11 July 2025
: Case report 
Term Pregnancy in Herlyn-Werner-Wunderlich Syndrome: Successful Management of Congenital Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA)
Unusual or unexpected effect of treatment, Rare disease
Norah Alqntash
ABDE 1*, Ebtesam Almajed ABEF 1, Kayan Alotaibi F 1, Mashael Alshahrani F 1, Yara Arfaj D 2, Rawda Albahyan D 3
DOI: 10.12659/AJCR.947938
Am J Case Rep 2025; 26:e947938
Table 3 Diagnostic and management workflow for OHVIRA syndrome.
| Step | Details | Findings suggesting OHVIRA |
|---|---|---|
| Patient presentation | 20-year-old woman with primary infertility for 3 years | History of failed ART trials |
| Clinical history | Regular menstrual cycles, alternating heavy/light flow | Suggests possible anatomical abnormality |
| Initial investigations | CBC, thyroid function, FSH, LH, prolactin | Elevated prolactin; otherwise, normal |
| Male factor evaluation | Semen analysis (HSA) | Normal sperm count and motility |
| Pelvic ultrasound | Didelphys uterus, fluid collection in vaginal canal (36.0×17.3 mm) | Suggests obstructed hemivagina |
| Pelvic MRI | Uterus didelphys, duplicated vagina, obstructed right hemivagina with fluid collection | Classic Müllerian anomaly |
| Renal ultrasound | Solitary left kidney, absent right kidney | Confirms OHVIRA (Herlyn-Werner-Wunderlich syndrome) |
| Surgical Intervention (Oct 25, 2018) | Examination under anesthesia, vaginal septum excision, hematocolpus drainage, hysteroscopy, Foley catheter insertion | Relieved obstruction, restored menstrual outflow |
| Postoperative course | Uneventful recovery, no complications reported | Successful treatment outcome |
| Follow-up (Sep 12, 2019) | Absence of menstruation, positive β-hCG (23,000 mIU/L), US-confirmed intrauterine pregnancy | Successful conception post-treatment |
| Pregnancy outcome | Full-term pregnancy, elective C-section on 2 April 2020 | Healthy male infant (2.4 kg) |
| OHVIRA – Obstructed Hemivagina with Ipsilateral Renal Agenesis, ART – assisted reproductive technology, CBC – complete blood count; FSH – follicle-stimulating hormone; LH – luteinizing hormone, HAS – husband’s semen analysis, MRI – magnetic resonance imaging; US – ultrasound; β-hCG – beta human chorionic gonadotropin. | ||