9 Key Facts to Know

Pregnancy and Asherman syndrome

In severe cases, Asherman syndrome can make it very difficult or impossible for a woman to get pregnant or carry a pregnancy to term. The scarring can distort and block the uterine cavity, preventing embryo implantation.

For women who can conceive, there’s a higher risk of pregnancy complications, including:

• Placental abnormalities like placenta previa (the placenta covers the cervix) or placenta accreta (the placenta attaches too deeply into the walls of the uterus)
• Recurrent pregnancy loss
• Preterm birth and low birth weight

Studies show that while treatment for intrauterine adhesions (IUAs) in women with infertility can lead to pregnancy rates of 40% to 80% and live birth rates of 30% to 70%, outcomes vary based on disease severity. Recurrence rates are significant, reaching up to 66% in severe cases, and pregnancies following treatment are often considered high risk due to complications such as placenta accreta, intrauterine growth restriction, and preterm delivery.

Advanced Reproductive Techniques and Their Effectiveness

While natural conception is possible for some women with Asherman syndrome, others may need assisted reproductive technologies (ART) to become pregnant.

These include:

• In vitro fertilization (IVF): IVF is often recommended for women with Asherman syndrome who’ve undergone hysteroscopic adhesiolysis to remove scar tissue. During IVF, embryos (fertilized in a lab) are transferred directly into the uterus.
• Intrauterine insemination (IUI): Although IUI is less effective than IVF, it may be an option for some women with mild Asherman syndrome. During IUI, washed and concentrated sperm are placed directly into the uterus.
• Gestational surrogacy: In severe cases of Asherman syndrome (where pregnancy is not recommended for medical reasons), gestational surrogacy may be an option. This involves using the expectant mother’s eggs or donated eggs (fertilized with the partner’s or donor’s sperm) and transferring the embryo to a surrogate’s healthy uterus to carry the pregnancy.

Note: The success of these advanced fertility treatments varies based on the severity of the woman’s Asherman syndrome, her overall health, her partner’s fertility status, and the outcomes of prior treatment.

Women with Asherman syndrome should prioritize finding a healthcare team that offers comprehensive monitoring and support to improve their chances of achieving their reproductive goals, whether through natural conception or ART.

Prevention and Early Detection

There isn’t a definitive way to prevent Asherman syndrome because it’s usually caused by injuries sustained during prior medical procedures rather than an inherent condition.

When possible, try to avoid D and C procedures and instead choose alternative treatments like suction curettage or vacuum aspiration, as these may be less likely to cause uterine scarring and adhesions. If you can’t avoid the D and C, ask your surgeon to use an ultrasound guide and be gentle to minimize trauma to the uterine lining.

Medications may sometimes be an alternative to surgery for managing certain conditions, like heavy periods.

Takeaway

Asherman syndrome is rare in which scar tissue forms inside the uterus. These are called intrauterine adhesions or intrauterine synechiae, which can lead to infertility and other reproductive problems.

Symptoms can vary, with some women experiencing lighter or absent periods, recurrent miscarriages, or pelvic pain, while others may have no symptoms at all.

Hysteroscopy is the gold standard for diagnosis, while treatment typically involves surgical removal of the adhesions (hysteroscopic adhesiolysis) followed by hormonal therapy and careful post-operative care to promote healing and prevent recurrence.

With the correct diagnosis and treatment, many women with Asherman syndrome can experience improved reproductive outcomes and overall well-being.

A Word from RMA Network

As fertility specialists who’ve dedicated years to helping women achieve their dreams of starting a family, we know just how emotionally and physically demanding Asherman syndrome can be.

We believe in empowering our patients with knowledge and support, guiding them through every step of their journey toward reproductive wellness. From diagnosis to treatment and post-operative care, we’re committed to giving them the best chance of success.

If you’re experiencing symptoms of Asherman syndrome or have been diagnosed with this condition, we encourage you to reach out. Our team is here to answer your questions, address your concerns, and provide you with the expert care you deserve. Together, we can explore your options and develop a personalized plan to help you overcome this challenge.