The uterus, also called the womb, is a pear-shaped reproductive organ in the pelvic cavity. This structure is around a hollow, thick organ with muscular walls. The lower third of the uterus (cervix) opens into the vagina. The upper part of the uterus is the fundus, which is where a fertilized egg develops into a fetus. Any problem with the uterus can affect pregnancy, and many uterine conditions produce symptoms.
Abnormal Uterine Position
When the uterus leans forward and protrudes over the top of the bladder, it is considered anteflexed or anteverted. A uterus that tilts back is called a retroverted uterus, meaning it leans away from the bladder. Approximately 1 in 6 women have a tilted uterus, which does not usually affect the chances of getting pregnant.
A few women (1-5%) have a uterus that is structurally abnormal, which is called a uterine abnormality. An abnormal uterus can cause late miscarriage. While it depends on the extent of the abnormality, uterine abnormalities do not usually affect the ability to become pregnant. The categories of uterine abnormalities include:
Agenesis – With this rare condition, the vagina does not form properly or is unusually short. With agenesis, the uterus is either really small or did not form at all. This condition is usually diagnosed when an adolescent begins her menses. Agenesis of the uterus can make sex uncomfortable and is usually treated with surgery.
Uterus didelphys – With this condition, the uterus has two inner cavities. Each cavity may or may not have its own cervix and vagina. Uterus didelphys is uncommon and affects only 1 in 350 women. It is possible to conceive with this condition.
Uniconuate uterus – When the uterus is half the size of a normal uterus and there is only one fallopian tube, it is called a uniconuate uterus. This rare abnormality affects only 1 in 1,000 women, and it develops during the early stages of life. Most women with this condition have two ovaries, but only one will connect to the uterus. Women with a uniconuate uterus can conceive but have a higher risk for miscarriage.
Bicornuate uterus – With this condition, the uterus is heart-shaped instead of pear-shaped. Only 1 in 200 women have a bicornuate uterus, which has a deep indentation at the top. Women are at higher risk for miscarriage with this condition, but pregnancy is possible.
Septate uterus – The inside of the uterus is divided by a fibrous or muscular wall, which is called the septum. A septate uterus occurs in 1 in 45 women, and the septum may extend only partially into the uterus, or it can reach as far as the cervix (called a complete septate uterus).
Arcuate uterus – This uterus is normal appearing, but it has a slight indentation at the upper portion. This common abnormality affects 1 in 25 women, and it does not affect pregnancy.
Diagnosis of Uterine Problems
If you experience problems with fertility, the doctor may conduct an evaluation to assess your reproductive organs and structures. Testing involve:
A 3-D ultrasound – Uses ultrasonic sound waves and visual images to assess for structural abnormalities.
Magnetic resonance imaging (MRI) scan – Uses strong magnetic fields and radio waves to develop detailed images of the reproductive structures.
Hysterosalpingography (HSG) – This test involves injecting dye into the uterus and fallopian tubes to assess for blockage and patency.
Laparoscopy – This minor procedure allows the doctor to insert a small scope with camera into the pelvic cavity.