Asherman’s Syndrome can strike any woman undergoing virtually any intra uterine procedure. But this condition, which can cause permanent infertility, remains largely unheard of among the public. Many specialists believe it is significantly under diagnosed and expect greater use of modern diagnostic techniques to recognize an increasing number of cases in the future.

A hysteroscopic study in the Netherlands appears to bear this out (Westendorp et al, 1998). The study, which aimed to assess the prevalence of adhesions after a D&C operation, found 40% of women in the study group developed Asherman’s Syndrome. Other studies suggest that 1 in 100 postpartum D&Cs result in Asherman’s. But women undergoing uterine surgery are very rarely informed of any risk to their fertility.

Asherman’s Syndrome is uterine scarring which most commonly develops after a D&C performed shortly after a miscarriage or birth. It can also be caused by an abortion, caesarean section and myectomy, or from an infection in the uterus, including Chlamydia, or the presence of a foreign body such as an IUD. In its severest form, the uterine walls adhere or the cavity fills with scar tissue but whether mild or severe, Asherman’s usually causes infertility and the loss of or reduction in menstrual flow.

The condition is thought to be under diagnosed because it is usually undetectable by straightforward diagnostic procedures such as ultrasound scan. A hysteroscopy is the most reliable method for diagnosis and as this method of examining the uterus telescopically becomes more widely used, some doctors believe the incidence of Asherman’s will rise. Another reason given for under diagnosis is that the symptoms of Asherman’s are often mistaken for other disorders. Although lighter, or absent periods can indicate the presence of adhesions, some women’s menstruation continues largely as normal. This means it can take years for a woman to be accurately diagnosed.

Hysteroscopy for Asherman’s treatment is a difficult operation that often needs to be repeated because of the tendency for scarring to reform. However, it can in some cases restore fertility although future pregnancies usually become much higher risk.

Many sufferers say that women should be alerted to the warning signs of Asherman’s following surgery and claim that greater awareness of Asherman’s among the medical profession and women would be a crucial step towards prevention, earlier diagnosis and more successful treatment.

References: 

Westendorp IC, Ankum WM, Mol BW, Vonk J. (1998) Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion.
Hum Reprod. 1998 Dec;13(12):3347-50.

Click here to see photos from a hysteroscopy to remove adhesions. The first two photos show adhesions, the third photo shows a microscissors removing the adhesions, and the fourth photo shows the uterus after removal of adhesions.