Q: I am 23 years old and am a known bicornuate uterus patient (two uteri with two separate cervix). I had my last period month and a half back. We had regular intercourse from my day 8 till day 17. I started getting spotting from day 18 but I ignored it for a week but it continued so I went to the doctor on day 24 and had a pregnancy urine test, which was slightly positive. We thought we'd wait for some more days and on the 44th day I repeated the test but it gave a negative result. But again I started spotting from the 43rd day onwards. I am unable to get my periods. What do I do, should I wait? When will fertilisation happen? Can I start having intercourse without getting my periods?

A:Irregular menses is known to occur in cases of bicornuate uterus and it is difficult to correct it if you are trying to conceive as well. You need to have a serial scanning done to document regular ovulation and then plan conception based on if cycles are ones with normal regular egg formation. Pregnancy can occur easily if there is no associated menses problem, but pregnancy can result in premature labour, abortions and small baby in a large percent of cases as compared to the normal population. The treatment options depend on what you want to achieve. If it is just regular periods- can do with help of hormone preparations containing oestrogen and progesterone cyclically. For conception, if cycles have become regular with egg formation, can achieve pregnancy knowing the higher risk of complications- possibly needing early hospitalisation and care to prevent mishaps. Surgery to remove one non functioning horn of the uterus or an operation to unify the two uteri is another option that may need to be considered, to improve chance of pregnancy and also reduce related complications of bicornuate uterus. Detailed ultrasound scanning to see the uterine size, function and tube patency must be planned before the surgery. The occurrence of all types of Müllerian duct abnormalities in women is estimated around 0.4%. A bicornuate uterus is estimated to occur in 0.1-0.5% of women in the U.S. It is possible that this is an underestimate since saddle abnormalities often go undetected. Effect on reproduction Previously, a bicornuate uterus was thought to be associated with infertility, but recent studies have not confirmed such an association. Pregnancies in a bicornuate uterus are usually considered high-risk and require extra monitoring because of association with poor reproduction potential. A bicornuate uterus is associated with increased adverse reproductive outcomes like: 1. Recurrent pregnancy loss. The reproductive potential of a bicornuate uterus is usually measured by live birth rate (also called fetal survival rate). This rate is estimated around 55-63% for a bicornuate uterus. 2. Preterm delivery. The risk for this is about 15 -25%. The reason that a pregnancy may not reach full-term in a bicornuate uterus is due to the fact that often the baby begins to grow in either of the protrusions at the top. The pregnancy will usually end in a miscarriage because there is not enough room for the baby to grow there. As a normal uterus will expand with a growing baby, the septum area of the bicornuate uterus cannot expand enough to accommodate growth. A short cervical length seems to be a good predictor of preterm delivery in women with a bicornuate uterus. 3. Malpresentation (breech birth or transverse presentation). If the baby happens to implant itself in the largest part of the uterus, it will have a chance of growing to full-term. However these babies often find themselves in an abnormal presentation, such as breech or transverse, since they may find it difficult to fit comfortably in a head-down position. The larger the baby grows the more likely this will be. A breech presentation occurs in 40-50% pregnancies with a partial bicornuate uterus and not at all (0%) in complete bicornuate uterus. Diagnosis There are many degrees of bicornuate uteri, and the degree can determine the likeliness of a pregnancy reaching full-term. Some women carry their pregnancies fully without their doctor even realizing that they have the condition. Other times, a bicornuate condition is detected early, when the mother feels cramping or spotting, for instance. It can sometimes be detected with an ultrasound scan though it is very difficult. As a result, a bicornuate uterus often goes undetected until delivery or diagnosed at a caesarean section.