Intrauterine adhesions (scar tissue), also called Asherman syndrome, can cause infertility, menstrual irregularities (light or absent menses) and recurrent pregnancy losses. In a previous blog, I have discussed the causes of Intrauterine adhesions. In this blog, we will discuss the treatment of intrauterine adhesions.
Most cases of mild intrauterine adhesions (solitary band of scar tissue) can be easily treated via hysteroscopy. The scar tissue can be cut with scissors, electric current (Versapoint) or laser. All three modalities are equally effective and the choice is based on the surgeon’s preference.
Severe Asherman syndrome, however, can be clinically challenging. These are patients with dense scar tissue that affects at least two-thirds of the uterine cavity and these patients have light or absent menses. The problem with these patients is that the adhesions often recur and may require multiple surgical procedures.
Doctors Myers and Hurst from the Carolinas Medical Center in Charlotte, North Carolina, discussed this very issue in a recent paper (Fertil Steril 2012;97:160-4). They utilized a comprehensive approach for treatment of severe intrauterine adhesions. The details were a follows:
The authors reported their experience in 12 women with severe intrauterine adhesions and absent menses. Using the above protocol, all 12 women resumed menses although the uterine lining was less than 4 mm in 5 of the 12 women. Six of nine women less than age 39 years (67%) became pregnant, and four of six achieved a term or near-term delivery.
Other authors have used hyaluronic acid (HA) to prevent recurrence of the adhesions. Seprafilm, a bioresorbable membrane from chemically modified HA (sodium hyalronate) and methyl cellulose, has been shown to significantly reduce intrauterine adhesions.
Women who get pregnant after treatment of Asherman syndrome still have a high risk of pregnancy complications, including miscarriage, premature delivery, abnormal placentation (placenta gets deeply embedded in the uterine musculature and can cause bleeding and other problems), intrauterine growth restriction (IUGR), and uterine rupture during pregnancy or delivery.
To see a Board Certified physician who has been successfully treating intrauterine adhesions for many years, make an appointment at one of InVia's four Chicago area fertility clinics.
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