The Uterine abnormality - case of Mullerian Agenesis
Mullerian agenesis is a congenital malformation of genital tract which occurs in 1 out of every 4,000 to 10,000 females. This condition is characterized by congenital absence of the vagina, uterus, or both. Diagnosis can be made after ultrasound/MRI or endoscopy.
In the given picture , fallopian tube is the pink and long structure lying on the bluish looking colon. The small bulging seen at the proximal end is the uterine horn and there is no uterus other than that. The patient had a diagnostic laparoscopy to view the internal structures. We can see that fallopian tubes are looking normal, but only a small peanut sized uterine horn is present in the place of uterus .
The patient never menstruated in her life , as by birth she was devoid of uterus . Her ovaries were normal , hence we were able to do egg collection and successful child birth could be achieved after embryo transfer was done to a surrogate mother . Although this is a rare condition , we have done 2 cases this month , when the patients came for surrogacy .
Before commencing the treatment, the patient and her family should be thoroughly counseled to prevent anxiety and low self esteem. She should be prepared psychologically to face the implications on reproduction.
Satisfactory vaginal creation can be usually managed non surgically and the most common method used is vaginal dilation; however, there are a variety of surgical options for creation of a neovagina. Evaluation for associated congenital renal anomalies or other anomalies is also very crucial.
Dr Anita mani.