Asherman’s syndrome and female fertility: what it is and how it can affect reproduction

At assisted reproduction clinics such as URE Centro Gutenberg, we deal with fertility problems on a daily basis. In all cases, we look for the cause affecting the future mother and/or father in order to offer the most appropriate reproduction treatment. Today we want to talk to you about Asherman’s syndrome and how it can be problematic for female fertility.

Asherman’s syndrome affects approximately 8% of women and can be found in between 2% and 22% of women with fertility problems. It is an acquired condition; you are not born with it. It is caused by the growth of fibrous tissue on a scar or in an area where trauma has occurred.

What is Asherman’s syndrome?

This syndrome is named after Israeli gynaecologist Josef Asherman, who first described it in 1948. Women affected by this condition have adhesions, or synechiae, inside the uterine or endometrial cavity. These adhesions cause partial or total obliteration of the cavity, making it narrower or deforming it.

Depending on the degree of severity of Asherman’s syndrome, we can find mild, moderate or severe cases. The latter, as you can imagine, has the worst prognosis, since in this case the uterine walls are completely adhered.

Causes of Asherman’s syndrome

Although there are various causes for this syndrome, in more than 90% of cases the origin is uterine curettage, following a spontaneous or induced abortion.

However, Asherman’s syndrome can also occur due to endometrial infections, IUD use, uterine surgery, etc.

Symptoms of Asherman’s syndrome

How can this condition be detected early? What symptoms usually appear before female fertility is compromised? Here are the most common ones:

Menstrual disorders. Decreased or absent periods (amenorrhea), mainly due to a reduction in functional endometrial tissue and obstruction of the cervix by adhesions, which prevent menstrual bleeding from occurring.
Pelvic or abdominal pain. Usually caused by this retention of menstrual bleeding.
Endometriosis. The possible retention of menstrual blood can, retrograde, go to the abdominal cavity, facilitating the generation of endometriotic foci in susceptible women.
Infertility. All these adhesions prevent the proper development of the endometrium, causing embryo implantation failure. Or, if pregnancy does occur, it can prevent proper development, leading to miscarriages.

Diagnosis of Asherman’s syndrome

It is usually diagnosed clinically during infertility testing when the patient comes in for her first fertility consultation.

The diagnosis can be suspected based on the symptoms and through ultrasound, hysterosonography or hysterosalpingography. It is confirmed with a diagnostic hysteroscopy.

Treatment of Asherman’s syndrome

The treatment of this syndrome consists of releasing or cutting the adhesions it produces, using a hysteroscopy. This procedure can be performed with or without anaesthesia, depending on the severity of the synechiae.

There is a risk of recurrence of Asherman’s syndrome in between 3 and 23% of patients. Fortunately, there are now treatments available, such as the use of oestrogen, to prevent this recurrence, although the results tend to vary.

You should also know that various research studies are currently being conducted, involving therapies with platelets, stem cells, etc., which could help regenerate damaged endometrial tissue. In patients with infertility, the goal of treatment is to improve the chances of a successful pregnancy.

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