Müllerian Duct Research Articles

A Common Path: Magnetic Resonance Imaging of Müllerian and Wolffian Duct Anomalies.

This review summarizes the pathway of Mullerian and Wolffian duct development, anomalies that result from disruptions to this pathway, and the characteristics on advanced imaging that identify them. In-office evaluation for reproductive anomalies is usually inadequate for the diagnosis of congenital reproductive anomalies. Magnetic resonance imaging (MRI) has usurped invasive diagnostic methods including laparoscopy, hysteroscopy, and vasography as the new gold standard. Because of its superior soft-tissue delineation and the availability of advanced functional sequences, MRI offers a sophisticated method of distinguishing reproductive anomalies from one another, characterizing the degree of defect severity, and evaluating for concomitant urogenital anomalies non-invasively and without radiation exposure to the patient. Congenital anomalies of the Mullerian and Wolffian duct can be incredibly nuanced, requiring prompt and accurate diagnosis for management of infertility. Definitive diagnosis should be made early with MRI.

FEATURES OF PRENATAL MORPHOGENESIS AND PECULARITIES OF THE UTRICULUS PROSTATICUS FETAL ANATOMY

Aim: To determine the peculiarities of the structural organization of the utriculus prostaticus (UP) in pre-fetuses and fetuses. Materials and methods: The study of macroscopic features and microscopic peculiarities of the prostate gland and the prostatic part of the urethra was carried out on 46 sections of human pre-fetuses and fetuses aged from 9 weeks to birth (31,0-375,0 mm PCL). The work uses the method of microscopic study of serial histological and topographic-anatomical specimens of the prostate gland, as well as the method of the thin preparation of the prostate part of the urethra in fetuses of different ages and morphometry. Results: In 58,0-66,0 mm PCL fetuses the paramesonephric ducts are reduced, except of their connected caudal part, which is a morphological substrate for the development of the UP. At 72,0-79,0 mm PCL fetuses, cavity is replaced by cellular mass. At the 85,0-120,0 mm PCL fetuses, the UP connects with the lumen of the urethra. The cavity of the UP intensivelly proliferates with cells. In fetuses of 125,0-135,0 mm PCL is presente dense arrangement of glandular elements, which are surrounded by fibrous-muscular membrane. In fetuses of 150,0-160,0 mm PCL, in the caudal direction, the cavity of the UP gradually narrows, it forms invaginations, especially in the middle and lower parts, or is divided into separate, interconnected chambers. In fetuses of 170,0-185,0 mm PCL, UP has elongated-oval or rounded-oval shape. In the caudal direction, the UP is directed ventral to the colliculus seminalis and is located slightly anterior and superior to the ejaculatory ducts. In 8-month-old fetuses, the lumen of the UP is lined with a pseudostratified cubical epithelium, outside of which there is a tunica muscularis. Ejaculatory ducts lined with a two-layer cuboidal epithelium are placed on both sides of the UP. A 270,0 mm PCL fetus has no UP at the apex of the colliculus seminalis. In fetuses 315,0-335,0 mm PCL, the process of cavity formation spreads to new areas of glandular formations of the prostate gland and their final branches. Most of the glandular formations open into the prostatic part of the urethra directly below the UP and the distal parts of the ejaculatory ducts. Microscopic examination of frontal sections of the prostate gland of a fetus with a 360,0 mm PCL revealed a septum in the UP which divides the cavity of the UP into the right and left halves of a round-oval shape. Conclusions: The formation of utriculus prostaticus occurs from the paramesonephric ducts in the 11th week of fetal development. At the beginning of the 4th month of intrauterine development, it gradually decreases in size. From the middle of the 5th month of prenatal development, the utriculus prostaticus lengthens, and starting from the fetus of 7 months, both its length and width increase. At the end of the fetal period, the utriculus prostaticus acquires a round-oval shape, its length increases from 0,5 to 4,3 mm during prenatal ontogeny.

Surgical Management of Mullerian Development Anomalies: 5 Years’ Experience of a Tertiary Care Center

Maldevelopment of the mullerian duct occurs in variety of forms and each anomaly is distinctive. This study was conducted to study clinical profile of patient with mullarian anomalies, different modalities used in diagnosis, and surgery performed to patients with mullerian duct anomalies. This was retrospective study of 23 patients who underwent surgery for different mullerian duct anomalies in last 5 years. There presenting problem, diagnostic modalities used, types of anomalies, other associated anomalies and different surgical management were evaluated. As per American Fertility society 6 patients belong to class I, 12 in class II and 5 in class III. Most of patients with Mayer Rokitansky Kuster Hauser (MRKH) syndrome had primary amenorrhea, patient of vaginal septum usually presents with cyclical abdominal pain, primary subfertility or dyspareunia. Patients with septate uterus had recurrent abortion 2D Ultrasonography (USG), Magnetic Resonance imaging (MRI) and hysteroscopy were modalities used for diagnosis of these defects. Patient of MRKH syndrome and vaginal agnesis were managed with vaginoplasty using amnion graft. Patients with septate uterus were managed with hysteroscopic septal resection. Septum resection was performed in all patients with transverse vaginal septum. Uterine anomalies are different groups of malformations with a broad spectrum of presentations. Management of each anomaly is individualized depending on the symptoms and fertility concerns.

Bicornuate Unicollis Uterus in Recurrent Spontaneous Abortion- A Case Report

Bicornuate Unicollis uterus is a congenital uterine anomaly due to malformation of the paramesonephric ducts, also known as Müllerian ducts, presenting in 3%-5% of the general population. It is relatively rare to associate uterine anomalies and pregnancy outcomes. Patients are often asymptomatic but can present with secondary infertility, disturbances in menstruation, recurrent early and late pregnancy loss, and intrauterine growth restrictions and deaths which can be a sign for the diagnosis of the abovementioned condition. Here, we discuss a case of a 28-year-old female, of low socioeconomic status, presented with a history of white-coloured vaginal discharge and two spontaneous abortions in the last two years. On gynaecological examination, a polyp of 2x2 cm was observed over the anterior lip of the cervix, with curdy white discharge present on per speculum examination. On per vaginum examination, the uterus was found to be anteverted and anteflexed, and the fornices were free. Magnetic Resonance Imaging (MRI) revealed it as a bicornuate uterus, and the patient was managed with septum resection and counseled for a successful future pregnancy outcome.

Surgical resection therapy of a rare presentation of persistent Mullerian duct syndrome: a case review

Persistent Mullerian Duct Syndrome (PMDS) is an extremely rare disease with less than 300 cases recorded in medical literature. Our patient was a 37 year old male who presented at the medical office with hematospermia as his sole complaint. He had previously undergone left orchidopexy and presented with hypotrophic left testicle and right testicle agenesis. PMDS differential was considered with the clear observation of a uterus-like structure during pelvic ultrasonography. The organs were later studied in magnetic resonance imaging and confirmed by post-surgery anatomopathological examination. Patient was discharged 24 h after surgery and developed azoospermia post-surgery.

A RARE CASE REPORT OF OHVIRA SYNDROME IN A MENTALLY RETARDED GIRL

Obstructed Hemi vagina & Ipsilateral renal agenesis or Herlyn werner Wunderlitch syndrome is a rare Mullerian duct anomaly with uterus didelphys, Unilateral Obstructed Hemi vagina & Ipsilateral renal agenesis. Patients can usually presents soon after menarche and mayshow non - specific and variable symptoms with resultant delay in diagnosis. The most common presentation is dysmenorrhoea , abdominal mass in the lower abdomen secondary to hematocolpos and or haematometra. Here presenting a case of 14 years old mentally retarded female presented with pain abdomen & mass per abdomen and was diagnosed as OHVIRA syndrome based on Ultrasonography & MRI pelvis. She was treated with hemi vaginal septal resection and was under follow up.

CONGENITAL UTERINE ANOMALY-BICORNUATE UTERUS WITH SUCCESSFUL PREGNANCIES OUTCOMES IN A TERTIARY HOSPITAL, SOUTHERN NIGERIA: CASE SERIES

Bicornuate uterus, a class IV Mullerian anomaly results from impairment in the fusion of the Mullerian duct. It is associated with both normal and many obstetric complications. We present two rare cases of bicornuate uterus with successful pregnancy outcomes among Nigerian ladies. The diagnoses of the bicornuate uterus were made incidentally during a routine antenatal ultrasound scan in their first pregnancies. These were confirmed intraoperatively and the patients were notified.
 In the first case, the foetal head occupied the cavity of the left horn and the breech in the cavity of the large right horn while in the second case, the right horn was empty and the foetus was in the left horn. These women with bicornuate uterus carried their pregnancies to term and had elective repeat caesarean sections with favourable foeto-maternal outcomes. The mothers and their babies are alive and doing well.
 Overall, the ladies had two and four successful pregnancy outcomes respectively. Women with a bicornuate uterus can achieve successful pregnancy outcomes despite the obstetric challenges of the anomaly. Thus, the index cases highlight that it is practically safe to forgo metroplasty in bicornuate uterus, in particular, asymptomatic women that had achieved successful pregnancies.

Two Cases of Herlyn-Werner-Wunderlich Syndrome with Severe Dysmenorrhea, One Misdiagnosis and One Missed Diagnosis

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare variant of mullerian duct anomalies characterized by the triad of uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis. We report two cases of HWW syndrome in young women with abdominal pain. This diagnosis can easily be missed if a clinician is not aware of the syndrome. In one case, the computed tomography image of obstructed hemivagina with hematocolpos was initially mistaken for a cystic tumor of adnexa by the radiologist; in the other case, correct diagnosis was missed for years despite numerous visits to different hospitals due to lack of awareness of the syndrome.

Reproductive Outcome in Women with different Types of Congenital Uterine Anomalies

Introduction: Mullerian ducts are the primordial analogue of female genital tract. They differentiate to form the fallopian tubes, uterine body, cervix and upper part of the vagina. A wide variety of malformation occur when this system is disrupted. The range from uterine agenesis, duplication of uterus to minor cavity abnormalities. All these congenital anomalies have been implicated as a potential cause for impaired reproductive outcome. Our aim was to evaluate the association between different types of congenital anomaly and various reproductive outcome. Material & Methods: This cross sectional descriptive study was conducted at the Department of gynae and obstetrics in Dhaka Medical College and Hospital (DMCH), Ad-din Women’s Medical College and Hospital and Gonoshasthaya Samaj Vittik Medical College and Hospital during the period of March 2012 to September 2022.The study subjects were women with uterine anomalies who were diagnosed during evaluation of causes for bad obstetric history, during infertility work up or incidental findings during antenatal investigations or during Carsarian section . Reproductive outcomes were observed in the form of infertility, miscarriage, preterm delivery, ectopic pregnancy, intra uterine growth retardation (IUGR) and post-partum haemorrhage (PPH). These were recorded in a standard research questionnaire. Data were analyzed regarding types of uterine anomalies and their reproductive performance. Results: During the study period total 84 patients were recruited with uterine anomalies. Regarding distributions of uterine anomalies in study subjects the most common uterine anomaly was bicornuate uterus (n-32,38%), followed by arcuate uterus (n-18,21%), septate uterus (n-16,19%), unicornuate uterus (n-12,14%), and uterine didelphys (n-6,7. 1%).Women with bicornuate uterus was associated with miscarriage (37.25%), term delivery (31.25%) and preterm delivery (25%). Therefore, bicornuate uterus was found more evident with miscarriage. Only two cases of ectopic pregnancy were observed in the study which was found with bicornuate uterus. And in arcuate uterus percentage of preterm delivery was 44.4%, term delivery 33.3%, miscarriage only 22.2%. Therefore, arcuate uterus was more associated with preterm delivery. In septate uterus miscarriage was maximum (37.5%) followed byl term and pre term delivery, 12.5% each We found 12 cases of unicornuateuterus, where pregnancy continued to term in 6(50%) cases,2 aborted and 4(33.3)were delivered before term. Infertility was more associated with canalization defect, 6 cases with septate and 2 with didelphys uterus. Among live births (preterm and term deliveries,) malpresentation (breech, transverse) was more common in bicornuate uterus (44%).PPh was found in 2 cases of didelphys and two of bicornuate uterus. One case of septate and one from bicornuate uterus were associated with IUGR. Conclusion: The study makes clear that congenital uterine anomaly is associated with poor reproductive outcome. The exact effect is dependent on the type of anomaly.

Cervical duplication in dogs

Two maiden bulldogs with cervical duplication were presented for breeding management. Dogs were successfully impregnated via endoscope-assisted transcervical insemination (TCI) and had their litters via cesarean surgery. A common uterine body between 2 cervical openings and 2 uterine horns was noticed (with no other reproductive abnormalities) at surgery. Duplication of the cervix has apparently not been previously described in dogs. With TCI becoming a more frequently used method of breeding, it is probable that defects involving failed or incomplete fusion of the paramesonephric duct during embryological development will be more frequently observed by clinicians.

Uterine didelphys: A Case report of successful term pregnancies in each endometrial cavity

Background: Uterine didelphys is a rare congenital anomaly that may increase the risk of pregnancy loss and adverse perinatal outcome. There is limited knowledge of specific increased risk related to uterine didelphys. Uterine didelphys occurs in approximately 1 in 3000 women and accounts for 8 -10% of all mullerian duct anomalies (MDAs). Aim: To present this rare congenital clinical condition and offer management modality experience from the Rivers State University Teaching Hospital (RSUTH). Case report: Mrs. MC was a 33 year old booked G3 Para 1+ 1 (alive), previous caesarean section, who presented for antenatal care. Her index pregnancy was complicated by premature uterine contractions and ante – partum haemorrhage at 29 weeks and 30 weeks gestation respectively which were managed successfully. Obstetric ultrasound scan revealed a second uterine cavity with separate endometrial plate in keeping with uterine didelphys. She subsequently had an elective repeat caesarean section at 38 weeks gestation for transverse lie and uterine anomaly. Findings were a gravid left uterus and an empty right uterus with a lower segment scar. The left uterus contained a live male neonate in transverse lie with a birth weight of 3.5 kg and good Apgar scores. The baby was successfully managed for neonatal Jaundice. The mother developed postpartum haemorrhage which was successfully managed. The mother and baby were discharged on the 5th and 12th post-operative day respectively in good clinical state. The mother was given appointment to the family planning clinic. Conclusion: We presented a patient with a rare congenital clinical condition – uterine didelphys who conceived spontaneously. She had a previous successful pregnancy on the right uterus followed by a spontaneous miscarriage and successfully carried the index pregnancy on the left uterus to term and was delivered by an elective repeat caesarean section with good fetal and maternal outcome.

Diagnosis of septate uterus.

The septate uterus is the most common structural uterine anomalies and it is associated with the poor reproductive outcome. It is believed to be the result of the failure in resorption of the tissue connecting the 2 paramesonephric ducts prior to the 20th embryonic week. The true prevalence of uterine septum is difficult to ascertain, as many uterine septal defects are asymptomatic. The septate uterus is usually diagnosed during an infertility evaluation and affects reproductive health by impairing fertility and increasing adverse pregnancy outcomes. The variations in uterine and cervical/vaginal anomalies collectively referred to as Müllerian anomalies. No consistent gold standard for the diagnosis of Müllerian anomalies exists. The preferred diagnostic method for Müllerian anomalies is two-dimensional ultrasound, other methods such as three-dimensional ultrasound, magnetic resonance imaging, hysterosalpingo contrast sonography, hysterosalpingography, hysteroscopy, and laparoscopy are also used to improve accuracy.

Physiological role and diagnostic value of anti-Mullerian hormone in pediatrics

Background. Anti-Mullerian hormone (AMH) has now gained popularity as a marker of ovarian reserve. It is important to determine the place and role of AMH in children. The purpose of this work was to analyze the data of the scientific literature on the role of AMH in pediatric practice. Materials and methods. A review of the literature in PubMed was conducted, limiting itself to articles in English and updating the search in February 2022. The search term was “anti-Mullerian hormone”. A total of 437 manuscripts were found, including 37 review articles. The search was gradually narrowed with filters of clinical trials and systematic reviews to 75 articles. The references of the original and review articles were then checked to ensure a complete review. AMH is responsible for the differentiation of the gonads, provokes the regression of Mullerian ducts in the male fetus, correlates with karyotype, sexual development, levels of luteinizing hormone, follicle-stimulating hormone, and its serum levels reflect the ovarian reserve in women, even in childhood. Serum AMH is high from prenatal life to puberty. In postnatal period, the secretion of AMH by the testes is stimulated by follicle-stimulating hormone and strongly inhibited by androgens. AMH is of clinical value as a marker of testicular tissue in men with differences in sexual development and cryptorchidism, as well as in the assessment of persistent Mullerian duct syndrome. Determination of AMH is useful for assessing the function of the gonads without the need for stimulation tests and guides the etiological diagnosis of childhood male hypogonadism. In women, AMH is used as a prognostic marker of ovarian reserve and fertility. The use of criteria developed for adult women is problematic for adolescent girls, as clinical signs associated with polycystic ovary syndrome are normal phenomena of puberty. AMH can be used as an additional criterion in the diagnosis of polycystic ovary syndrome in adolescents. However, the lack of an international standard for AMH limits comparisons between AMH analyzes. Conclusions. AMH has broad clinical diagnostic utility in pediatrics, but interpretation is often complex and should be made in the context of not only the age and sex, but also the stage of development and puberty of the child. Recognition of the role of AMH beyond the development and maturation of the gonads may lead to new diagnostic and therapeutic applications that will further expand its use in pediatric practice.

REPRODUCTIVE OUTCOME IN WOMEN HAVING CONGENITAL UTERINE ANOMALIES: A RETROSPECTIVE STUDY

Background: Congenital uterine anomalies result from failure of or incomplete development, fusion or canalisation of one or both Mullerian ducts during foetal life. [1] These anomalies are often asymptomatic and unrecognized, until menarche or starting of reproductive life. The spectrum of uterine anomalies ranges from an arcuate uterus, uterine didelphys , unicornuate , bicornuate, t-shaped and septate uterus.[3] Pregnancy occurs in many women despite these anomalies. The complication rates with pregnancy are considerably increased; complications include intrauterine fetal growth restriction, fetal malposition, preterm labor, preterm premature rupture of membrane and malpresentation (breech) [21]. Not surprisingly, the rate of caesarean delivery is markedly higher. [4] Thus we want to conduct a systematic review to evaluate the association between the different subtypes of uterine anomaly and various clinical presentations and reproductive outcomes. This study was carried out retrospectively in 52 patients Method: that were in the age group of 12-38 years and having congenital uterine anomalies and presenting with either primary or secondary infertility / amenorrhoea, bad obstetrical history, recurrent abortions, preterm deliveries and ectopic pregnancies using consecutive sampling. All patients were evaluated and investigated further including reproductive & perinatal outcome. Data were analyzed regarding type of uterine anomalies and their reproductive performance. Results & Conclusion: Results of study shows that patients with uterine anomalies have higher rates of reproductive loss, preterm deliveries, that increase obstetric intervention and perinatal mortality.

MULLERIAN CYST PRESENTING AS A LARGE ABDOMINOPELVIC CYST CAUSING OBSTRUCTIVE UROPATHY IN MALE: A RARE CASE.

Introduction: Mullerian duct cyst presenting as a large abdominopelvic cyst is a rare entity. A Mullerian duct cyst represents an incomplete focal regression of the embryological Mullerian duct in a male. Case Report: This is a case of a 55 year old gentleman presenting with a pelvic mass of chronic duration with a recent onset of pain abdomen and obstructive urinary symptoms. Radiological imaging revealed a large centrally located cystic pelvic mass and Left Hydroureteronephrosis. The patient underwent Left DJ stenting followed by an Explorative laprotomy and Marsupialization of the cyst. It is prerogative to understand the development of the male urinary tract and the Conclusion: reproductive system to diagnose rare midline pelvic pathologies and decide on surgical options for treatment of the same. In addition, the nal diagnosis being dependent on the histology of such pelvic masses makes it an additional diagnostic challenge for the surgeons.

A Rare Case of Paratesticular Cystadenoma with Ovarian Stroma Found by Scrotal Ultrasound on a Cirrhotic Patient with Elevated Alpha-fetoprotein

Abstract Introduction/Objective Paratesticular cystadenoma with ovarian stroma is a rare benign cyst-forming neoplasm with less than 10 cases reported in the literature. Typically, it presents in men aged 11 to 68 years (average 30) and is asymptomatic. The tumor is hypothesized to represent the efferent ductulus undergoing metaplastic change, the vestigial remnants of Mullerian duct, or mesothelium of the tunica vaginalis. Most tumors are considered benign, but a few cases of malignant transformation have been reported. Methods/Case Report We present a case of a 54-year-old male with a history of cirrhosis and elevated alpha-fetoprotein (17.85 ng/ML) who was found to have a paratesticular mass by scrotal ultrasound. Clinical history was obtained from review of electronic medical record. CD10 (Novocastra Clone 56C6) and progesterone receptor (PR) (Leica Clone 16) Immunoperoxidase stains were performed following the vendor recommendations. Surgical excision revealed a 0.6-cm polypoid nodule on tunica albuginea that was entirely submitted. Microscopically, the tumor was comprised of cystic spaces lined by cuboidal epithelium identical to that of the Fallopian tubes. There was a sparse spindle-shaped stroma underlying the epithelium similar to ovarian stroma. No nuclear atypia or mitosis was found. Immunoperoxidase stains showed the epithelium was positive for PR, and the stroma was positive for CD10. No evidence of germ cell tumor was identified. Results (if a Case Study enter NA) NA. Conclusion Characteristic histologic and immunophenotypic findings can aid in the diagnosis of paratesticular cystadenoma with ovarian stroma. Surgical resection for histological confirmation and long-term monitoring for the potential recurrence and metastatic spread are required.

A case of Uterine didelphis with cervical atresia: A Case Report

Congenital uterine malformations are deviations from normal anatomy resulting due to defective fusion of Mullerian ducts or the paramesonephric ducts in the developing embryo. The prevalence of female genital tract anomalies is 4%-7% in general population and up to 8%-10% in women who have recurrent pregnancy loss.(1) The type and degree of anatomical distortion has associated health implications that may include, cyclical abdominal pain, reproductive failure, obstructed menses and inability to engage in sexual intercourse.(2) Uterus didelphys (double uterus) is a developmental abnormality that results from the failure of fusion of the Mullerian ducts leading to separate uterine cavities and 2 cervices 1. It is a rare anomaly accounting for 5% of all uterine anomalies. (3) Cervical agenesis is a rare Mullerian anomaly with an incidence of 1 in 80,000 females. (4) It represents 3% of all uterine anomalies. It is rarely associated with a functioning uterus (4.8%). Cervical agenesis is often associated with vaginal atresia (less than 50%). It is important to classify these anomalies for easy diagnosis and plan appropriate preoperative treatment.

8849 Niamh Joyce MD, OBSTETRICS AND GYNECOLOGY, MRCOG, Fellow in Reproductive Medicine

<h3>Study Objective</h3> Video demonstration of fertility sparing laparoscopic treatment for a symptomatic Müllerian Tract abnormality <h3>Design</h3> Single Case Report. <h3>Setting</h3> Tertiary Academic Hospital. 3 port laparoscopy, with patient in Trendelenburg Lithotomy position <h3>Patients or Participants</h3> A 16-year-old nulliparous patient presented with intractable dysmenorrhea since menarche aged 15, associated with syncope. There was no response to analgesia or hormonal contraception and the impact on quality-of-life necessitated surgical review. Initial assessment by pelvic ultrasound identified normal ovaries and uterus but a solid appearing right adnexal lesion. Further imaging by MRI showed evidence of a double uterus with only the left sided uterus communicating with the vagina in keeping with an ASRM class II(b) abnormality. Differential diagnosis included Mullerian duct abnormality and accessory and cavitated mass. A uterine didelphys with only a left ostia was seen on hysteroscopy. Laparoscopy showed a uterine didelphys with a non-communicating, engorged right uterus and right fallopian tube. Her case was discussed at a multidisciplinary meeting where it was decided the most suitable treatment was to perform a laparoscopic hemi-hysterectomy with right salpingectomy to remove the right sided non communicating cavity and tube. This procedure was recorded with the patient's consent and will be shown as part of the video presentation. <h3>Interventions</h3> Laparoscopic hemi-hysterectomy for resection of non-communicating uterine horn. EBL minimal. Operative time 37 Mins, hospital stay 1 night. <h3>Measurements and Main Results</h3> A successful laparoscopic intervention was performed, and the patient was discharged day 1 post op. Review at clinic revealed completed resolution of symptoms, normal menses. Future fertility was a primary concern and was successfully conserved. Histology demonstrated a functioning endometrial cavity with focal adenomyosis. <h3>Conclusion</h3> Class II Müllerian abnormalities are uncommon, affecting around 0.06% of females. Symptoms can include pain or menstrual dysfunction as well as fertility/obstetric complications. When necessary, a minimally invasive approach can be utilized to treat these conditions.

Lesson Learned from MRI Evaluation of Mullerian Duct Anomalies [Letter

Lesson Learned from MRI Evaluation of Mullerian Duct Anomalies [Letter

MRI Evaluation of Mullerian Duct Anomalies: Practical Classification by the New ASRM System.

To describe variable mullerian duct anomalies using magnetic resonance imaging (MRI) and to classify these anomalies according to the available classification systems, namely the American Fertility Society (AFS) system, the European Society of Human Reproduction and Embryology (ESHRE) system, and the new American Society for Reproductive Medicine (ASRM) system. Retrospective chart review. The pelvic MRI studies and the clinical records of 64 females with mullerian congenital anomalies were retrospectively reviewed between January 2010 and December 2021. The mean age was 22 years (age range 2-63 years). Detailed imaging findings were recorded, and the resulting mullerian anomalies were then classified according to the three classification systems of interest. Variable mullerian anomalies were found among patients with multiple frequencies. Mullerian agenesis and hypoplasia were found in 12 patients (19%) and 16 patients (25%), respectively. Uterus didelphys was found in 5 patients (8%). Twelve (19%) patients had septate uterus, while 8 (12.5%) had a bicornuate anomaly. Unicornuate uterus was present in 7 patients (11%). Isolated vaginal anomaly was diagnosed in 4 patients (6%). Renal/urinary tract imaging was available for 27 (42%) patients, and accompanying urinary tract anomalies were noted in 10 of them (37%). Few ovarian and other extra-renal anomalies were observed. MRI could efficiently delineate the mullerian anomalies regardless of their complexity. Most of these anomalies were more efficaciously categorized by the ESHRE and the new ASRM systems, compared to the originally widely used AFS system. The new ASRM classification was found to be more practical as it is a modification of the original AFS system, using drawings with clear descriptions instead of symbols. This is particularly helpful in the radiological era, saving time and effort.