A.Pellicer Donnez, J. (1997) Endoscopic laser treatment of uterine malformations. Hum. most classes of Mu ¨ llerian anomalies. However, HSG and Reprod., 12, 1381–1387. hysteroscopy are only indicated in infertility investigation, Golan, A., Langer, R., Bukovsky, I. and Caspi, E. (1989) Congenital anomalies special clinical situations or suspected malformation. Currently, of the mu ¨ llerian system. Fertil. Steril., 51, 747–755. Green, L.K. and Harris, R.E. (1976) Uterine anomalies. Frequency of diagnosis the routine transvaginal echography (TVS) evaluating the and associated obstetric complication. Obstet. Gynecol., 47, 427–429. external shape of the uterus and, specifically, the presence of Heinonen, P.K., Saarikoski, S. and Pystynen, P. (1982) Reproductive a median endouterine septum at any point along its longitudinal performance of women with uterine anomalies. Acta Obstet. Gynecol. Scand., 61, 157–162. axis, is the best screening method (Nasri et al., 1990). More Jacobsen, L.J. and DeCherney, A. (1997) Hum. Reprod., 12, 1376–1381. recently, three-dimensional ultrasound has also shown its Pelosi III, M.A. and Pelosi, M.A. (1996) Laparoscopic-assisted transvaginal usefulness in a clinical setting to diagnose and classify metroplasty for the treatment of bicornuate uterus: a case study. Fertil. Mu ¨ llerian anomalies (Jurkovic et al., 1995; Raga et al., 1996); Steril., 65, 886–890. Simo ´ n, C., Martinez, L., Pardo, P. et al. (1991) Mu ¨ llerian defects in women (iv) the classes included as congenital uterine anomalies in the with normal reproductive outcome. Fertil. Steril., 56, 1192–1193. different reported series. Hypoplastic, T-shaped, diethylstilbes- Swolin, K. (1996) Electro-microsurgery, D: repair of unicornuate uterus and trol-exposed women (DES)-related anomalies and arcuate salpingosis isthmica nodosa. Hum. Reprod. Update, 2, No.2, item 8, CD-ROM. uterus are frequently not included. In the present communica- tion they are included as ‘minor uterine anomalies’ in spite of many cases causing frequent fertility problems (Acie ´ n, 1996). However, with the screening methods used (TVS) their identi- fication may not be strainght forward, or (with HSG) many Incidence of Mu ¨ llerian defects in fertile cases could be classified as normal or abnormal depending on and infertile women the observer, apart from a dependance on exposure (Sorensen, 1981). Logically, the cases with Mu ¨ llerian agenesis are Pedro Acie ´ n excluded from the series where fertility problems are analysed; 1 Division of Gynecology, Shool of Medicine, University of (v) the criteria and diagnostic tools used to classify the different Alicante, and OB-GYN Service, San Juan University types of uterine malformations clinically well recognized (e.g. Hospital, Alicante, Spain subseptus–septate versus bicornuate uterus, or bicornis bicollis 1 To whom correspondence should be addressed at: versus didelphys uterus), in spite of both following the Amer- Divisio ´ n de Ginecologı ´ a, Facultad de Medicina, Campus ican Fertility Society (AFS, 1988) classification of Mu ¨ llerian de San Juan, Apartado de Correos 374, 03080 Alicante, anomalies, or the similar one from Buttram (Buttram and Spain Gibbons, 1979; Buttram, 1983; Buttram and Reiter, 1985). We carefully observed the external shape of the uterus in laparoscopy, and if it had any visible depression on the middle Although uterine anomalies have been reported in 0.1–2% of all women, in 4% of those with infertility and in up to 15% part of the fundic uterine wall accompanied by an overall widening, it was classified as bicornuate uterus (Acie ´ n, 1993). of those with recurrent abortion (March, 1990), their true incidence is not known. The more liberal use of hysterosalping- Some of these cases are possibly classified as subseptus or septate uteri by other authors. Similarly, the distinction between ography and hysteroscopy, and the routine practice of ultrasono- graphy, and more recently, transvaginal ultrasound scanning arcuate and mildly subseptate or mildly bicornuate uterus is controvertial (Sorensen, 1981). (TVS) and transvaginal three-dimensional ultrasound (TDU) have led to an apparent increase in the incidence and, currently, Taking into account the aforementioned considerations, in this communication we investigated the incidence of uterine the figures cited above could be higher. In any case, there are no modern studies on the incidence of uterine anomalies in anomalies based on the review of the literature and the analysis of our material. From this respect, we have studied: (i) women the general population, and those on fertile and infertile women, or with recurrent pregnancy loss (RPL), have reported consulting for contraception or who were revised in the follow- up of contraceptive methods (pill, intrauterine device) during conspicuously varied results. This variability in the reported incidence of uterine anomalies is due to the fact that it the last 3 years (June 93 to June 96) in the Institute of Gynecology ‘Prof. P.Acie ´ n’. They were 241 women, 72 of depends on the following variables: (i) the population studied (gynaecological patients, those referred for metroplasty, fertile, whom had no previous pregnancies (single or married women); (ii) women consulting for recurrent abortion, subfertility or infertile or recurrent miscarriage women). In RPL patients, in whom the uterine malformations are more frequent, the incid- infertility during the same period, in both the Institute of Gynecology and the Infertility and Reproductive Endocrin- ence of anomalies depends on the inclusion criteria for RPL (two, three or more, late abortions, immature deliveries); (ii) ology Unit of San Juan University Hospital. They were 259 women, 200 of whom suffered from infertility (Table I). All the prospective or retrospective character of the investigation, directed search and physician interest and awareness to find women in both series were examined by the author, one or more times, and TVS was routinely performed looking for or reject an uterine anomaly, because most of the uterine malformations are clinically silent; (iii) the diagnostic methods uterine anomalies. An HSG and laparoscopy or laparotomy were also performed in the precise cases (HSG in the 75% of used. Hysterosalpingography (HSG) (and hysteroscopy) are the best general diagnostic tools for uterine anomalies, but women with uterine anomaly detected by TVS, and laparoscopy or laparotomy in 28%). Also included was a series recently they must be complemented with laparoscopy and/or others (magnetic resonance, pyelography) for a correct diagnosis in reported by the author, with regard to uterine anomalies and 1372 Downloaded from https://academic.oup.com/humrep/article-abstract/12/7/1372/700880 by guest on 09 June 2020