A Lesser-Known Cause Of Infertility

Every year, millions of women struggle to start or grow a family. Infertility, or the inability to get pregnant after at least 6 months, affects 10% of American women. Most infertility cases are common and easily identified by doctors. These include endometriosis, ovarian insufficiency, and tubal factors. However, there are rare conditions that can be just as serious. Asherman syndrome is one such condition affecting the integrity of the uterus.

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All about Asherman

Asherman syndrome is a rare, acquired condition with excess scarring in the uterus. The scarring occurs on the endometrium lining and results from irregular healing. Scars are common in other situations, but with Asherman’s, the uterus walls could heal and stick together. However, the bands of fibrous tissue reduce the size of the uterus, making pregnancy difficult. Women with Asherman’s struggle to get pregnant and are prone to multiple miscarriages.

What causes Asherman syndrome?

Since this is an acquired condition, something must have happened for the scar tissue to develop. The most common reason is the excess damage caused by dilation and curettage. This process removes tissue after an elective abortion, miscarriage, or childbirth. The resulting scarring can cause Asherman syndrome in a small subset of women. Other reasons include missed abortions, damage after C-sections, chronic infections, and surgical complications. Some women may have irregular periods, but an ultrasound after recurrent miscarriages is the primary signal of Asherman.

Treating this rare disease

Asherman can be serious if left untreated. Of course, infertility and repeated miscarriages is the direct result. However, some women who manage to go to term can have pregnancy complications, including placenta previa or placenta accreta. A surgeon can use either hysteroscopy or Hysterosalpingography (HSG) to diagnose and treat the condition. During HSG, the surgeon cuts away scar tissue with surgical instruments. From there, the surgeon can further prescribe estrogen to restore the endometrium lining. Studies show that 67% of women had a live birth rate 1-4 years after surgery.

Can IVF help?

Surgery is helpful, but some women will still experience infertility after surgery. The doctor will suggest in vitro fertilization (IVF) to address the complication. IVF consists of several steps, primarily extraction, fertilization, and implantation. The reproductive clinic harvests eggs from the woman’s uterus. The eggs are combined with sperm to form embryos. These embryos are then implanted in the woman’s uterus, prepared with hormone medication. In women without Asherman syndrome, the success of live birth with IVF starts from 25%. Women with the disease saw similar success rates after surgery but were more at risk for complications. If IVF continually fails, doctors may suggest surrogacy.

Treat Asherman with IVF

This rare condition can severely affect a woman’s ability to become pregnant. The reduced size of the uterus can restrict implantation and cause multiple miscarriages. Reproductive doctors can use surgery to clear the condition, but this does not guarantee a pregnancy. For women who still struggle to start or grow a family, IVF is a viable treatment option.

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