Asherman Syndrome (Intrauterine Adhesions) and Fertility
Asherman syndrome is a condition in which scar tissue forms adhesions inside the uterus. These can narrow the uterine cavity and reduce the surface available for an embryo to implant.
This article gives an informational overview of the causes, symptoms, how it is diagnosed, and what it means for fertility.
How does it develop?
When the basal layer of the uterine lining (endometrium) is damaged, the opposing surfaces can stick together as they heal. The causes most often reported are:
- Procedures inside the uterus, particularly surgical evacuation
- Interventions after childbirth or miscarriage
- Infections within the uterus
- Uterine surgery such as fibroid removal
What are the symptoms?
The most characteristic sign is a reduction in menstrual bleeding, or periods stopping altogether. Other possible findings:
- A marked decrease in menstrual flow
- Periods stopping completely
- Painful periods or cramping, where outflow is obstructed
- Difficulty conceiving
- Recurrent pregnancy loss
If your periods changed noticeably after a uterine procedure, mention it to your doctor.
How is it diagnosed?
Assessment begins with history and examination. On ultrasound the endometrium may appear thin or irregular, which can be a clue.
Methods that show the cavity in more detail include contrast imaging of the uterus and saline ultrasound. Our article on fertility testing covers the wider work-up.
The definitive diagnosis is made by hysteroscopy, where the inside of the uterus is viewed directly with a camera.
How is it treated?
Treatment is usually division of the adhesions during hysteroscopy, aiming to restore the normal shape of the uterine cavity.
Afterwards, measures your doctor considers appropriate may be used to reduce the chance of adhesions reforming, and healing is checked.
Response depends on how extensive the adhesions were and on the state of the endometrium, so it varies from person to person.
Fertility and IVF
Once the cavity is restored and the endometrium reaches an adequate thickness, pregnancy can be planned. The uterine environment matters for implantation, see endometrial lining and implantation.
For patients planning IVF, transfer timing is set according to how the endometrium responds. In some cases embryos are frozen and transfer is postponed to a more suitable cycle, see frozen embryo transfer.
Related Reading
- Endometrial Lining and Implantation: What Matters
- Uterine Septum and Fertility: What to Know
- Recurrent Miscarriage and Implantation Failure: Causes and What Can Help
Sources and references
This article is supported by the following independent, authoritative sources: