Arcuate uterus: a legitimate pathological entity? - Fertility and Sterility

Data on the arcuate uterus, its definition, and its consequences on fertility or reproductive outcomes are so conflicting that we may finally start to doubt its existence as a pathological entity. In a recent study, Surrey et al. (1x1Surrey, E.S., Katz-Jaffe, M., Surrey, R.L., Small, A.S., Gustofson, R.L., and Schoolcraft, W.B. The arcuate uterus: is there an impact on IVF outcomes after euploid embryo transfer?. Fertil Steril. 2018; 109: 638–643 Abstract | Full Text | Full Text PDF | Scopus (1) | Google ScholarSee all References)(1) evaluated the effect of an arcuate uterus on euploid blastocyst-stage embryo transfer, and concluded that it has no impact on assisted reproductive technology (ART) outcomes (no difference in live-birth rates) and should be considered an incidental finding, not requiring surgical resection. This conclusion is not especially new. Indeed, as indicated in the Society for Gynaecological Endoscopy (ESGE)-European Society of Human Reproduction and Embryology (ESHRE) classification (2x2Grimbizis, G.F., Gordts, S., Di Spiezio Sardo, A., Brucker, S., De Angelis, C., Gergolet, M. et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013; 28: 2032–2044 Crossref | PubMed | Scopus (161) | Google ScholarSee all References)(2), the term arcuate is quite confusing, as it includes patients with different degrees of uterine deformity in the absence of a precise definition. The term arcuate was actually removed from their last classification and a new subcategory (dysmorphic uterus) now groups together all minor deformities of the endometrial cavity, including indentations of less than 50% of uterine wall thickness (2x2Grimbizis, G.F., Gordts, S., Di Spiezio Sardo, A., Brucker, S., De Angelis, C., Gergolet, M. et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013; 28: 2032–2044 Crossref | PubMed | Scopus (161) | Google ScholarSee all References)(2). Surrey et al. (1x1Surrey, E.S., Katz-Jaffe, M., Surrey, R.L., Small, A.S., Gustofson, R.L., and Schoolcraft, W.B. The arcuate uterus: is there an impact on IVF outcomes after euploid embryo transfer?. Fertil Steril. 2018; 109: 638–643 Abstract | Full Text | Full Text PDF | Scopus (1) | Google ScholarSee all References)(1) refer to the American Society for Reproductive Medicine classification and guidelines (3x3Practice Committee of the American Society for Reproductive Medicine. Uterine septum: a guideline. Fertil Steril. 2016; 106: 530–540 Abstract | Full Text | Full Text PDF