Can intrauterine adhesions go away on their own?

No, intrauterine adhesions cannot go away without proper medical treatment. Once scar tissue forms within the uterus, it often requires surgical intervention, such as hysteroscopic adhesiolysis, to remove it and restore normal uterine functions.

Is pregnancy possible after Asherman’s Syndrome treatment?

Yes, in most cases, pregnancy is possible post-treatment, particularly for those ranging from mild to moderate. However, in severe cases, there is a chance of conception with the help of treatment like IVF.

How can the recurrence of intrauterine adhesions be reduced?

While recurrence cannot be completely prevented, certain steps can help lower the risk. Your doctor may insert a balloon or IUD temporarily, prescribe oestrogen therapy to support healing, and schedule a follow-up hysteroscopy to monitor recovery.

Intrauterine Adhesions & Fertility: Causes, Diagnosis & Treatment

When conception doesn’t occur as expected, exploring potential underlying causes is important. Irregular or absent periods, recurrent miscarriages, or a history of uterine procedures may point to intrauterine adhesions, a condition also known as Asherman’s Syndrome.

What Are Intrauterine Adhesions (Asherman’s Syndrome)?

Intrauterine Adhesions mainly occur when scar tissue forms within the uterus, causing the uterine walls to stick together. This issue can partially or completely block the uterine cavity, disrupting the menstrual cycle and making it challenging for an embryo to implant successfully.

When these adhesions are more extensive, dense, or severe, this condition is generally referred to as Asherman’s Syndrome. It can affect reproductive function and overall uterine health. Understanding and identifying these adhesions early is key to restoring normal uterine anatomy and improving fertility outcomes.

What Causes Intrauterine Adhesions?

Intrauterine adhesions form after the inner lining of the uterus is injured. Mostly, this occurs due to conditions that affect the uterine cavity. Some common causes are:

Dilation and Curettage (D&C): Often performed after a miscarriage, abortion, or to remove a retained placenta.
Caesarean Section (C-section): Surgical delivery can sometimes lead to scar tissue formation.
Surgical Removal of Fibroids or Polyps: Procedures like myomectomy or polypectomy may contribute to adhesion development.
Endometrial Infections: Infections such as pelvic inflammatory disease (PID) or genital tuberculosis can damage the uterine lining.
Pelvic Radiation Therapy: Though rare, radiation can affect the uterine cavity and cause adhesions.

Among these, D&C, especially when performed repeatedly, poses a higher risk of developing adhesions compared to C-sections or fibroid removal surgeries. Infections and radiation therapy, though less common, can cause more extensive damage when they do occur. Being aware of the varying risk levels can help guide appropriate prevention and follow-up care.

What are the Symptoms?

Symptoms of intrauterine adhesions may vary. There are no obvious signs, in some cases, until fertility problems arise. Nevertheless, the common symptoms are as follows:

Light periods or no periods at all (amenorrhoea)
Pain during menstruation, if blood is trapped by scar tissue
Repeated miscarriages
Difficulty getting pregnant or infertility
Pregnancy complications involving the placenta, such as placenta previa or placenta accreta

It’s important to seek medical evaluation if any of these symptoms appear, especially after a uterine procedure.

How do Intrauterine Adhesions Affect Fertility?

Intrauterine adhesions can interfere with conception and pregnancy in different ways:

Implantation issues: Scar tissue can replace or cover healthy areas of the endometrium, making it hard for an embryo to implant successfully. A non-receptive uterine lining reduces the chances of a pregnancy, even after fertilisation.

Distorted uterine structure: Adhesions can alter the normal structure of the uterus, affecting its function. This may block sperm from reaching the egg or disrupt an embryo's early growth.

Higher risk of pregnancy complications: Even if implantation occurs, adhesions increase the risk of miscarriage or abnormal placental attachment.

Fertility outcomes depend on the severity of your adhesions, ranging from mild to severe. Fortunately, many cases respond well to treatment, and fertility can often be improved.

How Is Asherman’s Syndrome Diagnosed?

To identify intrauterine adhesions, a doctor may use several tools, such as:

Hysterosalpingography (HSG): An X-ray that uses contrast dye to examine the shape of the uterus and fallopian tubes.

Sonohysterography: An ultrasound is performed after saline infusion into the uterus, which helps reveal any irregularities.

Hysteroscopy: One of the most accurate methods, this procedure involves inserting a small, lighted scope through the cervix to view the uterine cavity directly.

Hysteroscopy not only confirms the presence of adhesions but also allows for treatment at the same time.

What Treatment Options should you explore?

The purpose of treating intrauterine adhesions is to remove scar tissue, restore the normal shape of the uterine cavity, and prevent the adhesions from returning. Treatment is based on the severity of the condition and your fertility goals.

1. Hysteroscopic Adhesiolysis

This is the standard treatment for intrauterine adhesions. It involves using a hysteroscope, a thin, lighted tool inserted through the cervix, to visualise and carefully cut away the scar tissue within the uterus.

The procedure is typically done under anaesthesia and has a good success ratio, especially in mild to moderate cases. Most patients experience an early recovery and can resume normal activities within a few days.

2. Preventing recurrence

To lessen the chances of scar tissue reforming, doctors often use additional measures after surgery:

Intrauterine device (IUD) or balloon: Placed inside the uterus temporarily to keep the uterine walls from sticking together during healing.

Oestrogen therapy: Used to stimulate the regrowth of healthy endometrial tissue and support recovery.

Second-look hysteroscopy: Usually performed a few weeks after the initial procedure to monitor healing and remove any new adhesions if necessary.

These preventive steps greatly improve the chances of maintaining a healthy uterine environment in the long term.

3. Fertility Support

If you are unable to conceive after treatment, the Assisted Reproductive Technologies (ART) option may be taken into account:

Intrauterine Insemination (IUI): During ovulation, Sperm is placed directly within the uterus.
In Vitro Fertilisation (IVF): Eggs are fertilised in a lab, and embryos are transferred back into the uterus.

In many cases, natural conception is possible once the uterine cavity has been successfully treated.

What to Expect Post-Treatment

Recovery and outcomes depend on the extent of the adhesions and how well the uterus heals:

Mild cases: Often have excellent outcomes, with a high chance of natural conception.

Moderate to severe cases: May require more than one procedure and can still pose challenges, but many individuals go on to achieve healthy pregnancies.

Generally, recovery after hysteroscopic surgery is brief. You may consider frequent visits to check your healing progress. Most people are advised to wait about 2–3 months post-treatment before attempting to conceive.

If you’ve been dealing with fertility challenges, irregular periods, or have a history of uterine surgery, intrauterine adhesions may be a contributing factor. This condition can affect your ability to conceive, and the good news is that it’s often treatable. With timely diagnosis, fertility can often be restored. Early detection and a well-planned treatment are key. Working closely with a fertility specialist, staying aware of any changes in your cycle, and following through with treatment can greatly improve your chances of a healthy pregnancy.

FAQs on Intrauterine Adhesions (Asherman’s Syndrome) and Fertility Outcomes

Can intrauterine adhesions go away on their own?
No, intrauterine adhesions cannot go away without proper medical treatment. Once scar tissue forms within the uterus, it often requires surgical intervention, such as hysteroscopic adhesiolysis, to remove it and restore normal uterine functions.
Is pregnancy possible after Asherman’s Syndrome treatment?
Yes, in most cases, pregnancy is possible post-treatment, particularly for those ranging from mild to moderate. However, in severe cases, there is a chance of conception with the help of treatment like IVF.
How can the recurrence of intrauterine adhesions be reduced?
While recurrence cannot be completely prevented, certain steps can help lower the risk. Your doctor may insert a balloon or IUD temporarily, prescribe oestrogen therapy to support healing, and schedule a follow-up hysteroscopy to monitor recovery.