Frequency of Congenital Uterine Anomalies in Women with Infertility

Abstract

Congenital uterine anomalies are developmental malformations of the Müllerian ducts that may impair implantation, fertility, and subsequent obstetric outcomes. Their burden among infertile women remains underreported in local clinical settings, making routine uterine assessment an important component of infertility evaluation. Objective: To determine the frequency and types of congenital uterine anomalies among women presenting with infertility at a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Lady Willingdon Hospital, Lahore, from June 2025 to August 2025. A total of 104 women of reproductive age presenting with primary or secondary infertility were enrolled through non-probability consecutive sampling. Women with other identifiable causes of infertility, including uterine fibroids, ovarian cysts, tubal blockage, male-factor infertility, previous uterine surgery, and significant systemic comorbidities, were excluded. Demographic and clinical data were collected using a structured proforma. All participants underwent two-dimensional transvaginal ultrasonography followed by hysterosalpingography for assessment of uterine morphology. Congenital uterine anomalies were classified according to the American Fertility Society classification system. Data were analyzed using SPSS version 25.0, and post-stratification analysis was performed using chi-square or Fisher’s exact test, with p≤0.05 considered statistically significant. Results: The mean age of participants was 31.4±6.2 years, and the mean BMI was 27.3±5.1 kg/m². Primary infertility was observed in 62 women (59.6%), while 42 women (40.4%) had secondary infertility. The mean duration of infertility was 4.7±3.1 years. Congenital uterine anomalies were identified in 7 women, giving an overall frequency of 6.73% (95% CI: 2.73%–13.31%). Septate uterus was the most common anomaly, observed in 3 affected women (42.9%), followed by bicornuate uterus in 2 (28.6%), arcuate uterus in 1 (14.3%), and unicornuate uterus in 1 (14.3%). Among women with congenital uterine anomalies, primary infertility was more common than secondary infertility (71.4% vs. 28.6%), although this association was not statistically significant (p=0.699). Family history showed a significant association with congenital uterine anomalies, with a higher frequency among women with positive family history than those without it (21.1% vs. 3.5%; p=0.020). Conclusion: Congenital uterine anomalies were present in a clinically meaningful proportion of infertile women, with septate uterus being the most frequent anomaly. A positive family history was significantly associated with congenital uterine anomalies. These findings support the integration of routine uterine structural assessment into infertility workup to facilitate early diagnosis, counseling, and timely management of potentially correctable anomalies.