Asherman’s Syndrome is a condition that can affect a person’s ability to get pregnant. Today, we are going to provide a comprehensive overview of how it is caused, diagnosed, and treated by a fertility specialist.
What is Asherman’s Syndrome?
Intrauterine adhesions (IUA) or Asherman’s syndrome is a condition characterized by the presence of severe intrauterine adhesions (synechiae). These often destroy most of the basal layer of the endometrium.
Under the influence of the hormones estrogen and progesterone, the uterine lining (endometrium) develops from the basal layer. When most of this layer becomes incapacitated so that virtually no regeneration of the endometrium can take place, amenorrhea (cessation of menstruation) and infertility follow.
Who Is Affected by Asherman’s Syndrome?
Aside from Asherman’s Syndrome exclusively impacting the global female population, there are no identified geographical or genetic risk factors. According to the National Organization for Rare Disorders (NORD), women who have experienced miscarriages or underwent dilatation and curettage (D&C) within the first month of postpartum stand a greater chance of developing the condition.
It is important to note that Asherman’s Syndrome is an acquired condition. This means that a person can not be born with the condition. Instead, it results from an external cause.
IUA and Asherman’s Syndrome Causes
IUA most commonly results from post-partum or post-abortal inflammation/infection involving the uterine lining. It can also occur following uterine surgery, such as removal of fibroid tumors (myomectomy) or overzealous scraping at the time of D & C, that encroach upon or penetrate into the uterine cavity.
Asherman’s Syndrome Symptoms
Women living with Asherman’s Syndrome do not always display symptoms. However, some identified by the Cleveland Clinic include:
- Light periods (hypomenorrhea)
- Complete lack of periods (amenorrhea)
- Experiencing extreme cramps or pains
- Inability to conceive or remain pregnant
Diagnosis
The diagnosis of IUA/Asherman’s syndrome can be quite difficult to establish and should always be entertained when someone has a history of prior uterine surgery. This applies especially if associated with an infection.
The patient will describe a “defining event” (e.g. a termination of pregnancy with a subsequent infection), followed by a noticeable change in her menstrual pattern. For example, a heavy flow for 4-5 days reduces to a scant flow for 1-2 days. In some cases, a complete absence of menstrual flow in the months following this event may occur. Filling defects can be seen on HSG (dye test).
Sometimes, diagnosis can only happen during the time of a hysteroscopy. If a hysteroscopy is undertaken, the surgeon should be ready to remove (lyse) the adhesions at the same time. It does not make sense to end the procedure and tell the patient adhesions have been found and that another hysteroscopy is needed again in order to remove them.
Even a small number of adhesions can significantly interfere with pregnancy potential because the adhesions act like an IUD (intrauterine device). They can also diminish the available endometrium for successful implantation to take place.
However, it is also prudent to bear in mind that attempts to remove adhesions can actually make the situation worse, by causing more adhesions to develop. Therefore, experience with HSC and judgment on the part of the doctor are very important.
Treatment Options
Treatment involves a procedure called hysteroscopic lysis of adhesions. A telescope-like instrument is introduced via the vagina and cervix into the uterine cavity to allow direct surgical resection of as much scar tissue as possible.
The objective of the hysteroscopic lysis of adhesions is to remove as much scar tissue as possible and to free adhesions that fuse the walls of the uterine cavity together. This is intended to uncover and enable viable basal endometrium to resume growth and progressively cover as much of the surface of the uterine cavity as possible.
Post-operatively, a small balloon is often placed in the uterine cavity for a day or two. This keeps the opposing surfaces separated in the hope of preventing recurrence of adhesion formation. The woman usually receives supplemental estrogen to stimulate endometrial growth. It may be necessary to repeat this procedure to completely reset the scar tissue.
Endometritis severe enough to produce IUA usually scars and blocks the uterine entrance to the fallopian tubes. However sometimes, one or both tubes remain open (although there is usually some degree of damage to the inner lining). In such cases, the uterus is often incapable of allowing proper embryo implantation. Instead, a pregnancy could implant in a fallopian tube leading to an ectopic pregnancy.
Since the blood flow to the uterine lining is often damaged with the presence of adhesions, it may be necessary to assist endometrial development at the time of an assisted reproductive cycle. This can be accomplished with estrogen supplementations or the use of Viagra vaginal suppositories to improve blood flow and hence the delivery of estrogen to the endometrium. The response to these interventions and the determination as to whether the endometrium will develop adequately comes down to the blood flow dynamics and the amount of scar tissue.
Unfortunately, in some cases of IUA, there can be such widespread destruction of the basal endometrium (from which fresh endometrial cells must be generated), that improving blood flow with Viagra is often unsuccessful in improving estrogen-mediated endometrial development sufficient to achieve adequate improvement in endometrial growth. In such cases, the women should consider other options such as gestational surrogacy.
Preventative Measures
Because Asherman’s occurs primarily during the D&C procedure, the best way to prevent it is by opting for another form of medical evacuation after an event like a miscarriage or hemorrhage post-birth. Consult with your doctor to explore other options that might be more suitable for your specific situation.
Prognosis for Asherman’s Syndrome
Once treatment has concluded, the uterus should heal properly and the symptoms will subside. If a person wants to get pregnant after successful treatment, this should no longer pose a problem in most cases. Should conception problems persist, it is recommended to follow up with a fertility specialist.
Disclaimer
This blog is intended as an aid to provide patients with general information. As science is rapidly evolving, some new information may not be presented here. It is not intended to replace or define evaluation and treatment by a physician.
Get IUA and Asherman’s Syndrome Treatment in California
At RISE Fertility, our goal is to provide seamless and elevated fertility treatment. If you are experiencing symptoms of IUA or Asherman’s Syndrome, and you are trying to get pregnant, contact us today for a fertility assessment. Our team is standing by and waiting to assist you on your fertility journey – we are with you every step of the way!
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