How 'uterus didelphys' impacts women

A 30-year-old Pakistani woman, who has been undergoing treatment at a Sharjah fertility centre, has been diagnosed with the unique ‘uterus didelphys’.

A rare medical complication that is born out of the malformation of the womb, where it presents as a paired organ – a double womb.

According to Dr Daamini Shrivastav, of fertility clinic Conceive in Sharjah, who has been treating the woman, this complication is seen 1 in every 2,000 women worldwide.

“Most women go through life completely oblivious to the fact they have it which is what is interesting. If they're healthy and fit and fertile it doesn't interfere with their lives at all,” she adds.

“Sometimes the first sign may be recurrent miscarriages. Infertility can also be a presenting feature. In about 25 per cent of women who have uterine malformations, they could also have associated kidney malformations because the kidney and the uterus develop very close to each other.”

The doctor adds that while “the figures for this part of the world are not known.  It is probably higher in areas where there is a greater incidence of consanguineous marriages (marriages between close blood relatives).”

The lady had approached the Conceive Hospital in Sharjah after being unsuccessful to conceive. “She was married for five years and had two miscarriages, within just three months into the pregnancy,” points out the doctor.

After undergoing multiple investigations in her home country, she was diagnosed with a Bicornuate uterus or a womb with two horns.

“When we examined her, we found that she had a double vagina and double cervix as well. Her ultrasound scan confirmed the presence of double wombs, and both ovaries were seen.”

Uterus Didelphys, she explains, occurs due to a developmental malfunction.

“Somewhere in the developmental process as a foetus the fallopian tubes do not come together resulting in formation of a double womb.”

Dr Daamini confirms that “most women aren’t even aware they have the condition until they become pregnant and get an ultrasound scan done. If she gets an ultrasound about eight weeks into her pregnancy, chances are the ultrasound technician would spot the extra womb.

“But if the woman does not get an ultrasound until 20 weeks or more, the womb housing the fetus might have grown big enough to overshadow the extra womb in which case the ultrasound technician might not see it.”

It is interesting to note that the “twin wombs take up about as much space as a single uterus, which is about the size of a pear.  Together they resemble a valentine’s heart, each having a round top and a tapered bottom.”

Dr Daamini suggests ultrasound, sonohysterogram, magnetic Resonance Imaging (MRI), hysterosalpingography and 3-D ultrasound sonography as the diagnostic processes that could help identify the condition.

She insists that no surgery is advised to alert the situation. “Although surgery may help sustain a pregnancy if there is partial division within the uterus and no other medical explanation for a previous pregnancy loss.”

“Patients may need special attention during pregnancy as premature birth is common. C-section may be required in management of these patients during delivery.”

The doctor adds they have succeeded in managing her insulin levels from her PCOS and once her menstrual cycle is completed, she will be prepped for an IUI (intrauterine insemination). What is different about this case is that we will of course be injecting the sperm from her husband into both cervixes.”

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