou Soumana Diaouga, Houegbelo Lazare Laurent, Maimouna Chaibou Yacouba, Fougou Laouane Ari Mamane, Madeleine Garba Rahamatou, Nafiou Idi, Madi Nayama. Bicornuate uterus and pregnancy: ambiguity diagnosis (a case report). Pan Afr Med J. 2022 Dec 23:43:203. doi: 10.11604/pamj.2022.43.203.32905 (View)

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Isha Agarwal, Surekha Tayade, Sakshi Sharma. A Case Report of a Normal Pregnancy in a Bicornuate Uterus Through In Vitro Fertilization. Cureus. 2022 Sep 14;14(9):e29152. doi: 10.7759/cureus.29152 (View)

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Mk Abdullahi, Ld Aliyu. BICORNUATE UTERUS MIMICKING ECTOPIC PREGNANCY - A case report. J West Afr Coll Surg. 2012 Jan;2(1):84-90 (View)

Parneet Kaur, Deepan Panneerselvam. Bicornuate Uterus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.2023 Jul 24 (View)

Teddy Ikhuoriah, David Oboh, Chiya Abramowitz, Yakubmiyer Musheyev. Bicornuate uterus: A rare case of a viable full term pregnancy in the right uterine horn. Radiol Case Rep. 2023 Apr 5;18(6):2107-2111. doi: 10.1016/j.radcr.2023.03.014 (View)

FAQs from users: 'Is it possible to get pregnant through IVF with a bicornuate uterus?', 'Is twin pregnancy possible in a bicornuate uterus?', 'What are the consequences of a bicornuate uterus?', 'Is vaginal or cesarean delivery more frequent in women with bicornuate uterus?' and 'Can an IUD be inserted if the uterus is bicornuate?'.

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Authors and contributors

 Katharina  Spies
Katharina Spies
Katharina Spies has a medical degree from a German university and is a native German speaker. In addition, she speaks other languages such as English, Spanish and French, among others. Currently, Dr. Spies is the medical director of the Vida Fertility clinic in Madrid. More information about Katharina Spies
Licence: 282867990
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
 Zaira Salvador
Zaira Salvador
B.Sc., M.Sc.
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV

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