The Management Asherman’s Syndrome
Welcome to MART GROUP’s weekly Fertility Fact Sheet! In this edition, we shed light on a condition that affects women’s reproductive health known as Asherman’s syndrome. In addition, we will delve into its definition, incidence, causes, signs, and symptoms. As well as the diagnosis and treatment options, including recent advances in its management. Let’s start to dive into and expand our knowledge of this critical topic.
What is Asherman’s Syndrome?
Asherman’s syndrome is also called intrauterine adhesions. As well as uterine synechiae. It is a potentially severe condition. It involves the formation of scar tissue within the uterine cavity. These adhesions can range in severity from mild to extensive. They cause the walls of the uterus to stick together. As a result, fertility can be significantly affected. Because of this, it leads to difficulties in conceiving or recurrent pregnancy loss.
How common is Asherman’s Syndrome?
It is essential to recognize its impact on women’s reproductive health. Although, the exact incidence of the condition is not well-established. Hence, many cases may go undiagnosed. Asherman’s syndrome affects approximately 1-2% of women who undergo diagnostic or therapeutic uterine procedures. Therefore, Asherman’s syndrome constitutes 8 percent of gynecological cases in Nigeria. Examples include dilation and curettage (D&C) or cesarean section.
What are the Causes of Asherman’s Syndrome?
Trauma or damage to the uterine lining causes Asherman’s syndrome. Because it typically results from invasive procedures performed within the uterus. The most common causes include the following:
- Dilation and Curettage (D&C): This procedure involves scraping or suctioning the uterine lining to remove tissue. Since it is often performed after a miscarriage. As well as abortion or delivery.
- Cesarean Section: In some cases, scarring can occur after a cesarean section, mainly if complications occur during or after the procedure.
- Uterine Surgery: Any surgical intervention within the uterus, such as myomectomy (fibroid removal) or endometrial ablation, can increase the risk of developing Asherman’s syndrome.
What are the Signs and symptoms of Asherman Syndrome?
Asherman syndrome can present in a number of ways, which include:
- Infertility (most common) affects approximately
- Menstrual cycle disorders, including amenorrhea /absent menses (oligomenorrhoea or infrequent menses. Also, hypomenorrhea/ reduced menstrual flow.
- Cyclical/monthly pain with no actual bleeding can occur in patients with cervical adhesions/stenosis because there is a blockage to the outflow of blood. This can lead to a backflow of blood, eventually resulting in endometriosis (endometrial tissue outside the uterine cavity). This is also a contributory factor to infertility in these women.
- Repeated pregnancy loss
- Disorders of placentation, including placenta accreta and previa, are relatively rare.
How can Asherman’s Syndrome be Diagnosed?
- Hysteroscopy is the gold standard method for the diagnosis of intrauterine adhesions,
- Hysterosalpingography (HSG) – the dye test
- Sonohysterography (SHG) involves a transvaginal scan after introducing sterile water or saline. Since it has a diagnostic accuracy comparable to HSG for identifying intrauterine adhesions.
- Magnetic Resonance Imaging (MRI) can be an additional diagnostic tool.
Recent Advances in Treatment and Management of Asherman’s Syndrome:
Early diagnosis and appropriate treatment are crucial for managing Asherman’s syndrome effectively. The primary goals of treatment are to remove or reduce the adhesions, restore the normal uterine cavity, and improve the chances of a successful pregnancy. Recent advances in the treatment and management of Asherman’s Syndrome include:
- Hysteroscopic Adhesiolysis: This minimally invasive procedure involves using a hysteroscope to visualize and remove the adhesions while minimizing further uterine trauma.
- Adjuvant Therapies: In our center, we initially use additional treatments, such as hormonal therapy or intrauterine devices (IUDs), that we recommend to prevent new adhesions from forming after surgery.
- Regenerative Medicine: Emerging techniques using stem cells, growth factors, and tissue engineering show promise in regenerating the damaged uterine lining and improving reproductive outcomes in women with Asherman’s syndrome.
- Platelet-Rich Plasma Endometrial Infusion: Platelet-rich plasma (PRP) therapy has gained popularity in various fields of medicine. By infusing PRP directly into the endometrium., So, growth factors and bioactive molecules can stimulate follicular growth and cause endometrial regeneration. Medical Art Center is actively researching the safety and efficacy of PRP endometrial infusion and its role in restoring endometrial lining after surgical adhesion removal.
Results of Management:
We have managed about 200 cases of AS at the MART Medicare over five years with an average of 6 instances monthly, with hysteroscopic adhesiolysis, some of whom eventually got pregnant following IVF and had successful deliveries.
Our team of consultants managed Mrs. A.B., a 42-year-old woman with secondary infertility x 6 years at MART. She was evaluated and tested. And we discovered poor endometrial expansion. Because of an adhesion band noted in the uterus. She had a successful hysteroscopic adhesiolysis. Thereafter, a repeat uterine cavity examination showed excellent endometrial distension. She had IVF done, and she was successful. She delivered a live baby afterward.
Conclusion:
Asherman’s syndrome is a condition that requires prompt recognition and diagnosis. Furthermore, managing Asherman’s Syndrome requires appropriate management to restore fertility and improve pregnancy outcomes. By understanding its definition, incidence, causes, and treatment options, including recent advances in its direction, individuals and healthcare professionals can work together to provide the best care for those affected by this condition.
