Reproductive impairment and the malformed uterus

Although in this review, chief interest is in the reproductive potential of the malformed uterus, a classification of Muellerian maldevelopment can scarcely pivot only on the uterus; many times the vagina and sometimes the tubes are also involved. A simple classification comprises three groups: I. Agenesis. II. Problems of vertical fusion. A. Obstructive. B. Nonobstructive. III. Problems of lateral fusion. A. Obstructive. B. Nonobstructive. Agenesis of the uterus and vagina (Rokitansky-Kuster-Hauser syndrome) certainly in an impairment of the reproductive system, but this entity is characterized by no reproductive potential whatsoever and therefore will not be further considered. Problems of vertical fusion may be considered to represent faults in the junction between the down-growing Muellerian ducts (Muellerian tubercle) and the up-growing derivative from the urogenital sinus. Problems of lateral fusion of the two Muellerian ducts are especially noteworthy, in that obstructive lesions seem to have been observed clinically only when the obstruction was unilateral. This observation is of considerable embryologic interest in view of the fact that unilateral obstruction is almost invariably accompanied by absence of the ipsilateral kidney. It is therefore likely that bilateral obstruction would be associated with bilateral kidney agenesis with consequent nonviability of the developing embryo. Attention to obstructive lesions is often urgently necessary for the prevention of deterioration of reproductive capacity due to retained mucus or menstrual blood. On the other hand, attention to nonobstructive malformations is seldom in the nature of an emergency but may be required before reproduction is possible.