The Uterus, Abnormalities and What’s Normal



It was a bit of a letdown when a doctor told me that the anteverted uterus was common…very common in fact. I have one. And that meant that lots of women with that shape of womb conceive and carry babies to term.

But I do remember that there was a TTC friend, who told me she had been diagnosed with an anteverted uterus, and that was the reason she was still TTC. Given the doctor’s diagnosis and my own scan, I knew there was something else at stake; it couldn’t just be the positioning of her uterus.

And as it turned out, there was a lot more at stake; like a male factor infertility, which was only discovered several years into their journey, as her DH had refused to go for a test. His reason? Just a year before they got married, he had “mistakenly” impregnated a lady, who went on to give birth to a baby boy. So, there was no way he could have a problem, not when he had proven his virility so recently.

At the end of the day, when the issues on both sides were addressed, the couple went on to have a baby of their own, and are currently pregnant with another baby. Mind you, it’s still the same uterus, which had been labelled faulty by another doctor, that she is still using.

The uterus is like the raison d’etre of the female reproductive cake. From the moment the embryo swims into it’s terrain and implants, the womb takes on a job that sees it expanding and growing in shape and size, from a tiny part of the body to accommodating a whole human being, albeit a miniature version, but a human being nonetheless.

The uterus has three layers: the inner lining (endometrium); the middle muscular layer (myometrium); and the outer layer (perimetrium). The uterus is connected to the fallopian tubes, the cervix, and (via the cervix) the vagina.

In as much as lots of women have normal shaped uterus, some women have  congenital uterine abnormalities, which is when the uterus didn’t develop as it should, even before the women were born. We will be discussing some of the different shapes of the uterus in this article, their chances of conception and live birth.


What is normal?


A regular uterus:

The uterus is an inverted pear shaped muscular organ located in the middle of the female pelvis. A regular uterus is about 7.5cm long, 5cm wide and 2.5cm deep. Inside, it is hollow (that’s where the baby stays) with thick, muscular walls.  The uterine walls, as earlier explained, accept the embryos and nurture it/them for nine months.

A regular-shaped uterus with no underlying problems should make  conception easy and childbirth too. However, there might be complications too, but nothing that cannot be surmounted.



Bicornuate (heart-shaped) uterus

A bicornuate womb is a heart-shaped womb. There are really no challenges with conception; it is actually sustaining the pregnancy until 40 weeks that’s the challenge. Due to the shape of the uterus, incidences of miscarriage and preterm labour are very high.

And in instances where pregnancies progress far, the heart shape of the uterus can affect how the baby lies in the womb, which increases the risk of ceaserean birth.

But I guess that is way better than having to suffer a loss.

One woman with a bicornate uterus suffered recurrent miscarriages; sometimes very early miscarriages, some in the second trimester, and some were actually stillborns, until a cervical stitch was put in to strength her uterus. Today, hers is a success story.


Didelphic (double) uterus

The story of the lady, who has two vaginas and wombs trended online for some weeks, early this year, with many people speculating how she was going to achieve a pregnancy, and then sustain that pregnancy, but that speculation was put to rest when she announced that she was pregnant, and had already zeroed her mind in on a ceaserean birth, thanks to her double womb structure.

A didelphic womb is when one normal womb is split in two, with each side having its own cavity. Generally the duplication affects uterus and cervix, but it can also affect the vulva, bladder, urethra and vagina. We know that it affected the woman’s vagina in this case. Women with a didelphic womb have no extra difficulties with conception, and it is only linked to an increased risk in premature birth, but with the world’s attention on this woman, that is not likely her case.

A classic example that this is not impossible is the woman who delivered two babies from her two wombs several years ago. The baby girls were born via CS, but they and their mom, who was called Womber Woman, were fine.


Unicornuate uterus

Moving on to the unicornuate womb, which is a rare structure of womb, and as you can imagine, it comes with it’s own challenges.

In this instance, the womb is half the size of a normal womb, because one side of it failed to develop. With this womb structure, there is an increased risk of ectopic pregnancy, late miscarriage or preterm birth. Women with a unicornate womb can often conceive, although there is an unsubstantiated report that unicornate womb is more common in women dealing with infertility.

As it is obvious in this success story, which I shared sometimes ago, it is very much possible to conceive and carry baby to term with a unicornate womb.


Septate uterus

In a regular shaped womb, the wall of muscle linking the fallopian tubes to the uterus usually moves along smoothly from one end to another but that is not the case in a septate womb. With this shape of the womb, the wall of muscle comes down the centre, splitting the uterine cavity in two, but not enough to declare it a double womb.

Sometimes the muscle comes down only part way, and other times, it comes all the way down, making conception harder. And when conception happens, there is also an increased risk of first-trimester miscarriage and preterm birth.

Seeing that the womb can’t be seen with the ordinary eyes, most women are unaware that they may have an abnormal shaped womb when they become pregnant, unless, they had undergone some investigations which would reveal it.

One of the following investigations that can reveal the shape of a woman’s uterus include a hysteroscopy, a laparoscopy or a three-dimensional pelvic ultrasound scan, as  a regular ultrasound scan might not be able to detect these structural defects, except in the cases of didelphic (double) womb or a unicornuate womb, which looks very different from a regular womb structure.

Apart from the shapes of the uterus, there is the issue of positioning of the uterus, which is majorly a function of the tilt of the uterus as well as the location of the fundus (top of the uterus).

The tilting of the uterus can be either anteverted (tilted forward towards the bladder) or retroverted (tilted backwards toward the spine).

Approximately 75% of women have an anteverted uterus, the other 5% have a retroverted uterus.

One thing that is sure with all of these womb shapes and positioning is the fact that it is not impossible to achieve conception and carry baby to term. It may come with complications, but it is not impossible.

So, even in the midst of challenges, there is hope, and it is to that light I urge TTC mamas to look.

You will get to mommaland.



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