In Vitro Fertilization Outcomes in Women with Mullerian Anomalies: Revisiting the Controversy

Objective It is well known that uterine anomalies are associated with higher rates of obstetrical complications, but only few studies have focused on in vitro fertilization (IVF) outcomes in these patients, showing conflicting results. The aim of this study was to determine whether uterine anomalies are associated with decreased rates of embryo implantation and clinical pregnancy cycles in IVF.

Study design A retrospective cohort study performed between 2006-2016. Medical records were screened to identify mullerian anomalies. Only the first cycles of patients with a definitive diagnosis and available fresh embryos to transfer were included. Implantation rates (IR) and clinical pregnancy rates (CPR) were compared between the anomalies group to age & period matched controls with anatomically normal uteri.

Results 34 patients with the following types of congenital uterine malformation were included in the final analysis: 7 arcuate, 12 unicomuate, 12 bicornuate, 1 uterus didelphy and 2 T-shape uteri. Mean patients age was comparable in both groups (35.26 vs 35.21), so as body mass index (p=0.27) and follicular stimulating hormone (FSH) day 3 (p=0.19). The mean number of retrieved oocytes was 7.91 in the anomalies group vs 8.76 in control group (p=0.321). IR was comparable between the groups (18% vs 12%, p=0.417), so as the number of embryos transferred (1.88 vs 2.06, p=0.394). CPR and live birth rate were also comparable between the groups: 41.2% vs 26.5% (p=0.15) and 23.5% vs 11.8% (p=0.17), respectively.

Conclusion When compared to women with normal uterine anatomy, women with uterine anomalies undergoing IVF have comparable IR and CPR. Our findings may be of vital importance when providing preconceptional counseling to women with uterine anomalies.