Ask Dr. Marc......Unicornuate uterus

This question and answer was originally published on the blog clomidandcabranet.com  by Katie: "Infertility Warrior, Mommy to two, wife of rock and roller, Child and Adolescent Psychotherapist , and Parenting Expert in Los Angeles, CA"  

Dear Dr. Marc

My name is Kelly, I am 31 and my husband Simon is 39 (he has a 16 year old daughter from a previous marriage). I am currently seeing a fertility specialist and recently had cycle day three testing, ultrasound and an HSG. Upon completion it was determined that I have Diminished Ovarian Reserve and a Unicornuate Uterus on my left side (one Fallopian tube that is completely healthy on my left side as well as a good looking uterus on my left side, both ovaries although they are small). My husband had a sperm analysis done as well and his Count/Motility/Volume were more than double the normal range. So we now know that the infertility issues are due to my body alone. We have discussed our options with our Dr and have decided to go ahead with medicated IUI cycles starting in May 2013 although our Dr thinks IVF is a better option. We cannot afford to do IVF at this time, IUI is far more cost effective for us. My question is how likely am I to conceive from IUI. My Dr only gave me a 2% chance of conceiving naturally, 5% with medicated IUI and 30% with IVF each cycle. Is that accurate? Or is it possible my chances may be higher given that my husband has exceptional sperm and even though I do have DOR I am still fairly young?

I appreciate your taking the time to answer my question. Thank you in advance.

Sincerely,

Kelly

Hi Kelly,

As I see it, there are a few issues to discuss. 

First, I think it is important to recognize that infertility is NEVER due to one partner alone. Remember that making a baby is a team effort.  Just because one partner’s tests are normal and the others are not, does not necessarily mean that one person is at fault or responsible.  Further, remember that women have many more variables at play in this situation.  Men only have to have a few normal sperm; women need normal tubes, ovaries and uterus not to mention the anatomic and hormonal environment for the 9 months of pregnancy!  It really is a lot, so don’t get down on yourself!

Second, the unicornuate uterus is worth discussing.  A unicornuate uterus is due to an abnormality which occurred during embryonic development.  Simply speaking, half of the uterus did not form.  The prognosis of a unicornuate uterus can range from poor to good, but it depends a lot on the final size of the uterus.  If it is very small, pregnacy complications are common.  If it is close to normal size, the prognosis is better.  From your letter, it sounds like your uterus is of decent size so as not to be too much of a problem.  One thing I would recommend however, is that your doctor also evaluate your kidneys.  The kidneys and uterus form at near the same time during development and it is not uncommon for women with a uterine abnormality to also have a renal (kidney) abnormality.

Third, the diminished ovarian reserve (DOR) may be a bigger deal.  I assume that your doctor is basing the diagnosis on day 3 blood testing.  This usually includes follicle stimulating hormone (FSH) and estradiol (E2) levels.  I recommend that you also have your AMH and antral follicle count assessed as well.  All of these tests together will give you a more complete idea of your ovarian reserve and therefore your chances for conception.  Regardless of the results,  the fact that you are young is definitely a positive factor!

Fourth, the fact that your husband’s semen analysis is normal is a good thing.  Unfortunately, an "exceptional" semen analysis where all the measurements are well above normal does not improve chances over a "normal" semen analysis.

As far as numbers, I’d say your doctor is probably pretty accurate.  Maybe your chances are 5-10% with medicated IUI, but it really depends on your response to the medication and your ovarian reserve levels. 

The bottom line is that doing something will definitely increase your chances over doing nothing.  If you could try IVF, that would be great.   However if you cannot, then IUI is a reasonable way to go.

Good luck!

Dr. Marc