Does Uterus Shape Affect Fertility?

Your uterus is a thick-walled muscular structure that houses your growing baby from when it’s a few microscopic cells (embryo) to a fully-fledged newborn. So it’s no surprise that our uteruses (or uteri, whichever you prefer!) do a lot of the heavy lifting when it comes to pregnancy and fertility. But sometimes, the shape of our uterus takes center stage in the fertility drama, and can cause delays or issues with conception or pregnancy ‒ a uterine difference can cause fertility issues for around <5% of women around the world. If you’re in that <5%, we see you. You might be wondering whether it’s a curable hiccup or a permanent roadblock when it comes to your fertility. Rest assured, we’ve got answers to all your uterus-shape questions. The good news? They’re on the positive side! (Content warning: We’ll be using some technical, medical language in this article, so it’s as accurate as possible. So terms like “abnormal” or “abnormality” will be used to describe uterus shapes or uterine differences.)
In this article: 📝

• What shape should your uterus be?
• What does it mean to have an abnormally shaped uterus?
• Can you get pregnant with a curved uterus?
• How common is a T-shaped uterus?
• Is it hard to get pregnant with a T-shaped uterus?
• Can you get pregnant with a heart-shaped uterus?

What shape should your uterus be?

The uterus is best described as an upside-down pear-shaped organ. 🍐 It has thick muscular walls and a single cavity. The uterus has three parts: the isthmus, corpus, and cervix. The isthmus is the top part of the pear that’s connected to the two fallopian tubes. The corpus is the middle cavity. And the cervix is the narrowed part that connects to the vagina. Here’s a labeled uterus diagram to help you picture what’s going on in there:

What does it mean to have an abnormally shaped uterus?

An abnormally-shaped uterus is where there is a structural abnormality in any of the main parts of your uterus: the isthmus, corpus, or cervix. Having an abnormally shaped uterus is something that develops when you’re a fetus, at week 22 of pregnancy. The development of the female reproductive organs begins at 6 weeks of gestation, as a scheduled series of events. If there’s any disruption in these events, it can lead to a uterine abnormality or a differently shaped uterus, which can impact your fertility later in life. There are different classes of uterine abnormalities, as classified in the medical field:

• Absence or abnormal development of the uterus (Class I)
  
  
• Single-horned uterus (Class II)
  
  
• Double uteri and cervices (plural of cervix) (Class III)
  
  
• Heart-shaped or bicornuate uterus (Class IV)
  
  
• Septate uterus (Class V)
  
  
• Arcuate uterus (Class VI)
  
  
• T-shaped uterus (Class VII)

Can you get pregnant with a curved uterus?

A curved uterus or a retroverted uterus isn’t technically a uterine abnormality, but rather a natural variation of uterine position where it curves towards the spine rather than the abdomen. Generally, a curved uterus doesn’t affect your chance of pregnancy or implantation, if it’s genetic. But if your curved uterus is caused by fibroids, Pelvic Inflammatory Disease (PID), or endometriosis, it could affect your fertility.

How common is a T-shaped uterus?

While there are no exact statistics on how common a T-shaped uterus is globally, the good news is that it’s slowly becoming extinct in women of reproductive age today. A T-shaped uterus is a uterine anomaly seen in women whose mothers ingested DES (diethylstilbestrol), a nonsteroidal estrogen during the years 1940-71, when it was prescribed to avoid miscarriage and other pregnancy complications. Even for the rare population with a T-shaped uterus, a simple procedure known as hysteroscopic metroplasty can be carried out to decrease complications and increase chances of fertility.
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Is it hard to get pregnant with a T-shaped uterus?

Yes, it can be quite hard to get pregnant with a T-shaped uterus due to abnormal uterine features and the fertility complications they can bring. One of the reasons is that a T-shaped uterus has a very thin endometrial lining, while a thick one is best for the embryo to implant and grow. There is a chance that it can lead to pregnancy complications such as ectopic pregnancy and pre-term delivery. But there is hope ‒ to avoid potential pregnancy complications, your doctor will likely recommend a hysteroscopic metroplasty. Hysteroscopic metroplasty is a procedure that’s essentially a surgical correction, which helps enlargen the lateral walls to increase the endometrial volume of the cavity of the uterus. This increases the chances of conception and implantation of the embryo.

Can you get pregnant with a heart-shaped uterus?

Yes, it is possible to get pregnant with a heart-shaped uterus. While it may not cause issues while trying to conceive, a heart-shaped or bicornuate uterus can cause issues after conception, like pregnancy loss, pre-term delivery, or restricted intrauterine growth, due to the abnormal shape. But, again, there is hope. If these complications are managed carefully with reduced risk, women with a heart-shaped uterus are said to have better delivery outcomes compared to other uterine abnormalities.

Ultimately, uterine abnormalities and different uterus shapes are as rare as they come. But, if you have a differently shaped uterus, it shouldn’t deter you on your fertility journey. Your healthcare providers can help you get the necessary resources and treatments for a healthy pregnancy. A diagnosis can be hard, we know. But uterine anomalies can be surgically corrected, their causes detected, and treatment cycles such as IVF or ICSI are available to help with these fertility hiccups. There are also studies that showcase a boost in natural pregnancies or conception in IVF cycles, for those with a differently shaped uterus. With optimal treatment, counseling, and management, it is possible for you to see a shift from infertility towards a path of better chances at conception. And, as always, if you want to share your story or hear other women’s experiences with a differently-shaped uterus, we’re having the conversation on Peanut. You’re not alone.