Can a Bicornuate Uterus Cause Miscarriages?

Question: Can a Bicornuate Uterus Cause Miscarriages?

I had a hysterosalpingogram (HSG) and the doctor says I have a bicornuate uterus. Does that explain my miscarriages?


According to most research, a bicornuate uterus is not a risk factor for recurrent first-trimester miscarriages. There's some evidence that having a bicornuate uterus means higher risk of preterm delivery and also of incompetent cervix (cervical insufficiency), which can lead to second-trimester miscarriages, but a bicornuate uterus is most likely not the explanation for recurrent miscarriages in the first-trimester.

That said, another type of uterine malformation called a septate uterus can cause recurrent first-trimester miscarriages -- and the two conditions have a very similar appearance on images from an HSG. Thus, it is quite common for women who really have a septate uterus to be misdiagnosed as having a bicornuate uterus. This can lead to problems, because a septate uterus calls for a completely different approach than a bicornuate uterus. (A bicornuate uterus may not require any treatment at all in some cases.)

So, if you are having multiple miscarriages and have been diagnosed with a bicornuate uterus based only on the results of an HSG, consider seeking a second opinion to confirm the diagnosis. With three-dimensional ultrasound or laparoscopy, doctors can reliably distinguish a septate uterus from a bicornuate uterus.


Alborizi, Saeed, Sedigheh Dehbashi, and Mohammad E. Parsanezhad. "Differential diagnosis of septate and bicornuate uterus by sonohysterography eliminates the need for laparoscopy." Fertility and Sterility 2002. 78(10:176-178.

Braun, P, F. Grau, R. Pons, D. Enguix. "Is hysterosalpingography able to diagnose all uterine malformations correctly?A retrospective study." European Journal of Radiology 2005. 53(2):274-79.

Mishell, Daniel R. et al. Management of common problems in obstetrics and gynecology. Wiley-Blackwell, 2002. Page. 404.

Proctor, Jon A. and Arthur F. Haney. "Recurrent first trimester pregnancy loss is associated with uterine septum but not with bicornuate uterus." Fertility and Sterility 2003. 80(5):1212-1215.

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