This chapter discusses the congenital uterine malformations and their reproductive implications. Patients with congenital absence of the vagina usually lack the uterus as well. Imperforate hymen and transverse vaginal septum are vertical fusion anomalies. Double uterus, septate uterus and unicornuate uterus are obstructive lateral fusion anomalies. In strassman procedure a transverse fundal incision is made in case of a bicornuate uterus and the two uterine cavities are unified. In Tompkins procedure for septate uteri a median bivalve is made and no tissue is excised. The two cavities are opened and unified. In Jones procedure which is usually reserved for the wide septum, a wedge resection of the septum is done and the uterine cavities are unified. In uterus didelphys, there is duplication of the uterus, cervix, and vagina. Fertility of women with didelphic uterus was comparatively good. Patients with congenital uterine malformations undergoing IVF have a good pregnancy rate.