Uterine malformation: causes, fertility impact and pregnancy options

How congenital uterine anomalies can affect fertility and pregnancy – and which diagnostic and treatment options are available today.

Being diagnosed with a uterine malformation often raises many questions, especially for women or couples who are trying to conceive. Concerns about fertility, miscarriage risk or the ability to carry a pregnancy to term are common and entirely understandable.

Modern reproductive medicine allows for precise diagnosis and an individualized assessment of fertility and pregnancy prospects. This article provides clear, evidence-based information on uterine malformations, their causes, their impact on fertility and pregnancy, and the treatment options available at Kinderwunschzentrum Dresden.

What Is a Uterine Malformation?

Medical Definition

A uterine malformation is a congenital structural variation of the uterus resulting from incomplete or altered development of the Müllerian ducts during embryogenesis. These ducts normally fuse and form the uterus, fallopian tubes, cervix and upper vagina.

If this process is disrupted, different uterine anomalies may develop, affecting the shape, size or internal cavity of the uterus.

How Common Are Uterine Malformations?

Epidemiological data indicate that:

• Approximately 4–7% of women have a congenital uterine malformation
• The prevalence rises to 8–10% among women with infertility
• Up to 15% of women with recurrent miscarriages have an underlying uterine anomaly

These figures highlight the clinical relevance of uterine malformations in fertility medicine.

Types of Uterine Anomalies

Not all uterine malformations affect fertility or pregnancy outcomes in the same way. The exact type is crucial for prognosis and treatment decisions.

Septate Uterus

A septate uterus is characterized by a fibrous or muscular septum dividing the uterine cavity partially or completely.

Clinical relevance:

• Increased risk of miscarriage
• Reduced implantation potential

This is one of the most common and most treatable uterine malformations.

Bicornuate Uterus

A bicornuate uterus has two partially separated uterine cavities with a single cervix.

Possible effects:

• Fertility often preserved
• Higher risk of preterm birth
• Abnormal fetal positions

Surgical correction is rarely required.

Unicornuate Uterus

A unicornuate uterus develops from only one Müllerian duct, resulting in a smaller, single-sided uterus.

Medical implications:

• Reduced uterine volume
• Increased risk of miscarriage and preterm birth
• Pregnancy is possible but requires close monitoring

Uterus Didelphys

In uterus didelphys, two separate uterine cavities and often two cervices are present.

Clinical considerations:

• Fertility is often maintained
• Pregnancy complications may occur
• Individualised obstetric care is essential

Associated Organ Anomalies

Because the reproductive and urinary systems develop closely together, uterine malformations may be associated with:

• Kidney anomalies
• Ureteral variations

Additional diagnostic imaging is therefore often recommended.

Can a Uterine Malformation Cause Infertility?

A uterine malformation does not automatically lead to infertility. Many women conceive naturally. However, depending on the type and severity, implantation difficulties or early pregnancy loss may occur.

Key influencing factors include:

• Type of uterine anomaly
• Blood supply to the endometrium
• Size and shape of the uterine cavity
• Presence of associated conditions

Uterine Malformation and Pregnancy

A uterine malformation during pregnancy may increase the risk of:

• Miscarriage
• Preterm delivery
• Fetal growth restriction
• Breech or transverse fetal position
• Need for cesarean section

The individual prognosis varies greatly and depends on the exact anatomy.

How Are Uterine Malformations Diagnosed?

Accurate diagnosis is essential for optimal counseling and treatment planning. Common diagnostic tools include:

• Transvaginal ultrasound
• 3D ultrasound
• Pelvic MRI
• Hysteroscopy
• Laparoscopy in selected cases

Accurate classification is essential for treatment decisions and assessing the prognosis.

Treatment Options for Uterine Malformations

Surgical Correction

Surgery is not required for every uterine anomaly. It is considered when:

• A septate uterus is present
• Recurrent miscarriages have occurred
• Implantation failure persists

Hysteroscopic septum resection is minimally invasive and supported by strong clinical evidence.

Prognosis and Success Rates

Clinical studies and registry data indicate:

• Significant improvement in live birth rates after septum resection
• Many women with uterine malformations achieve successful pregnancies
• Personalised care reduces pregnancy complications

A uterine malformation does not mean that having a child is impossible.

Emotional Aspects of a Uterine Malformation Diagnosis

Receiving this diagnosis can trigger feelings of fear, grief or uncertainty. It is important to emphasise that uterine malformations are congenital and not caused by lifestyle or personal behavior.

Clear medical information, empathetic counseling and a realistic perspective often help patients regain confidence and emotional stability during fertility treatment.

FAQ – Common Questions About Uterine Malformations

Can you get pregnant with a uterine malformation?

Yes. Many women conceive naturally. The chances depend on the specific anomaly.

Does a uterine malformation increase miscarriage risk?

With certain anomalies, yes—especially with pronounced changes. Treatment can reduce the risk.

Is surgery always necessary?

No. Surgery is only recommended when there is clear medical benefit.

How is a uterine malformation confirmed?

Through advanced imaging such as 3D ultrasound, MRI, hysteroscopy and laparoscopy.

A uterine malformation does not define your fertility future — schedule a personal consultation.

With modern diagnostics, individualised treatment and compassionate care, many women achieve a healthy pregnancy.

Book your consultation via Doctolib at Kinderwunschzentrum Dresden and take the next step with clarity and confidence.