Asherman Syndrome: Causes, Symptoms, and Its Impact on Fertility

Asherman syndrome, named after Israeli gynaecologist Dr Joseph Asherman, is a rare medical condition that affects female reproductive health. While several medical conditions have been frequently discussed as the cause of infertility, such as PCOS/PMOS and endometriosis. A very rare condition, Asherman’s syndrome or Asherman’s disease, might also be responsible for infertility.

This rare but significant medical condition occurs when scar tissue forms inside the uterus. The abnormal growth of scar tissue reduces space for the uterine lining to grow normally. As fertility is one of the main areas of concern when it comes to female health, a woman who is aware of the causes, symptoms, and treatment options of Asherman syndrome will be able to make the right choices and avoid unwanted outcomes.

What is Asherman Syndrome?

A medical condition associated with the growth of scar tissue, also called intrauterine adhesions, inside the uterus or cervix, is widely known as Asherman syndrome. The scar tissue buildup shrinks the space by partially or completely sticking the walls of the uterus together, reducing the normal uterine cavity. Although the condition is not common and very rare, it is often associated with menstrual abnormalities, infertility, and recurrent pregnancy loss. The severity of this problem varies from person to person, as scar tissue ranges from thin, delicate bands to thick, dense adhesions. Some women may develop only mild adhesions with few symptoms. While others may face a complete blockage of the uterine cavity.

Early diagnosis with the help of clinical evaluation is vital, since most cases of Asherman syndrome are curable. A thorough evaluation involves a complete analysis of the patient’s history, symptoms, and physical examination. Evaluation in terms of any past surgeries, infection, and fertility problems is necessary for the cure of Asherman syndrome.

Asherman Syndrome Causes

It is mainly caused by trauma to the lining of the uterus, known as the endometrium. This tissue is damaged, and there is scar tissue formed during the healing process.

Some of the major causes include:

• Dilation and Curettage (D&C)

Dilation and curettage is one of the major causes of Asherman’s syndrome that takes place after a miscarriage, abortion, or delivery. The risk of suffering from Asherman syndrome is high if the procedure is carried out after pregnancy, since the lining of the uterus is softer and more fragile at this stage.

• Cesarean Section

A C-section is an uncommon cause for scar tissue to develop but a potential factor that contributes to Asherman syndrome. The chances are higher if infections occur after a C-section.

• Uterine Surgery

In case a woman undergoes surgeries to remove fibroids, uterine polyps, or congenital uterine abnormalities. There is a chance that the surgery undergone could cause damage to the uterine lining and adhesions.

• Pelvic Infections

Some pelvic infections, like endometritis or pelvic inflammatory disease, can also be among the causes of Asherman syndrome. Genital tuberculosis, which is common in developing countries, can also result in intrauterine scarring.

• Radiation Therapy

Radiation treatment received to the pelvic region for cancer treatment may also develop scar tissue inside the uterus due to damage to the endometrial lining.

Asherman Syndrome Symptoms

The symptoms of Asherman’s syndrome depend on the amount and position of the scar tissue. It is important to note that some women may not have any symptoms at all before trying to get pregnant.

Common symptoms may include:

• Light menstrual periods (hypomenorrhea)
• Absent menstrual periods (amenorrhea)
• Severe cramps without menstruation
• Fertility problems
• Recurrent miscarriages
• Pain in the pelvis
• Infertility
• Difficulties during pregnancy due to implantation

Some women with this syndrome may ovulate regularly, but observe decreased menstrual bleeding due to scar tissue preventing regular uterine lining shedding. As some of these symptoms can be characteristic of other gynaecological disorders, a proper medical diagnosis is required.

Impact of Asherman Syndrome on Fertility

In discussing Asherman syndrome and pregnancy, one aspect which is of major concern is how this condition affects fertility. For conception to take place properly, there must be an implantation of the embryo on the uterine lining, which, in the case of Asherman syndrome, is minimal due to the scar tissue formed.

In case of untreated Asherman syndrome:

• Infertility: Due to the formation of scar tissue, the process of implantation becomes more difficult.
• Recurrent Miscarriages: As the process of implantation takes place in areas where there is limited or no blood flow, miscarriage can easily take place.
• Pregnancy Complications: Some complications that may occur in women who suffer from Asherman syndrome include placenta accreta, placenta previa, premature delivery, and poor placental attachment.

Fortunately, correct management will contribute significantly to increased opportunities to conceive. To treat the syndrome, it is necessary to conduct adhesiolysis of the uterus under a hysteroscopic procedure and remove the scar tissue from the uterine cavity with a hysteroscope.

Hormone replacement therapy is usually recommended, for instance, to take estrogen in order to guarantee a smooth recovery of the uterus. Many women have achieved healthy pregnancies after having undergone proper treatment for Asherman syndrome.

Why Fertility Planning Matters?

Along with medical treatment, financial planning is also crucial for fertility care. In several cases, women with Asherman’s syndrome may have to undergo tests, surgical procedures, medication, consultations and, sometimes, assisted reproductive treatments. The expenses will quickly add up and even cause more stress amid their emotional experience. Financial planning enables patients to go through infertility treatments without having to worry about sudden expenses. A well-designed future fertility plan by Safetree allows patients to prepare for those costs and have affordable fertility care.

Conclusion

It should be noted that Asherman’s syndrome is a rather rare condition; however, it may have a serious influence on menstrual well-being, fertility, and pregnancy. Thus, it is essential to detect symptoms on time, understand what causes the disease, and consult a specialist in order to increase the probability of effective treatment.

Nowadays, due to innovations in hysteroscopic surgery, it is possible for many women suffering from Asherman syndrome to restore the function of their uterus and carry a baby. Besides medical treatment, careful preparation is also important. SafeTree can help future couples to get ready for financial issues related to fertility.

FAQs

Can you get pregnant with Asherman’s syndrome?

Yes, following a successful removal of uterine scars, conception is possible in Asherman’s syndrome. This depends on how severe the adhesion is, as well as the general reproductive health of the affected woman.

How rare is Asherman’s syndrome?

In the general population, Asherman syndrome is considered a rare condition. However, it is more commonly seen in women who have undergone procedures such as dilation and curettage (D&C) after pregnancy, miscarriage, or childbirth.

Published by: A2V Insurance Brokers Pvt. Ltd. (SafeTree)

Related Blogs