Asherman's Syndrome and fertility
Asherman's Syndrome is a problem that affects the female uterus.
Asherman's Syndrome is a problem that affects the female uterus. It consists of the formation and persistence of adhesions or fibrosis within the inner walls of the uterine cavity. Naturally, this may seriously affect the uterine function of conceiving and gestating a baby.
This syndrome is most frequently caused by trauma to the cavity and its subsequent abnormal scarring. Abortions and dilation and curettage (D&C) performed after a miscarriage, interventions to remove uterine fibroids or polyps, infections, etc. are the situations that most often lead to Asherman's Syndrome.
The symptoms that women experience range from a reduced number of menses to a complete absence of them, as well as recurrent miscarriages or fertility problems.
In order to correctly diagnose what is happening in the endometrial cavity, a detailed study must be conducted that includes an extensive interview with the patient, gathering information on issues that might have caused problems in the uterus. We also rely on imaging tests: trans-vaginal ultrasound, diagnostic hysteroscopy and hysterosalpingography.
The trans-vaginal ultrasound scan is the visualization of the uterus through the vagina using ultrasound technology. It is the scan that is typically performed in the gynaecologist office. When Asherman's syndrome is suspected, endometrial evaluations must be performed at different times of the cycle, since the endometrium grows abnormally in areas where there are adhesions or synechiae. The 3D ultrasound scan will add important information and will rule out associated pathologies.
The diagnostic hysteroscopy will allow us to clearly see the adhesions, the degree to which the cavity is affected, the quality of the endometrium, the tubal ostia and the possibilities of real treatment and a prognosis adapted to the severity of the case. It is a simple technique that does not require general anaesthesia and by using saline we can access the inner uterus to observe its characteristics on a television monitor. No hospitalisation required.
The hysterosalpingography provides less information than the diagnostic hysteroscopy, which is why it can usually be avoided.
Once we have diagnosed Asherman's Syndrome, we must place it in the clinical context of the patient. That is, if gestation is desired and not achieved, there have been repeated miscarriages or implantation failures, or there is simply a decrease in the menses. Then we can decide on the ideal treatment.
Traditionally, treatment has been performed through hysteroscopy by selecting the adhesions and trying to avoid them from reappearing with the insertion of intrauterine devices.
Recently, the importance of uterine vascularisation in endometrial growth has also been considered, so if we promote a good sub-endometrial irrigation, the endometrial regeneration will improve the cavity wall tissue.
A treatment plan was recently published that combines several key factors in the successful treatment of Asherman's Syndrome.
- Evaluation of endometrial thickness prior to repair.
- Surgical hysteroscopy and resection of adhesions.
- Laparoscopic control of adhesiolysis.
- Prevention of new adhesions and scarring with intrauterine balloon and insertion of IUD.
- Promotion of endometrial proliferation with hormonal therapy and vasodilators.
- Evolutionary ultrasound controls.
The prognosis for treatment success varies and depends on the degree to which the endometrial cavity was initially affected. Therefore, each case should be considered as unique in order to determine the possibilities we have of achieving our goal.
At Instituto Bernabeu, we aim to offer couples with infertility problems individualised solutions based on our experience by exploiting the full potential of our technologies and resources and incorporating the latest evidence from known successful treatments.
Therefore, within the Instituto Bernabeu Implantation Failure Unit, we assist couples diagnosed with Asherman's Syndrome with a detailed evaluation of their case by determining a realistic prognosis of treatment and offering good reproductive advice.