What is Ashermans Syndrome?

Asherman syndrome is a rare, acquired condition with excess scarring in the uterus. The scarring occurs on the endometrium lining and results from irregular healing. Scars are common in other situations, but with Asherman’s, the uterus walls could heal and stick together. However, the bands of fibrous tissue reduce the size of the uterus, making pregnancy difficult. Women with Asherman’s struggle to get pregnant and are prone to multiple miscarriages.

In severe cases, the entire front and back walls of the uterus can fuse together. In milder cases, the adhesions can appear in smaller areas of the uterus. The adhesions can be thick or thin, and may be sparsely located or merged together.

The main symptom of people with Asherman syndrome is experiencing few or no periods. Having pain at the time their period should be due, but don’t have any bleeding.

This could indicate that you’re menstruating, but the blood is unable to leave the uterus because scar tissue blocks the exit.

If your periods are sparse, irregular, or absent, it may be due to another condition, such as:

Stress
Pregnancy
Over exercising
Obesity
Sudden rapid weight loss
PCOS
Menopause
The contraceptive pill

How can Ashermans Syndrome affect your fertility?

Asherman can be serious if left untreated. Of course, infertility and repeated miscarriages is the direct result. However, some women who manage to go to term can have pregnancy complications, including placenta previa or placenta accreta. A surgeon can use either hysteroscopy or Hysterosalpingography (HSG) to diagnose and treat the condition.

During HSG, the surgeon cuts away scar tissue with surgical instruments. From there, the surgeon can further prescribe estrogen to restore the endometrium lining. Studies show that 67% of women had a live birth rate 1-4 years after surgery. Surgery is helpful, but some women will still experience infertility after surgery. Fertility Specialists usually suggest in vitro fertilization (IVF) to address the complication.

IVF consists of several steps, primarily extraction, fertilization, and implantation. The reproductive clinic harvests eggs from the woman’s uterus. The eggs are combined with sperm to form embryos. These embryos are then implanted in the woman’s uterus, prepared with hormone medication. In women without Asherman syndrome, the success of live birth with IVF starts from 25%. Women with the disease saw similar success rates after surgery but were more at risk for complications. If IVF continually fails, doctors may suggest surrogacy.

Ashermans Syndrome also comes with a high risk of certain conditions during pregnancy, which include:

Placenta Accreta. The placenta attaches itself too deeply into the uterine wall. This leads to a high-risk pregnancy after birth, all or part of it remains attached, and it causes too much bleeding.

Placenta Previa. The placenta blocks the cervix’s opening, which can cause severe bleeding during pregnancy and birth. It also increases the risk of premature delivery.

Excessive bleeding. It can lead to pregnancy loss, infection, or could be a sign of an ectopic pregnancy. An ectopic pregnancy is a pregnancy that happens in your Fallopian tube.‌

The most common cause for the condition is surgical scraping or cleansing of tissue during a dilation and curettage surgery (D&C). The procedure is usually performed after an elective abortion procedure, miscarriage, or during the removal of a retained placenta after delivery. The trauma that results in the uterine walls after the procedure leaves a scar.

Another cause is endometrium infections like genital tuberculosis. Genital tuberculosis is when tuberculosis bacteria enter your reproductive system. The cases of Asherman syndrome vary from one person to the other, and finding out your cause should be on a case-based approach.

A variant of the syndrome exists in which the uterine walls don’t stick together. Instead, the endometrium is exposed, either because the basal layer has been removed or destroyed. Radiation treatment could also cause Asherman syndrome.

Furthermore, diagnostic severity and outcomes are assessed according to different criteria (e.g. menstrual pattern, adhesion reformation rate, conception rate, live birth rate). Follow-up tests (HSG, hysteroscopy or SHG) with your fertility specialist are necessary to ensure that adhesion’s have not reformed. Further surgery may be necessary to restore a normal uterine cavity.

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