Unicornuate Uterus

Jared and I decided in October/November 2007 that we would like to start a family. I had been on birth control for the last ten or so years, so figured it would take a few months to get that out of my system. I began to monitor my monthly cycles….which haven’t been very consistent my entire life. So I started writing it down each month, and my cycles would range from 32 days to 45 days. It made it so every month I would get excited when my cycle didn’t come in the 32 day range….and I kept thinking that would be my lucky month, and we might have conceived. Month after month of being let down, I approached my OBGYN who I have been seeing since I was young. She didn’t appear to be concerned and at one point along the way I decided it was time to switch doctors, I wanted someone a little bit more interested in my well being and helping me along the way. The minute I made the change, the new doctor was very proactive in helping me try to figure out what was going on. She looked over all my records, my monthly cycles, etc. She didn’t have any doubt that we were monitoring things accurately and seemed interested in pushing it a bit further to make sure everything was okay.

In July 2008 I went to see my regular physician about a serious left side pain I was having, it was a constant pain that lasted for six straight days. He sent me in for a CT scan and they found an ovarian cyst – not a big one, and I was told it was normal and I had nothing to worry about. I made sure that my new OBGYN was aware of this issue, and it didn’t seem to concern her, but we still hadn’t conceived so she decided I needed to go see a radiologist to see what he could tell me.

In October 2008 I went in for a Hysterosalpingogram (HSG) which is an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them. It often is done for women who are having a hard time becoming pregnant (infertile). During the HSG, a dye (contrast material) is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. An HSG also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.

The day of my exam, the radiologist told me that the dye went through my right fallopian tube, very fast and my uterus appeared to be tilted to the right, but because of how quickly it all happened, he couldn’t see if my left fallopian tube was open or not. He didn’t seem all that concerned and sent me on my way. He also sent the reports to my OBGYN who called me with the results, saying my uterus was tilted, etc. and that it was fairly normal and we had nothing to worry about.

In the meantime, Jared went in for a sperm analysis and his results came back normal, so at this point it was determined that we were both totally capable of creating a child. After all the results were in, my OBGYN decided that she wanted me to begin taking a pill called “Clomid” or “Clomiphene Citrate” The goal of clomiphene therapy in treating infertility is to establish normal ovulation rather than cause the development of numerous eggs. Once ovulation is established, there is no benefit to increasing the dosage further. Numerous studies show that pregnancy usually occurs during the first three months of infertility therapy and treatment beyond six months is not recommended. Clomiphene can cause side effects such as ovarian hyperstimulation (rare), visual disturbances, nausea, diminished "quality" of the cervical mucus, multiple births, and others. I was told I could only take the clomid for three months and if nothing came from that, we would discuss my options at that point. I was extremely hesitant to take a pill – I am not sure I can entirely explain why. I wasn’t really worried about the side effects, but I just truly felt that I shouldn’t have to go through all this work to have a baby, I felt it was something that should just happen naturally. At this point though, I felt we had tried the natural way for so long, that maybe this was a necessary step. So I went ahead with the pills. By mid February 2009, I had finished my third and final cycle of clomid, and still had not conceived.

My OBGYN at this point referred me on to a fertility specialist. My first scheduled appointment was on February 24th, she went over my background/history and didn’t seem to have any concerns, although my doctor hadn’t sent the radiology films from the HSG I had done the prior year. She wanted to take a look at those before she could determine anything else. I left her office not feeling like the appointment was very effective, I mean she sent me home with some information but I was still feeling a bit empty. After leaving her office that day, I called the doctor and had them forward the films to the fertility specialist. I received a phone call first thing March 2nd, on a Monday morning from the specialist telling me she was extremely concerned about the films she received. She said that after carefully examining them and having another doctor examine them for a second opinion, she felt there was more going on with my uterus than I had been told. She said she thought I had something of a mullerian anomaly called a “unicornuate uterus”. She quickly explained it basically meant she thought I only had half of my uterus but wanted me to go in that week for a pelvic MRI to get a closer look at what was going on.

Friday March 6th I went in to have the MRI done. The MRI was totally painless, just very loud – sounded like a jackhammer all around me for about 30 minutes. The technician didn’t give me any information, other than the results would be sent to my doctor and she would have them first thing Monday morning.

Tuesday March 10th I had an appointment at 3pm to discuss the results of the MRI. As it turned out, the fertility specialist was correct in her readings. The MRI found that I only have half of my uterus. Meaning, I only have my right fallopian tube, I was born without a left one. I do however have both my left and right ovaries, although without a left fallopian tube, when I ovulate each month, if I ovulate on the left side, the egg has no fallopian tube to get to, so the egg basically goes away. I also learned that a regular woman’s uterus is about the size of her fist. Because I only have half a uterus, my uterus is half the size of a normal person’s. Basically for me, this means that when/if I do conceive, the baby won’t have as much room to grow and move around.
Having a unicornuate uterus first and foremost is an extremely rare and uncommon thing to have and unfortunately brings a significant risk of pregnancy loss and preterm labor, as well as ectopic pregnancy. Estimates vary by specific study, but one literature review found pregnancy outcomes in women with unicornuate uteri to be miscarriage in 37%, preterm birth in 16%, and term birth in only 45%. Doctors believe the miscarriage risk is due to abnormalities in the blood supply of the unicornuate uterus that might interfere with the functioning of the placenta (or increase the odds of implantation in the tube). The risk of preterm labor is thought to be because of space restrictions, because a unicornuate uterus is smaller than a typical uterus, the growth of the baby might trigger early labor.

What this means for me is that if/when I do get pregnant, I will be referred to a high risk pregnancy specialist who will closely monitor me and the pregnancy throughout.
It has also been suggested that Jared and I try “artificial insemination” at the time of ovulation, as the chances of getting pregnant that way would increase rather than trying on our own. I have an appointment this Friday March 20th to see if I am ovulating and on which side. If I happen to be ovulating on the right side, then getting pregnant should be much easier. However, if I am only ovulating on the left side, well then we have to wait until the next month to try again. We have decided to hold off on the artificial insemination because I am actually going on April 7th to meet with another fertility specialist at OHSU to see what more he can tell me and if I like him better than my current specialist. Once I have the second opinion, we believe it might be easier to make decisions as to what we want to do.

As for now, it is a waiting game, yet we are very fortunate that we have an answer as to what is going on. However, it brings a whole new set of fears that we will just have to face as the time comes. I will keep updating my blog as I learn more for those that are interested. Thanks for all the love and support….we really appreciate it!