Pregnancy After Asherman's Diagnosis

In some cases pregnancy may occur spontaneously and without complication depending on the severity of Asherman’s. In some cases where the endometrium has been badly denuded down to the basal layer a condition called "Unstuck Asherman's" can occur and the endometrium will fail to respond to hormonal influence, even in the presence of exogenous estrogen. In this case surrogacy is the only viable option for a biological child.

In some cases pregnancy can occur with the aid of fertility drugs and/or treatments such as IVF. Pregnancy after treatment for Asherman's syndrome will greatly increase the chance of placental implantation issues such as placenta previa (low lying placenta growing over the cervix which mandates a cesarean section and which can be caused by previous scarring of the fundus of the uterus), placenta accreta (placenta attaches too deeply causing problems with placental removal and hemorrhage at the time of delivery), cervical incompetence secondary to multiple dilations of the cervix from multiple curettages and/or multiple hysteroscopies to treat the Asherman’s and abnormal fetal lie (the fetus lies is and grows in an abnormal position presumably due to abnormal and restricted uterine shape). These conditions can be detected during routine ultrasound.

Pregnancy Risks in a Post-Ashermans Pregnancy

NOTE: This document is not a substitute for medical advice. You should ask your doctor about the risks involved in a post-Asherman’s pregnancy. Also, note that the information provided here applies only to women who have had their adhesions removed. If a woman gets pregnant with adhesions still in her uterus, the risks are different. Getting pregnant with adhesions remaining in the uterus is usually not recommended.

What are the risks involved in a post-Asherman’s pregnancy?

 

The risks involved in a post-Asherman’s pregnancy vary, depending on how severe the Asherman’s was. If the Asherman’s was very mild, then after the adhesions are removed, pregnancy is statistically no riskier than for a woman who never had Asherman’s. Obviously this can vary in individual cases, but the statistics show no increased risk.

If the Asherman’s was moderate or severe, there is some increased risk in subsequent pregnancies.

The risks are:

  • First-trimester miscarriage. (Of course this is a significant risk in any pregnancy, but it's higher after Asherman’s.)
  • Placenta accreta. (One study of 137 post-Asherman’s pregnancies found a 9% risk of placenta accreta.) Placenta accreta means the placenta grows into the wall of the uterus. This isn't harmful to the baby, but after the baby is born, when it's time for the placenta to come out, if you have placenta accreta the placenta will be "stuck" and not come out. The doctor might have to do a D&C to remove it. In the worst cases of placenta accreta, in which they cannot get the placenta out without causing the mother to hemorrhage uncontrollably, they sometimes have to do a hysterectomy. Several members of the Asherman’s message board have had placenta accreta but most just needed a D&C, not a hysterectomy. Note that when they do the hysterectomy, they can usually just remove the uterus but leave the ovaries in place, which means you'll continue to ovulate each month, and you won't go through menopause until you reach the normal age for menopause. (Of course you won't get a period, but that's not the same as menopause.) Besides placenta accreta, placenta increta and placenta percreta are also risks, although they are extremely rare.  means the placenta grows even more deeply and firmly into the uterine wall than placenta accreta.  means the placenta grows all the way through the wall of the uterus and sometimes extends to nearby organs.
  • Placenta previa. This means low-lying placenta. Normally the placenta should implant high up in your uterus but if the uterine walls aren't in good condition (for example due to you having had Asherman’s), sometimes the placenta implants lower, sometimes even covering the cervix. Placenta previa can increase your risk for bleeding during pregnancy, increase the risk of preterm delivery, and increase the risk of harm to mother and baby due to blood loss during delivery. However, if discovered early, more than 99% of mothers with placenta previa are just fine, and most of the babies come out of it just fine too. You could end up on bed rest for a substantial part of the pregnancy though. Fortunately the risk of placenta previa seems to be much lower than the risk of placenta accreta. Some of the A-list doctors think placenta previa is not a significant risk at all, if you've had all your adhesions removed. We have seen it occasionally on the Asherman’s message board though.
  • Incompetent cervix (this is where the cervix dilates way too early in the pregnancy, resulting in loss of the baby or resulting in preterm delivery, depending on what week of pregnancy you're in). Asherman’s doesn't increase your risk of incompetent cervix, but having multiple D&Cs does increase the risk. Most doctors think having a lot of hysteroscopies doesn't increase the risk, but a few doctors think it does. So it's wise to be monitored for incompetent cervix if you get pregnant, just in case.
  • Some perinatologists (high risk OBs) say that Asherman’s theoretically increases the risk of intrauterine growth retardation (IUGR), which is where the fetus doesn't grow as well as it should, possibly due to placental insufficiency, but we have never seen a case of post- Asherman’s IUGR on the Asherman’s message board.
  • Vasa Previa. This is a rare (1:3000), heartbreaking condition which occurs when one or more of the baby’s placental or umbilical blood vessels cross the entrance to the birth canal beneath the baby. When the cervix dilates or the membranes rupture, the unprotected vessels can tear, causing rapid fetal hemorrhage. When the baby drops in to the pelvis, the vessels can be compressed, compromising the baby’s blood supply and causing oxygen deprivation. The Vasa Previa page includes more information about this condition.
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