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The prevalence of uterine anomalies and their impact upon early pregnancy in women conceived following assisted reproduction treatment.
MedLine Citation:
PMID:  21337662     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 1392 subjects undergoing ART over a period of 5 years from 2004 - 2009. Three-dimensional transvaginal scan was performed in the early follicular phase of the menstrual cycle (day 2-5) and repeated in the late follicular phase (day 10-14) if the shape of the uterine cavity could not be assessed in the first scan. All subjects who conceived following ART was followed up to 12 weeks of gestation. The Chi-square test was used to compare the pregnancy rates and miscarriage rates between women shown to have uterine anomalies and those with normal uteri. RESULTS: 1385 subjects were included for final analysis after excluding after excluding 17 subjects in whom a definitive diagnosis could not be made. Whilst 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%), subseptate (n = 5; 0.4%), unicornuate (n = 6; 0.4%), bicornuate (n = 1; 0.1%) and T-shaped uteri (n = 1; 0.1%). A total of 440 subjects who underwent ART have been followed up. The pregnancy rates in women with arcuate uteri (55%; 36/66) and major uterine anomalies (70%; 7/10) were statistically similar (P = 0.09 and P= 0.11 respectively) to that of the matched controls with normal uteri (43.4%; 158/364). While first trimester miscarriage rates were similar (P = 0.81) between the control group (12.7%; 20/158) and women with arcuate uteri (13.9%; 5/36), women with major uterine anomalies experienced a higher miscarriage rate (42.9%; 3/7; 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 were not associated with a reduction in pregnancy 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.
Authors:
K Jayaprakasan; Y Y Chan; S Sur; S Deb; J S Clewes; N J Raine-Fenning
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-18
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Nottingham University Research and Treatment Unit in Reproduction (NURTURE), Division of Human Development, School of Clinical Sciences, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom NG7 2UH. k.jayaprakasan@nottingham.ac.uk.
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