IVF with a Bicornuate Uterus

In this article, we will explore the possibility of IVF with a Bicornuate Uterus, discussing the particular IVF treatment considerations, success rates and ways to reduce pregnancy risk factors.

What is a Bicornuate Uterus?

A bicornuate uterus is a type of congenital uterine anomaly (a birth defect) where the uterus is heart-shaped instead of the normal pear shape. This occurs when the uterus fails to fully fuse during fetal development, resulting in two uterine cavities (or "horns") that are partially or completely separated.

There are two types of Bicornuate Uterus:

Complete	Two fully separate cavities, each with its own horn
Partial (or Incomplete)	Two cavities partially separated at the top, but shared lower part

This is different from a septate uterus, which has a single uterus divided by a thin wall of tissue. 

Can you have IVF with a Bicornuate Uterus?

Yes, you can have IVF with a bicornuate uterus, but there are additional considerations and potential risks during both the IVF process and pregnancy that should be carefully managed by your fertility and obstetric team.

Key Challenges with IVF in Bicornuate Uterus

1. Choosing the Right Implantation Site

• The embryo is typically placed in one horn of the uterus
• Some horns may have better blood flow or more endometrial development than the other
• Ultrasound-guided embryo transfer is essential to place the embryo correctly
• Hysteroscopy may be needed to assess the better cavity amongst the two

2. Increased Pregnancy Risks

Compared to women with normal uterine anatomy, those with a bicornuate uterus are at higher risk for:

• Early miscarriage
• Preterm labour
• Malpresentation (breech or transverse baby)
• Uterine rupture (rare, but more likely in severe cases or with prior surgery)

3. Limited Uterine Space

• Each horn has reduced space, which may affect how the pregnancy develops (especially in twins).
• Multiple embryo transfer is generally avoided to reduce risk.

 

Medical Management Tips

Step	Why It Matters
Detailed imaging (3D ultrasound or MRI)	Helps assess uterine shape and best horn for embryo placement
Single embryo transfer	Reduces risks of miscarriage and preterm birth
Close pregnancy monitoring	Watch for growth restriction, preterm labour, or malposition
Surgical correction (metroplasty)	Rarely done before IVF unless multiple losses have occurred

 

Summary

IVF with Bicornuate Uterus	Details
✅ Possible?	Yes
🔬 Requires special imaging?	Yes, for optimal embryo transfer site
🚼 Pregnancy risks?	Higher than average, especially miscarriage, preterm labour
💡 Preferred IVF strategy?	Single embryo transfer + close monitoring

IVF can be successful with a bicornuate uterus, especially when managed by a fertility clinic experienced with uterine anomalies. Antenatal care should be a under a consultant led care in NHS/Private.

IVF Success rates with a Bicornuate Uterus 

IVF Success Rates in Bicornuate Uterus

A 2021 retrospective cohort  study comparing IVF outcomes between women with a bicornuate uterus and those with normal uterine anatomy found:

• Clinical pregnancy rate: 45.9% for the bicornuate group vs. 58.8% for the control group (P = 0.172)
• Live birth rate: 40.5% for the bicornuate group vs. 43.9% for the control group (P = 0.723)
• Cumulative live birth rate: 58.2% for the bicornuate group vs. 64.8% for the control group (P = 0.375) pubmed.ncbi.nlm.nih.gov

These differences were not statistically significant, indicating that a bicornuate uterus does not significantly hinder IVF success.

Can you carry twins with a bicornuate uterus?

Yes, it is possible to carry twins with a bicornuate uterus, but it is considered high-risk and comes with significantly increased complications compared to singleton pregnancies or pregnancies in a normal uterus.

Why Twin Pregnancies Are Riskier in a Bicornuate Uterus

A bicornuate uterus is divided into two separate “horns,” meaning each horn has less space than a normal uterus. This can make it difficult to support two growing foetuses.

Major Risks:

Risk	Description
Miscarriage	Increased risk, especially if both embryos implant in the same or separate horns
Preterm labour / delivery	Very common due to limited space
Intrauterine growth restriction (IUGR)	One or both twins may grow poorly
Malpresentation	Breech or transverse positions more likely due to abnormal uterine shape
Uterine rupture	Rare, but more likely in cases with previous surgery or very stretched horns
Placental issues	Higher risk of abruption or abnormal placentation

 

IVF and Twins in a Bicornuate Uterus

Why Doctors Strongly Recommend Single Embryo Transfer (SET):

• Transferring more than one embryo increases the likelihood of twins, but the risks in a bicornuate uterus outweigh the potential benefit.
• If twins do occur, doctors will monitor very closely, and in rare cases, may even recommend selective reduction to improve the chance of a healthy singleton delivery.

 

What Happens if Twins Occur Naturally?

If spontaneous or IVF-related twins implant:

• Doctors will use frequent ultrasounds to check where the foetuses are developing (in the same horn or one in each).
• Twin pregnancies where each twin implants in a separate horn may carry slightly less mechanical risk, but both scenarios are monitored as high-risk.
• Expect early delivery, possibly via scheduled C-section.

 

Summary

Can you carry twins with a bicornuate uterus?	✅ Yes, but high risk
Recommended approach in IVF	Single embryo transfer to avoid twin pregnancy
Main complications	Preterm birth, miscarriage, growth restriction, malposition
Delivery method	Often C-section, sometimes early
Monitoring	High-risk OB care with frequent imaging and assessments

 

Twin pregnancies in a bicornuate uterus can be carried, but they require expert prenatal care, close monitoring, and often early delivery. If you're considering IVF or are already pregnant with twins and have a bicornuate uterus, a maternal-fetal medicine specialist (MFM) should be part of your care team.

Bicornuate uterus and IVF treatment considerations

If you have a bicornuate uterus and are planning or undergoing IVF treatment, there are several specific considerations that your fertility and maternal care team will take into account to improve the chances of conception and ensure a safer pregnancy.

1.Detailed Uterine Assessment Before Treatment

•  3D ultrasound, MRI, or hysterosalpingography (HSG) will help:
• Confirm the diagnosis
• Differentiate from similar conditions (like septate uterus, which may be surgically correctable)
• Determine whether the uterus is partially or completely divided. A hysteroscopy may be advised in select cases for better cavity assessment
• This helps decide the safest horn for embryo transfer

 

 2. Targeted Embryo Transfer

• Embryos are usually transferred to one uterine horn—the one with better shape and blood flow, if identifiable.
• Ultrasound-guided embryo transfer is critical to:
• Ensure precise placement
• Avoid inserting the embryo in a horn that cannot support pregnancy well

3. Single Embryo Transfer (SET)

• Strongly recommended to avoid twin pregnancy, which is high-risk in bicornuate uteri due to limited space and poor foetal positioning.
• Multiple embryos could implant in separate horns, increasing the risk of miscarriage, preterm birth, and uterine rupture.

4. Medical Optimization Before Transfer

• May include pre-treatment with oestrogen or progesterone to improve endometrial lining quality.
• In some cases, hormonal cycles are carefully controlled to optimize the uterine environment for implantation.

5. No Surgical Correction for Bicornuate Uterus Before IVF

• Unlike a septate uterus, which can be surgically corrected (hysteroscopic metroplasty), a bicornuate uterus typically cannot be fully corrected.
•  Surgery (Strassman metroplasty) is rarely done unless:
• There are multiple failed pregnancies
• The uterus is very asymmetrical or severely malformed

6. Pregnancy Monitoring

Even after successful IVF, a pregnancy in a bicornuate uterus is automatically high-risk, so:

• Early and regular ultrasounds to confirm proper implantation and foetal development.
• Monitoring for preterm labour, growth restriction, malpresentation, and cervical insufficiency
• Cervical cerclage (stitch in the cervix) may be considered if there are signs of premature shortening.

 

Summary of IVF Considerations

IVF Aspect	Bicornuate Uterus Consideration
Uterine imaging	Required (3D US, MRI, or HSG) for planning
Embryo transfer strategy	Single embryo, targeted horn, ultrasound-guided
Twin pregnancy risk	High—avoid with SET
Pre-treatment	May involve hormonal prep for optimal endometrial lining
Surgery before IVF	Rare; only for severe or recurrent pregnancy loss
Pregnancy monitoring	Consultant led care in NHS/private

 

Final Advice:

If you're pursuing IVF with a bicornuate uterus:

• Work with a Fertility consultant/specialist familiar with uterine anomalies.
• Once pregnant, transfer care to Consultant led care who is specialized in maternal-foetal medicine for high-risk pregnancy management.