Philippine E-Journals

Shapeshifter: Müllerian Anomalies and Infertility

Nicole Angela A. Domingo | Regta L. Pichay

 

Abstract:

Müllerian anomalies are congenital anomalies involving the fallopian tubes, uterus, cervix, and vagina. They are an important structural cause of abnormal uterine bleeding and infertility. The appropriate management of infertile women with different forms of these anomalies remains challenging. Misdiagnosis leads to inappropriate interventions, hence, diagnostic accuracy for these anomalies is paramount. This is a case of a 34-year-old nulligravid who initially sought consult at our outpatient department for profuse vaginal bleeding, and was admitted for correction of severe anemia. Her history revealed her desire for pregnancy. Her past medical history revealed infertility for five years and that she was a diagnosed case of uterus didelphys. Diagnostic work-up was done including transvaginal sonography, saline infusion sonohysterogram, hysterosalpingogram, and pelvic MRI, revealing different diagnoses namely: uterus didelphys, a bicornuate uterus with a functional left horn, and a unicornuate uterus with a rudimentary functional left horn. She was maintained on lynestrenol 500mcg/tab once a day to achieve glandular atrophy prior to surgery. Laparoscopy was done which confirmed the diagnosis of a unicornuate uterus with a rudimentary functional left horn, along with a congenitally absent kidney and ureter ipsilateral to the rudimentary horn. This case report tackles the importance of establishing a correct diagnosis when dealing with müllerian anomalies especially since the primary target population would be women desirous of pregnancy, and the correct intervention could make all the difference.