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THE DIFFERENCE BETWEEN A BICORNUATE UTERUS AND A SEPTUM


BY FRED LICCIARDI , MD


This is an issue I have been dealing with since the start of my practice. It's the identical story over and over again. I came across the same thing 2 times this month. The issue is far from trivial because the proper diagnosis will change the method of treatment. Delayed diagnosis (sometimes for years) will delay and sometimes prevent pregnancy.


OK, what's a bicornuate uterus? A bicornuate uters is an abnormality in the way the uterus is shaped. It does not develop; some women are born with them. Uterine and/or vaginal abnormalities that are present from birth are lumped into a category of Mullerian Abnormalities. There are many different varieties, and all are rare.


In a girl embryo, the uterus starts as 2 tubes that merge together to form a larger hollow structure. If the 2 tubes do not completely come together, a bicornuate uterus develops. It is a uterus with 2 horns , one going out to the left and one going out to the right.


This is a very general description. There are tons of variations. Some bicornuate uteri have larger horns and are not connected in the middle, and others are


mostly connected in the middle with just a small amount sticking out as horns.


Here's the rub. I have seen many patients who were told they have bicornuate uteri but their real diagnosis was a septum. This mistake has happened even if the patient had a HSG, 3-d ultrasound, 3-d sonohysterogram, MRI or even hysteroscopy.


So what? It's a big what. The uterus with the septum is smooth over the top. The bicornuate dips at the top, sometimes considerably.


The reason it is vital to know your diagnosis has to do with treatment. If you have a septum, most (not all) doctors would recommend treatment. This is because an experienced reproductive surgeon can fix a septum relatively easily. It's done through the vagina using a hysteroscope. The doctor looks in, then slides a tiny scissors through the scope and makes small cuts at the septum until it is gone, making the uterus normally shaped. Some doctors will recommend a laparoscopy at the same time to guide themselves through the surgery. Others will perform the surgery using the


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