Diagnosis of Asherman's Syndrome

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Asherman's Syndrome is a gynecological disorder causing a decrease in menstrual flow, abdominal pain, cessation of menstruation and infertility. In females with the disorder, such symptoms and findings occur due to inflammation of the lining of the uterus (endometritis) and the development of bands of scar tissue abnormally joining portions of the uterus (intrauterine adhesions and synechiae). Dr. Stefan Semchyshyn describes Ashermanîs Syndrome as -a house that is being overrun by cobwebs.° The scar tissue becomes so dense that is impossible for a baby to grow.

The condition can be very mild, or it can be severe and irreversibly damage the uterine cavity. It is common for the diagnosis of Ashermanîs Syndrome to be made if a woman has had a previous D & C and the following symptoms: history of infertility, unusually light and sometimes infrequent periods, and history of early miscarriage. These intrauturine adhesions can occur spontaneously or as a result of trauma to the uturus, such as surgical scraping or cleaning of tissue from the uterine wall (also known as a dilatation and curettage, or a D & C . It is more likely to occur when there is an infection that presents itself either before or after . Once this condition is present, early miscarriages often occur.

Infections of the endometrium (e.g., tuberculosis) or other factors may be involved as well. Former U.S. Surgeon General C. Everett Koop recommended in a report in 1987 that adverse effects of abortion on the physical health of the woman require further study. One infertility problem that is clearly appearing as a post-abortion complication, says Koop, is Asherman's Syndrome. Although the data is spare, National Center for Health Statistics surveys of hospital discharges with Asherman's Syndrome detect an increase from 1988 (7000) to 1992 (9000), with 1989 and 1991 reporting 11,000 cases. Other countries outside the U.S. report a much higher number of cases. Some researchers suspect the availability of safer abortions, with fewer post-abortion infections, keeps the number of cases lower in the U.S.

The diagnosis of Asherman's Syndrome is not always certain. The condition may be diagnosed in one of several ways. Your doctor could check serum progesterone levels every couple of weeks to see if you ovulate. If you ovulate (serum progesterone above 2.5 ng/ml) and still don't have a period, then Asherman's is a consideration. Following a simple, in-office ultrasound, a Hysterosalpingogram (HSG) may be performed. An HSG is an X-ray of the uterus and works as long as this X-ray is performed by a method that uses a small tube placed just inside the cervix. Unfortunately, HSGs are now usually performed by placing a small balloon catheter into the uterus. This technique is quick and easy to do and is excellent for evaluating the fallopian tubes, but according to some physicians, it can miss Asherman's syndrome.

Consequently, some doctors prefer to use a procedure called saline hysterosonography, which uses ultrasound. After determining there is no pregnancy, a tiny catheter is placed into the cervix. Saline fluid (salt water) is injected into the uterus and the ultrasound is repeated. This technique can show the intrauterine adhesions quite well. The gold standard for diagnosis, however, is hysteroscopy, which involves placing a small viewing device into the uterus to see the inside.

If Ashermanîs Syndrome is diagnosed, surgery is routinely performed to rid the uterus of scar tissue. Some physicians have treated Ashermanîs with an IUD, but that is thought to cause an increase in ectopic pregnancies. If not treated, Asherman's Syndrome patients suffer with symptoms including infertility, menstrual irregularities, pelvic pain, miscarriages and ectopic pregnancy. Although the etiology behind how Asherman's Syndrome effects fertility is not totally certain, explanations include: the adhesions block sperm migration up in the uterus; and the embryo cannot implant into the uterine lining, thus it implants in the cervix or fallopian tube (ectopic pregnancy) and/or a miscarriage occurs.

Following treatment of Asherman's Syndrome, the rate of fertility restoration is high, but not 100 percent. Success rates are above 85 percent when adhesions are minimal. However, if scar tissue has replaced most of the uterine cavity, there is little hope of restoring normal uterine function.

For more information, contact the:

National Womanîs Health Network
514 10th Street NW
Suite 400
Washington D.C. 20004
Phone: (202) 628-7814
Fax: (202) 347-1168
e-mail: not available

Related Articles:

1. Tricopoulos, D., Handiness, N., Danezis, J., Kalandidi, A., Kalapothaki, V., "Induced Abortion and Secondary Infertility," 83, 1976, pp. 645-650.

2. Hogue, C.J.R., Cates, W., Tietze, C., "Impact of Vacuum Aspiration Abortion on Future Childbearing: A Review," 15, 3,1983, pp. 119- 126.

3. Daling, J.R., Emanuel, I., "Induced Abortion and Subsequent Outcome of Pregnancy in a Series of American Women," 297, 23, 1977, pp. 1241-1245.

4. Koop, C.E., "A Measured Response: Koop on Abortion," 21, 1989, p. 31.

5. Klein, S.M., Garcia, C.R., "Asherman's Syndrome: A Critique and Current Review," 24, 9, 1973, pp. 722-735.

6. Ismajovich, B., Lidor, A., Confino, E., David, M.R, Treatment of Minimal and Moderate Intrauterine Adhesions (Asherman's Syndrome), Journal of Reproductive Medicine 30, 10, 1985, pp. 769-772.

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