We reached out to Dr Astha Gupta, Senior IVF Consultant & Infertility Expert, Obstetrics & Gynaecology, Delhi IVF New Delhi, for a clinical perspective on this.
What Causes Asherman Syndrome?
Asherman syndrome, also known as intrauterine adhesions (IUA) or intrauterine synechiae, usually develops after injury to the lining of the uterus. Common causes include:- Dilation and curettage (D&C): Particularly after a miscarriage, abortion, or retained placenta.
- Uterine surgery: Procedures involving the inside of the uterus such as removal of fibroids or a caesarean section.
- Treatment for retained products of conception: Removal of pregnancy tissue after delivery or miscarriage can occasionally injure the endometrium.
- Postpartum haemorrhage: Bleeding after delivery that requires uterine intervention, such as manual removal of tissue, can injure the uterine lining.
- Uterine infection or inflammation: Certain infections such as genital tuberculosis can damage the uterine lining and contribute to adhesion formation.
- Severe pelvic infections: Infections that spread beyond the uterus can also damage the endometrium and lead to scar formation.
What Are the Symptoms of Asherman Syndrome?
Dr Astha explains that some women have no obvious symptoms. When symptoms occur, they may include:- Lighter periods than usual, or periods that stop altogether (amenorrhoea)
- Recurrent miscarriage
- Difficulty conceiving
- Period-like pain without bleeding, caused by trapped blood
- Abnormal menstrual bleeding
- Complications in a later pregnancy, such as abnormal placental attachment
Dr Astha Gupta, Senior Consultant Infertility Expert, Obs & Gyn, Delhi IVF
How Is Asherman Syndrome Diagnosed?
A doctor may suspect intrauterine adhesions based on your menstrual history, previous uterine procedures, and fertility history.Doctors may recommend:
- Hysteroscopy: This is the standard method used to diagnose Asherman syndrome. A thin, lighted camera is passed through the cervix into the uterus, allowing the doctor to view the cavity directly and assess the extent of scarring.
- Saline infusion sonography: Saline is introduced into the uterus during an ultrasound to outline the uterine cavity. It can help identify abnormalities, including adhesions.
- Hysterosalpingography (HSG): An X-ray test using contrast dye can show the shape of the uterine cavity and whether the fallopian tubes are open. However, it may not detect or define intrauterine adhesions as accurately as direct hysteroscopy.
How Is Asherman Syndrome Treated?
The primary treatment for significant intrauterine adhesions is hysteroscopic adhesiolysis. The surgeon uses fine instruments passed through the hysteroscope to carefully cut and separate the scar tissue, restoring the shape of the uterine cavity.After the procedure, doctors often place a temporary balloon or an intrauterine device to keep the walls apart while the lining heals, along with a course of oestrogen to support tissue regrowth. A second-look hysteroscopy is commonly performed a few weeks later to check for new adhesions and clear any that have reformed.
Can You Get Pregnant After Asherman Syndrome Treatment?
Pregnancy is possible after treatment, but the chances depend on the severity of the adhesions, the amount of healthy endometrium remaining, and other fertility factors.A study of 60 women with Asherman syndrome treated at a tertiary care hospital in Indore found that pregnancy rates after treatment were highest in mild cases, at 53.3%, compared with 26.9% in moderate cases and 9.5% in severe cases. This shows that both the extent of the adhesions and timely treatment influence the outcome.
Asherman syndrome is a treatable cause of infertility, and early evaluation of abnormal periods or difficulty conceiving after a uterine procedure can help identify intrauterine adhesions and guide appropriate fertility treatment.
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FAQs on Asherman Syndrome: Can Scar Tissue in the Uterus Affect Fertility?
- Can Asherman syndrome be cured completely?
Most cases improve significantly after treatment. Mild to moderate adhesions respond well, while severe cases may need more than one procedure and carry a higher chance of scar tissue reforming. - How soon can I try to conceive after treatment?
Doctors generally advise waiting for one to two normal menstrual cycles after the uterine lining has healed before attempting to conceive, though this varies by case.