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Intrauterine Adhesions (Asherman’s Syndrome)

Intrauterine adhesions (IUA) or formerly known as Asherman’s syndrome is a condition characterized by the presence of adhesions or scar tissue in the endometrium.

When the endometrium is scarred and injured, amenorrhea (cessation of menstruation), recurrent pregnancy loss and infertility may follow.

 

IUA can result from post-partum or post-abortion inflammation of the uterine lining, but it can also occur following uterine surgery such as removal of polyps and fibroids (myomectomy) resected abdominally or hysteroscopically. A severe pelvic infection unrelated to surgery may also lead to Asherman syndrome.

Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis. Uterine complications related to these infections are less common.  Whether you are trying to improve your fertility,  our compassionate fertility specialist will be able to advise and help you.

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Symptoms of intrauterine adhesions

The adhesions may cause amenorrhea (lack of menstrual periods), repeated miscarriages, and infertility.

However, such symptoms could be related to several conditions. They are more likely to indicate Asherman syndrome if they occur suddenly after a dilation and curettage – dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping or other uterine surgery.

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Effects of IUA on fertility

The degree of IUA significantly impacts clinical and pregnancy outcome.

Severe cases may result in a reduction in the days and the amount of menstrual blood flow and can be closely related with repeated pregnancy loss and infertility.

Mild cases may even go unrecognized for a long time or until pregnancy is desired.

Additionally, IUA may block the junction where the uterus connects with the fallopian tubes (internal tubal ostia). In such cases, embryo implantation may be compromised and the pregnancy may implant in the fallopian tube, resulting in an ectopic pregnancy.

Diagnosis of IUA

A pelvic exam does not reveal problems in most cases. Tests may include:

  • Hysteroscopy

  • Hysterosonogram

  • Transvaginal ultrasound examination

  • Blood tests to detect tuberculosis or schistosomiasis

Treatment of IUA

Treatment involves surgery to cut and remove the adhesions or scar tissue. This can most often be done with hysteroscopy, which uses small instruments and a camera placed into the uterus through the cervix.

After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent adhesions from returning. Your health care provider may place a small balloon inside the uterus for several days in the hope of preventing recurrence of adhesion formation. You may also need to take estrogen while the uterine lining heals.

You may need to take antibiotics if there is an infection.

In some cases, endometrial lining may be relatively thin following hysteroscopic treatment of IUA. Additional estrogen administered vaginally along with vaginal Viagra treatment may help improve the thickness of the inner lining of the uterus.

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