Müllerian Duct Anomalies: Role in Fertility and Pregnancy

Mark Sugi, Rubal Penna, Priyanka Jha, Liina Pōder, Spencer C. Behr, Jesse Courtier, Evelyn Mok-Lin, Mok-Lin E, Joseph T. Rabban, Rabban JT, Hailey H. Choi, Choi HH
Radiographics : a review publication of the Radiological Society of North America, Inc · 2021 · vol. 41(6) , pp. 1857–1875 · doi:10.1148/rg.2021210022 · PMID:34597219 · W3203833734
Review OA: closed CC0 ⤵ 2 in-corpus citations
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This review discusses the impact of Müllerian duct anomalies on female fertility and pregnancy outcomes, highlighting their role in recurrent pregnancy loss and assisted reproductive technologies.

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Abstract

Müllerian duct anomalies (MDAs) have important implications for the reproductive health of female patients. In patients with both infertility and recurrent pregnancy loss, the incidence of MDAs is as high as 25%. Congenital uterine anomalies are often only part of a complex set of congenital anomalies involving the cervix, vagina, and urinary tract. Multiple classification systems for MDAs exist, each with different criteria that vary most for the diagnosis of septate uterus. Recognizing the features that guide clinical management is essential for interpretation. Identification of an MDA should prompt evaluation for associated urinary tract anomalies. In patients with infertility who seek to use assisted reproductive technologies such as intrauterine insemination, recognition of MDAs may have an affect on reproductive success, particularly in patients who have an incomplete and clinically occult septum that divides the cervix. Two-dimensional US is the first-line modality for evaluating the uterus and adnexa. Three-dimensional (3D) US or MRI may help to visualize the external uterine fundal contour and internal indentation of the endometrial cavity, which are two morphologic characteristics that are keys to the diagnosis of congenital uterine anomalies. Hysterosalpingo contrast-enhanced US may be performed in conjunction with 3D US to evaluate uterine morphologic characteristics, the endometrial cavity, and tubal patency in a single examination. MRI helps to characterize rudimentary uteri in patients with müllerian hypoplasia and allows assessment for ectopic ureters, abnormally positioned ovaries, or associated deep infiltrative endometriosis. Online supplemental material is available for this article. ©RSNA, 2021.

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MeSH descriptors

Mullerian Ducts Mullerian Ducts Mullerian Ducts Urogenital Abnormalities Urogenital Abnormalities Urogenital Abnormalities Cervix Uteri Cervix Uteri Cervix Uteri Female Female Fertility Fertility Humans Humans Pregnancy Pregnancy Uterus Uterus Uterus

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