My period finally returned on July 2nd, so I was able to schedule a sonohystogram (SHG) to diagnose my Mullerian anomaly. Coincidentally, the SHG was scheduled for July 12, exactly one year after I went into preterm labor with Peter.
I felt like a proper diagnosis was long overdue; I’ve been wondering which flavor of bifid uterus I have for 3 years – bicornuate uterus, septate uterus, or uterus didelphys. Radiologists and sonographers always called it a bicornuate uterus, but a little internet research quickly informed me that Mullerian anomalies are often misdiagnosed and cannot be acurately diagnosed via conventional ultrasound. I planned to have diagnostic imaging done after my miscarriage in August 2008, but because my periods are irregular, I was never able to schedule a sonogram during the requisite post-menses, pre-ovulation window. After I lost Peter’s twin, I assumed that my history of recurrent miscarriage indicated that my uterus was septate rather than bicornuate. Then Peter was born 3 months early, and I thought that I had a bicornuate uterus because some studies indicate that second trimester losses and preterm birth are most highly associated with bicornuate uterus. Finally, I read all the open-access research reviews of Mullerian anomalies that I could find via Google and concluded that my history is most consistent with the diagnosis of septate uterus. But a nagging voice in the back of my head wondered whether my uterus is totally wonky – perhaps I have a bicornuate uterus / septate uterus combination with cervical duplication? Or a complete septate uterus with the septum extending through my cervix? Something that could explain why Peter arrived so early, so precipitously.
Today’s SHG was quick and painless. And most importantly, my reproductive surgeon was able to tell me definitively that the exterior of my uterus is normally shaped, but a relatively large septum divides the interior in two. The septum is of typical width and 4-5 cm long. My doctor didn’t tell me what fraction of the interior of the uterus my septum extends, but a typical uterine cavity is about 7 cm long. I’m glad that I have a septate uterus because now I can schedule a hysteroscopic septoplasty to correct my uterine anomaly. Corrective surgery is generally not recommended for women with other uterine anomalies. Removal of my septum should greatly improve my chance of having positive pregnancy outcomes in the future. Also good news: I have one cervix and two kidneys, just like a “normal’ girl. Really, I’m not too unusual. My septum is larger than average, but it is just a septum, the most common Mullerian anomaly.