Molecular Basis of Mullerian Agenesis Causing Congenital Uterine Factor Subfertility- a Systematic Review

Abstract: Infertility affects around 1 in 5 couples in the world. Congenital absence of the uterus results in absolute infertility in females. Mullerian agenesis(MA) is the nondevelopment of the uterus. Mayer-Rokitansky-Küster-Hauser(MRKH) syndrome is a condition of uterovaginal agenesis in the presence of normal ovaries and 46 XX Karyotype. With the advancement of re-productive techniques, having a biological offspring in women with MA is possible. The exact etiology of MA is unknown although several genes and mechanisms affect the development of Mullerian ducts. Through this systematic review of the available literature, we searched for the genetic basis of MA. The aims included identification of the genes, chromosomal locations, changes responsible for MA, and fertility options, in order to offer proper management and counseling to these women with MA. A total of 85 studies were identified through searches. Most of the studies identified multiple genes at various locations although the commonest in-volved chromosomes 1, 17, and 22. There is also conflicting evidence of the involvement of var-ious candidate genes in the studies. The etiology of MA seems to be multifactorial and complex involving multiple genes, and mechanisms including various mutations and mosaicism.