Simultaneous Natural Conception in a Rudimentary Horn and ICSI Pregnancy in a Unicornuate Uterus Managed by Fetocide with Successful Preterm Delivery: A Case Report

Bashir Adam M, Shera MA, A Nadkarni
In: International Journal of Women's Health, Vol Volume 18, Iss Issue 1, Pp 1-8 (2026) · 2026 · W7139826421
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This case report describes a 39-year-old woman with primary infertility and multiple intramural fibroids who conceived simultaneously via natural conception (rudimentary horn pregnancy) and donor oocyte ICSI (intrauterine pregnancy) in the setting of a congenital uterine anomaly. Early transvaginal and three-dimensional ultrasound identified a unicornuate uterus with a non-communicating rudimentary horn, and at 12 weeks ultrasound-guided fetocide with potassium chloride was performed for the rudimentary horn, while the intrauterine pregnancy progressed without reported complications to a cesarean delivery at 34 weeks of a healthy neonate. A key limitation is that, as a single-patient case report, it cannot establish generalizable effectiveness or safety. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Mohamed Bashir,1 Mohsin Ashraf Shera,2 Aditi Nadkarni2 1Department of Obstetrics and Gynaecology, Jubba Hospital, Mogadishu, Somalia; 2Department of Obstetrics and Gynaecology, Nadkarni’s 21st Century Hospitals, Vapi, GJ, IndiaCorrespondence: Mohamed Bashir, Department of Obstetrics and Gynaecology, Jubba Hospital, Mogadishu, Somalia, Tel +252 615 524 092, Email [email protected]: Simultaneous intrauterine and rudimentary horn pregnancies are exceedingly rare, particularly when one arises from assisted reproduction and the other naturally. Early diagnosis is essential to prevent life-threatening complications, such as rudimentary horn rupture. Careful ultrasound evaluation is critical to detect subtle congenital uterine anomalies that may otherwise go unrecognised.Case Presentation: A 39-year-old woman with primary infertility and multiple intramural fibroids conceived naturally and via intracytoplasmic sperm injection (ICSI). Her 43-year-old husband had oligo-astheno-teratozoospermia. After myomectomy and counselling, she underwent donor oocyte ICSI with her husband’s sperm; the second cycle resulted in conception. Four weeks later, a transvaginal ultrasound confirmed a viable intrauterine pregnancy. At seven weeks, a second gestational sac was noted in the rudimentary horn. Three-dimensional ultrasound confirmed a unicornuate uterus with a non-communicating rudimentary horn unconnected to the cervical canal or main cavity. At 12 weeks, ultrasound-guided fetocide was performed using 0.2 mL of potassium chloride. The intrauterine pregnancy progressed uneventfully, culminating in a cesarean delivery at 34 weeks of a healthy female neonate weighing 2.3 kg. Both mother and infant remained well at the six-week follow-up.Conclusion: This case illustrates the rare coexistence of a natural rudimentary horn pregnancy and an ICSI-conceived intrauterine pregnancy in a unicornuate uterus. It highlights the importance of detailed, high-resolution imaging, vigilant antenatal surveillance, and timely multidisciplinary management to ensure favourable maternal and fetal outcomes.Keywords: unicornuate uterus, rudimentary horn pregnancy, ICSI, fetocide, assisted reproduction, twin gestation anomaly
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International Journal of Women's Health (Mar 2026) Simultaneous Natural Conception in a Rudimentary Horn and ICSI Pregnancy in a Unicornuate Uterus Managed by Fetocide with Successful Preterm Delivery: A Case Report Abstract Mohamed Bashir,1 Mohsin Ashraf Shera,2 Aditi Nadkarni2 1Department of Obstetrics and Gynaecology, Jubba Hospital, Mogadishu, Somalia; 2Department of Obstetrics and Gynaecology, Nadkarni’s 21st Century Hospitals, Vapi, GJ, IndiaCorrespondence: Mohamed Bashir, Department of Obstetrics and Gynaecology, Jubba Hospital, Mogadishu, Somalia, Tel +252 615 524 092, Email [email protected]: Simultaneous intrauterine and rudimentary horn pregnancies are exceedingly rare, particularly when one arises from assisted reproduction and the other naturally. Early diagnosis is essential to prevent life-threatening complications, such as rudimentary horn rupture. Careful ultrasound evaluation is critical to detect subtle congenital uterine anomalies that may otherwise go unrecognised.Case Presentation: A 39-year-old woman with primary infertility and multiple intramural fibroids conceived naturally and via intracytoplasmic sperm injection (ICSI). Her 43-year-old husband had oligo-astheno-teratozoospermia. After myomectomy and counselling, she underwent donor oocyte ICSI with her husband’s sperm; the second cycle resulted in conception. Four weeks later, a transvaginal ultrasound confirmed a viable intrauterine pregnancy. At seven weeks, a second gestational sac was noted in the rudimentary horn. Three-dimensional ultrasound confirmed a unicornuate uterus with a non-communicating rudimentary horn unconnected to the cervical canal or main cavity. At 12 weeks, ultrasound-guided fetocide was performed using 0.2 mL of potassium chloride. The intrauterine pregnancy progressed uneventfully, culminating in a cesarean delivery at 34 weeks of a healthy female neonate weighing 2.3 kg. Both mother and infant remained well at the six-week follow-up.Conclusion: This case illustrates the rare coexistence of a natural rudimentary horn pregnancy and an ICSI-conceived intrauterine pregnancy in a unicornuate uterus. It highlights the importance of detailed, high-resolution imaging, vigilant antenatal surveillance, and timely multidisciplinary management to ensure favourable maternal and fetal outcomes.Keywords: unicornuate uterus, rudimentary horn pregnancy, ICSI, fetocide, assisted reproduction, twin gestation anomaly

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