Evaluation of Arcuate Uterus in Infertility Using 3D Transvaginal Ultrasound: A Retrospective Cohort Study

To determine the prevalence and clinical significance of arcuate uterus among infertile women using three-dimensional transvaginal ultrasound (3D-TVUS).

This retrospective cohort included 327 women evaluated for infertility between January 2021 and May 2025. Arcuate uterus was defined as fundal indentation < 10 mm and angle ≥ 90°. The primary outcome was live birth, with subgroup analysis in assisted reproductive technology (ART) cases. Logistic regression was used to assess independent associations.

Arcuate uterus was found in 19% (62/327) of infertile women and was more frequent in unexplained infertility than in explained cases (32% vs. 14%; cOR 2.82, 95% CI 1.59-5.00, p = 0.001). Live birth rates did not differ significantly between arcuate and normal uterus, overall (17% vs. 14%; aOR 1.3, 95% CI 0.2-5.9) or in ART (65% vs. 63%; aOR 1.1, 95% CI 0.5-2.4). Reproducibility was excellent (κ = 0.94).

Arcuate uterus was relatively common, especially in unexplained infertility, but did not independently affect live birth. 3D-TVUS assessment may help identify subgroups within unexplained infertility, warranting validation in multicenter studies.