All of these women have UUs…and all of these women have children!

All of the information below is based on my research, experience, and what I have heard from other women with unicornuate uteruses only and is not meant to be a substitution for professional medical advice. Please consult your doctor for information regarding your condition.

Hello! My name is Kristen, and I have a unicornuate uterus (UU).

I imagine you’re here because you or a loved one was recently diagnosed with a UU. I’m sorry we had to meet this way, but I’m glad you found my blog!

This specific blog post, and my Embrace Your Unicorn blog in general, is meant to provide you hope and community during your UU journey. The Internet can be a dark, depressing place when you first start researching your UU. I hope you are able to learn something new, feel supported, and recognize that you are not alone.

Also, as you read through these FAQs, you’ll see pictures of real women with UUs and their babies. Their babies! You’ll also see how each of these UU miracle babies were conceived: naturally, IVF, etc.

Hear me loud and clear, friend: It is possible.

You got this.

Both babies conceived via “effortless IVF”

After receiving my unicornuate uterus (UU) diagnosis in 2018, I was a mess. A million questions wrecked me like a violent tornado. Would I be able to get pregnant? What would a pregnancy be like if I could get pregnant? How did I not know about my UU sooner? How many other women have UUs?

Both boys were conceived naturally. Photographer: Kendrah Damis Photography

I hear from many women with UUs that one of the first things they do is head to Google. I did the opposite. Even though I had a million questions, I avoided the Internet like the plague. I knew that I wasn’t ready to face the facts. That my grief was too acute. That I couldn’t risk adding salt to the raw wound with even more bleakness.

Two weeks after my diagnosis, I did my first Google search: “Unicornuate uterus and pregnancy.” The results were everything I feared. Miscarriage. Preterm birth. Ectopic pregnancy in rudimentary horn. (What is heck rudimentary horn?!)

"The reproductive performance of women with unicornuate uterus is poor.”

My lifelong dream of becoming a mother was slipping away with every discouraging statistic I read.

All three girls were conceived naturally. Their mama is expecting her fourth baby now too (also conceived naturally!).

That was until I stumbled upon Alyssa’s UU story. Not only did Alyssa have a UU, she also had poor egg quantity and quality - just like me. Alyssa shared her IVF experience that ultimately led to adorable son. She did it! She had a baby with a UU! She gave me the hope I needed to continue on in my journey.

May you find hope within this blog like the hope I found in Alyssa’s story. And may you find answers to your million questions below. I wish a blog post like this was available to me when I first was diagnosed.

Conceived naturally. Did not know about UU until giving birth.

An important note

Before I dive into answering FAQs, I need to say something. I’m answering these questions to the best of my ability/knowledge, but I can’t guarantee everything is 100% accurate. You’ll also see that I answer with “I don’t know” sometimes. At the very least, I hope these questions get you thinking and help you prepare conversations with your doctor. Also, if you have a UU and have more to add to any of the answers below, email me or comment at the bottom of the post, and I’ll add your insights to this post as well!

Conceived naturally after two failed IVF transfers.

General

Why me?
I grappled with this question for a long time. In fact, starting this blog was one of the ways I chose to cope with this question. (Check out my very first blog post after receiving my UU diagnosis.) Just know you’re not alone if you’re asking yourself this question.
What do I ask my doctor?
Use this list as a starting point for what questions to ask your doctor. And prepare for your doctor to not have answers for all of your questions. I’ve learned throughout this process that more research needs to be done about UUs. Even maternal-fetal medicine (MFM) docs who specialize in high-risk pregnancies don’t have all the answers. To better understand your anatomy and fertility, your doctor might recommend that you get assessed through a hysterosalpingography (which allows evaluation of the uterine cavity and your fallopian tubes), and/or an MRI scan (which is considered the best imaging technique for uterine abnormalities). Along the way, you may discover other interesting information about your reproductive abilities. For example, in addition to my UU, I also have poor egg quantity and quality and endometriosis. These are important things to know as your attempt to get pregnant.
Is there a support group with other UUs? / How can I find others like me?
YES! In addition to staying plugged into the community on this blog, you can find amazing UU support groups on Facebook! Check out Unicornuate Uterus TTC and Unicornuate Uterus Pregnancy and Beyond on Facebook. There are 1,800 women in the UU Pregnancy group! You can also join my blog’s Facebook Group called Embrace Your Unicorn and/or follow me on Instagram @embraceyourunicorn. My FB group and IG are open to anyone - my friends/family who want to follow my infertility journey, people who are interested in embracing what life throws at them, and/or people who are looking for a community of authentic people!

Older baby conceived via IVF. Younger baby conceived naturally.

Anatomy

What is a unicornuate uterus (UU)?
A UU is rare condition where a female’s uterus does not form properly during fetal development, resulting in a half uterus. It is caused by abnormal or failed development of one Müllerian duct. What the heck are Müllerian ducts?! Let me explain! They are the tissue that make up the earliest recognizable stage of the female reproductive tract. Developing female fetuses have two Müllerian ducts. (Did you catch all of that?!) Essentially, when we were growing in our mama’s belly, something went awry when our uterus was forming, and one of the Müllerian ducts didn’t descend to meet with the other Müllerian duct to form a complete uterus. Normal uteruses have two “horns.” We have one horn, hence “UNICORNuate". Did you know that “cornu” is the Latin word for horn? One horn = Uni corn = unicorn(uate) uterus! Tada!
What size is my UU?
Great question! My UU was measured during an MRI. I don’t remember the size of it right now, and to be honest, this didn’t end up being relevant during my fertility journey.
What size is a normal sized uterus?
An average uterus is 3 to 4 inches by 2.5 inches.
Is it genetic? / Will I pass this on to my baby?
I don’t know. I actually can’t remember if I asked my doctor this. I think I did, and I think she said that she doesn’t know. No one in my family has a UU. I know a lot of other women who do not have any family history of UU either. That being said, I am aware of a woman whose mother and aunt also have UUs.
If I only have one ovary and one fallopian tube do I only ovulate every other month?
I don’t know. I have two ovaries and two fallopian tubes. Great question to ask your doctor!
What’s the status of my kidneys? Do I have both kidneys?
Women with genital abnormalities (like a UU) may also have urinary abnormalities (like a missing kidney). If you are diagnosed with a UU, your doctor will most likely want to check your kidneys. Likewise, if a woman is first diagnosed with a missing kidney, doctors may want to look for genital abnormalities.
What is a rudimentary horn? What does it mean if it is communicating or non-communicating? How can I find out if I have one? What should I do/expect if I have one?
In my best lay(wo)man’s definition, a rudimentary horn is the other side of the uterus that did not properly form and fuse with the main uterine cavity. For example, I have a right-sided unicornuate uterus and a left-sided rudimentary horn (sounds so weird, huh?!). My rudimentary horn is basically like a tiny uterus on the left side of my lower abdomen that never fully descended to connect with my right uterus. My rudimentary horn is connected to my right-sided uterus via connective tissue that, quite honestly, looks like a thick string of spaghetti. Ha! Mine is considered a “non-communicating” rudimentary horn because the connective tissue is not hollow like a straw and therefore does not allow any back-and-forth exchange of anatomical goo (very scientific term). (Check out this blog post to see pictures of my UU and rudimentary horn!) It was determined that my rudimentary horn was non-communicating via a hysterosalpingo-contrast-sonography (usually shortened to HyCoSy). This is an ultrasound procedure where saline is squirted into your uterus to check out the shape of your uterus and to check for any abnormalities. Then dye is squirted into your fallopian to see if they are blocked. No saline or dye traveled from my right-sided uterus via the connective tissue into my rudimentary horn, so it was determined my horn was “non-communicating.” If your UU is connected via hollow straw-like connective tissue, this is called a “communicating” rudimentary horn. The reason doctors care about how your UU is connected to your rudimentary horn is because of the possibility of an embryo implanting in the rudimentary horn. This could be dangerous because the rudimentary horn could rupture. If your rudimentary horn is communicating, your doctor may want to do a surgery where they remove the horn before you get pregnant to eliminate this risk.
Will I start menopause earlier?
I don’t know. Great question.
What contraception can I use?
I don’t know much about this, but a doctor once told me that I wasn’t a candidate for an IUD, a device that is inserted into your uterus, due to my UU. In the past, I’ve just taken oral birth control pills.

Getting Pregnant

Will I be able to have children? / What does this mean for my fertility?
Having a UU does not mean you cannot have your own biological children. You can get pregnant, maintain a pregnancy, and have a healthy baby. Many women with UUs conceive babies naturally without any reproductive assistance, like an IUI or IVF.
Can I have a baby naturally or do you always need assistance?
You can definitely conceive a baby naturally! Many women with UUs don’t learn about their UU until giving birth to their first (or second!) child. I conceived my son via IVF, but that was because I also have poor egg quantity/quality and endometriosis. A triple whammy!
Will I need other assistance (progesterone) to maintain pregnancy?
Maybe, maybe not. Many women do not need any assistance to get pregnant or maintain a pregnancy with a UU. It depends on your body and your pregnancy. Ask your doctor about this.
Can I still get pregnant if I ovulate from the ovary that is not connected to my UU? For example, my UU is on the right side and is connected to my right ovary. But I sometimes ovulate from my left ovary that is not connected to my UU.
I’ve heard from two women with UUs that yes, it is possible to get pregnant if you ovulate from the ovary that is not connected to your UU. One woman got pregnant when she ovulated from the opposite side! Additionally, one woman with a UU told me that her doctor told her that it is actually a myth that we alternate from which ovary we ovulate every month. We all grow up to believe that one month, we ovulate from our right ovary. Then the next month, we ovulate from the left ovary. Right-left-right-left-right-left. Her doctor said that’s not necessarily true. Interesting information to know!
Can an IUI work? Is IVF necessary? Is there a lower success rate with IUI/IVF? Should I have embryos genetically tested?
Intrauterine insemination, or IUI for short, can definitely work for women who require that level of reproductive assistance with UUs! In vitro fertilization (IVF) may not be necessary for you, but it is necessary for some women with UUs (it was necessary for me). I don’t know if there is a lower success rate with IUI or IVF for women with UUs. My guess is that it has more to do with your ovarian health (egg quantity and quality) than it does with your UU. But this is a great question for your reproductive endocrinologist (RE). As for getting your embryos genetically tested if you do IVF, I know some women who did and some women who did not. Discuss this question with your RE!

Pregnancy

What specialist should I see for surgery and obstetric care?
UU pregnancies are considered “high risk.” General obstetricians (OBs) may not feel confident in providing care to women with UUs, so they refer us to maternal fetal medicine (MFM) doctors. (Side note: MFMs are also referred to as perinatologists.) MFMs specialize in providing perinatal care to women with high risk pregnancies. I worked with an awesome MFM. I’d recommend thinking about being monitored by an MFM if you have a UU and are pregnant.
How should I be monitored during pregnancy?
This depends on your body, your other health conditions, and your baby. Ask your doctor to create an individualized care plan based on your unique health needs. I will say that I was monitored more frequently during my pregnancy than women with normal uteruses.
Am I more likely to have a miscarriage with a UU?
I’ve read different statistics about the likelihood that a woman with a UU will miscarry. One 2009 literature review found that 34% of UU pregnancies end in miscarriage. This seems pretty high at first glance, but when you think about it, normal pregnancies end in miscarriage at least 10-20% of the time. My take-away is that miscarriages are more likely with a UU, but not drastically higher.
Why am I more likely to have a miscarriage with my UU?
According to this website, the reason UUs are more susceptible to miscarriage is threefold: 1) Decreased blood flow to the uterus compared to a normal uterus. Most uteruses have two arteries supplying blood, and a UU only has one. 2) Smaller size which may complicate fetal development in the second trimester and beyond. And 3) complications with the cervix. Women with UUs may be at increased risk for incompetent cervix (who are you calling incompetent?!) because of the uterus’s smaller size. If not managed well, cervical issues may result in preterm delivery.
Am I at higher risk for ectopic pregnancy?
The same 2009 literature review I mentioned above also found that 2.7% of UU pregnancies are ectopic, where the fertilized egg implants and grows outside of the main cavity of the uterus (like in a fallopian tube). In a normal uterus, an ectopic pregnancy occurs 2% of the time. The likelihood that you’ll have an ectopic pregnancy with a UU (2.7%) is about the same as with a normal uterus (2%).
How long can I carry a baby for? / Will I make it full term?
Back in 2018, I polled the women in a UU Facebook group about gestational length with their first UU pregnancies. More than 50 women responded, and the average pregnancy length was 36 weeks + 5.6 days. Not bad, UU sisters! I had a c-section at 37 weeks + 1 day due to my gestational hypertension (unrelated to my UU). My son was fine and dandy in my uterus and could have hung out in there longer if we didn’t need to make him evacuate due to my rising blood pressure. Also, in the same 2009 literature review as above, it was found that preterm delivery occurs in 20% of UU pregnancies compared to about 10% of normal uterus pregnancies.
What other risks other than preterm labor come with UU?
Increased risk of miscarriage (see above), incompetent cervix (read about my experience with this here), and a whole list of other complications that the Internet will try to scare you with. My advice: don’t worry about the other risks now. Just take each step as it comes, and you’ll confront them as the badass unicorn mama you are when you get to it. And breathe. Go ahead - take a breath right now. This shit can be scary. Breathing…breathing is good. :) (Reminder: you got this!)
How far can my uterus stretch in pregnancy?
Pretty gosh darn far. Farther than you might think. Way to go, UUs! (Clearly I don’t have a scientific answer to this question!)
Can I carry twins? / What happens if I conceive a multiple pregnancy?
You can carry twins with a UU, but it is with much higher risks. The women I’ve known with UUs who had twins experienced additional challenges with their pregnancies such as preterm delivery and loss of one of the babies. Check out Ashley’s UU story to learn more about her experience with twins. Also, my MFM told me that comparing a woman with UU carrying twins to a woman with a normal uterus carrying triplets (or quadruplets, etc…) is not the same. In addition to a UU being smaller, it also has one less artery supplying it with blood, and, simply put, just does not have the ability to stretch as crazily large as a normal uterus.
Will my belly be lopsided?
Probably! You couldn’t tell my belly was lopsided when I was standing/sitting, but it became very noticeable when lying on my back. Check out this picture of my belly at 35 weeks. I’ve seen dozens of beautifully lopsided pregnant UU bellies in the Facebook group, UU Pregnancy and Beyond.
How often should I be checked and monitored?
This depends 100% on how your pregnancy evolves. In general, I’d say that UU pregnancies are monitored more closely than non-UU pregnancies. Your doctor will guide you with this. Also advocate for being monitored more closely if that’s what you want! During my pregnancy, I was followed very closely because of the slew of issues I encountered: intense bleeding at about 13 weeks, my incompetent cervix and need for a cerclage, my preterm contractions, preterm contractions, my perinatal anxiety disorder, or my gestational hypertension that I developed in the last week of pregnancy. Don’t let my complications scare you - I know many, many other women with UUs who had zero pregnancy complications.
Am I more likely to need a cerclage with a UU?
Maybe. You might need a cerclage if your cervix, the bottom balloon-tie-sort-of-thing of your uterus, starts to shorten too early in your pregnancy. The cervix is meant to stay strong and long throughout your pregnancy to keep the baby in! As you near the end of your pregnancy, your cervix naturally starts to shorten to prepare for the baby’s exit. (Cervix be like: “Hey uterus and little human - please make sure your seat backs and tray tables are in their full upright position…thank youuuuuuu.”) If your cervix shortens too early, it could result in preterm delivery. Modern medicine has invented the highly technical cerclage where a doctor essentially ties fishing wire around your cervix to keep ‘er shut. Bada bing bada boom!
Should I be on bed rest?
Ask your doctor. My MFM was against bed rest. She said that recent research has indicated that bed rest has been found to not be helpful and can actually increase risks for things like blood clots. Instead of bed rest, my doctor told me I was unable to do anything more than the basics of daily life. No going for walks around the neighborhood. No exercise. No lifting. Just work, home, couch, repeat. These strict precautions were only due to my very complicated pregnancy. You may
What are the chances of my baby being breech?
I don’t know the exact likelihood, but I can pretty confidently say that the chances of your baby being breech are probably more likely with a UU than with a normal uterus due to the decreased size. The baby has less room to flip around. My son was breech most of the second and third trimesters.
Can my baby be turned in a UU if breech?
Probably not. There are old wives’ tales about how to flip your baby, but I don’t know if I buy them. I bet there are some women who swear by them! My MFM was pretty confident that my baby wasn’t going to flip in my UU due to the small space. But hey - I’m not going to stop you from trying something out! Always consult your doctor before you try anything.
Is there a risk of uterine rupture if I have more than one pregnancy?
I don’t know. I know many women with UUs who have two…three…four children with no uterine rupture. In fact, I’ve observed that many UU mamas typically have better subsequent pregnancies because their uteruses have stretched a bit (I really do think this is a real thing!) and their body has figured out what the heck it needs to do. But ask your doctor about this one.

Giving Birth

Will I have to have a C-section?
Not necessarily. Many women with UUs have vaginal births. I had a C-section because my son was breech and I developed gestational hypertension. It depends on your unique situation.
What will it mean for birth?
I had a C-section, so I don’t know what this would mean for a vaginal birth. Ask your doctor.

Baby

Will my UU impact the size and/or health of my baby?
Babies growing in UUs are closely monitored since intrauterine growth restriction (IUGR) or fetal growth restriction (FGR) is more common with UUs. IUGR/FGR is when your baby is smaller than expected for the number of weeks of pregnancy, usually defined by falling below the 10th percentile. My son was always right on track. I know a woman with a UU who recently birthed a solid and completely healthy 8 pound baby (#uupower). Chat with your doctor about this if you have concerns.

You’re not alone. You’re a UU goddess. You can do this.

Email me with any questions or need to vent/be heard below by clicking CONTACT at the bottom of this page. I look forward to meeting you, fellow UU sister!

xoxo,
Kristen and the amazing UU community

(Side note: Embrace Your Unicorn was selected to be in the Top 100 Fertility Blogs and Websites by Feedspot. Coming in strong at #68!)

Unicornuate Uterus: Frequently Asked Questions (FAQs)