What are the causes of intrauterine adhesions?

Intrauterine adhesions (scar tissue in the uterine cavity) are sometimes seen during an infertility work up. Dr Joseph G. Asherman originally published a series of papers about intrauterine adhesions in 1948. The term “Asherman syndrome” has been used to describe the disease ever since.

Intrauterine adhesions are formed due to injury to the uterine lining

• This can be due to scraping of a pregnant uterus (curettage, D&C) during treatment of miscarriage, termination of pregnancy or after a cesarean section. A possible explanation for scar tissue forming in a gravid uterus is the low estrogen levels that are present at the time of the surgery. Estrogen is needed for the uterine lining to regenerate and low estrogen levels predispose formation of scar tissue.
• Trauma to a nonpregnant uterus can also result in Asherman syndrome. Scar tissue can form once again after scraping (diagnostic D&C), surgery for removal of fibroids (myomectomy) and insertion of an intrauterine device (IUD).
• Hysteroscopic surgery can result in scar tissue. Surgeries that can cause scar tissue include removal of fibroids (30 – 45% chance), resection of uterine septum (6 – 7%) and endometrial ablation (35%).
• The role of routinely encountered infections is controversial. Scar tissue due to tuberculosis, however, can totally destroy the uterine lining.
• Genetic disposition. Some patients are prone to developing scar tissue. They and can develop severe form of intrauterine adhesions even after a gentle suction curettage, or for no apparent reason.

What are the symptoms of intrauterine adhesions?

Intrauterine adhesions can cause menstrual problems (light or absent menses, painful menses), infertility, recurrent miscarriages. They can also be completely asymptomatic.

The symptoms from intrauterine adhesions will vary based on the severity of the disease. Patients with some degree of adhesions will have light menses. Those with severe adhesions can have absent menses. If there is blockage of the menstrual flow, then the blood can collect in the uterine cavity (hematometra) and cause pain.

How is Asherman syndrome diagnosed?

The diagnosis of intrauterine adhesions can be done with hysterosalpingography, ultrasound, hysterosonogram or hysteroscopy. Sometimes a combination of these diagnostic modalities is needed.

The treatment of Asherman syndrome will be discussed in a follow up blog.

To see a board-certified fertility specialist who is qualified to identify medical issues that could be affecting your fertility, make an appointment at one of InVia's four Chicago area fertility clinics.