{"id":60401,"date":"2023-09-14T11:51:50","date_gmt":"2023-09-14T09:51:50","guid":{"rendered":"https:\/\/www.juanacrespo.es\/?p=60401"},"modified":"2023-10-26T11:55:50","modified_gmt":"2023-10-26T09:55:50","slug":"asherman-syndrome-pregnancy","status":"publish","type":"post","link":"https:\/\/www.old.juanacrespo.es\/en\/asherman-syndrome-pregnancy\/","title":{"rendered":"ASHERMAN&#8217;S SYNDROME: HOW IT CAN AFFECT YOUR PREGNANCY AND FERTILITY"},"content":{"rendered":"<p>Some <a href=\"https:\/\/www.juanacrespo.es\/en\/uterine-malformations-causes-and-diagnostics\/\" target=\"_blank\" rel=\"noopener\">uterine pathologies<\/a>, such as <strong>Asherman&#8217;s syndrome<\/strong>, fibroids, congenital abnormalities, or <a href=\"https:\/\/www.juanacrespo.es\/en\/endometrial-polyps\/\" target=\"_blank\" rel=\"noopener\">endometrial polyps<\/a>, can be the cause of infertility, recurrent miscarriage, or premature birth.<\/p>\n<p>Its diagnosis and treatment are crucial to achieve a viable pregnancy, requiring the intervention of professionals and <a href=\"https:\/\/www.juanacrespo.es\/en\/\" target=\"_blank\" rel=\"noopener\">specialists in gynecology and assisted reproduction<\/a>.<\/p>\n<h2>What is Asherman&#8217;s Syndrome?<\/h2>\n<p>Asherman&#8217;s syndrome is an acquired and rare uterine pathology.<\/p>\n<p>Its main characteristic is the <strong>development of scars<\/strong> (uterine adhesions), generally <strong>associated with a history of dilation and curettage or intrauterine surgeries<\/strong>, which lead to the formation of adhesions in the cervix and\/or between the walls of the uterus, causing it to deform and, in some cases, reduce in size.<\/p>\n<h2>How does Asherman&#8217;s syndrome affect fertility?<\/h2>\n<p>The alteration of the uterine cavity due to Asherman&#8217;s syndrome can be associated with fertility problems, including <strong>difficulties in embryo implantation and recurrent miscarriages<\/strong>.<\/p>\n<p>It can also lead to gynecological symptoms such as <strong>secondary amenorrhea, hypomenorrhea, or pelvic pain<\/strong>, which we will discuss further.<\/p>\n<p><strong>Why does it occur? What are its causes?<\/strong><\/p>\n<p>As mentioned earlier, Asherman&#8217;s syndrome is an acquired condition.<\/p>\n<p>It occurs most commonly in women who have undergone dilation and curettage procedures after a voluntary or spontaneous abortion.<\/p>\n<p>Other causes that can lead to the formation of scar tissue in the uterus include:<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">Severe pelvic infections, such as tuberculosis and schistosomiasis.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">Intrauterine surgeries, such as myomectomy.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">Trauma.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">Endometriosis.<\/li>\n<\/ul>\n<p>According to the <a href=\"https:\/\/www.ashermans.org\/home\/\" target=\"_blank\" rel=\"noopener\">International Asherman&#8217;s Association<\/a>, this alteration of the uterine cavity <strong>affects 1.5% of women who have undergone hysterosalpingography<\/strong>, between <strong>5% and 39% of women with recurrent miscarriages<\/strong>, and <strong>up to 40% of patients who have undergone dilation<\/strong> and curettage due to retained products of conception after childbirth or incomplete abortion.<\/p>\n<h2>How can I know if I have Asherman&#8217;s syndrome?<\/h2>\n<p>Asherman&#8217;s syndrome presents common symptoms, including:<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Absence of menstrual periods or scanty menstruation<\/strong> (amenorrhea) due to adhesions obstructing the passage of menstruation from the uterus to the vagina.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Pelvic or abdominal pain<\/strong> due to the retention of menstrual bleeding.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Retrograde menstruation<\/strong>. In some cases, difficulties in expelling endometrial tissue during menstruation can lead to its backward release into the abdominal cavity through the fallopian tubes, forming endometriosis implants.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Recurrent miscarriages<\/strong> due to the deformation of the uterine cavity and the inability of the embryo to implant in the uterine walls.<\/li>\n<\/ul>\n<p>When these symptoms suddenly appear after a dilation and curettage, scraping, or other uterine surgery, the risk of developing the disease is quite high. However, since this symptomatology can be related to other gynecological pathologies, <strong>more precise tests are usually required for diagnosis<\/strong>.<\/p>\n<h2>Diagnosis of Asherman&#8217;s syndrome<\/h2>\n<p>In most cases, Asherman&#8217;s syndrome cannot be predicted or prevented.<\/p>\n<p>The first step in determining if a woman has this anomaly is to <strong>check for adhesions and abnormalities in the uterine cavity<\/strong>.<\/p>\n<p>The gynecologist will review the patient&#8217;s medical history on one hand and perform some tests on the other.<\/p>\n<p>These tests include:<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Transvaginal ultrasound<\/strong>\n<p>Common in clinics, quick, and minimally invasive, it allows for the observation of the interior of the uterine cavity. However, interpreting the obtained images can sometimes require more specialized techniques.<\/p>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Hysterosalpingography<\/strong> (HSG)\n<p>A combination of X-rays with contrast dye that &#8220;maps&#8221; the shape of the uterus and fallopian tubes. The image is captured through X-rays. It is a very effective technique for detecting adhesions, obstructions, and other uterine abnormalities such as fibroids or polyps.<\/p>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Hysteroscopy<\/strong>\n<p>If ultrasound and hysterosalpingography do not provide conclusive data, experts may perform a <a href=\"https:\/\/www.juanacrespo.es\/en\/hysterosalpingography\/\" target=\"_blank\" rel=\"noopener\">diagnostic hysteroscopy<\/a>. In other words, they will introduce a camera into the uterine cavity. Diagnosing Asherman&#8217;s syndrome and establishing a precise diagnosis is much easier with this test since it allows direct visualization of adhesions.<\/li>\n<\/ul>\n<h2>Is there a cure for Asherman&#8217;s syndrome?<\/h2>\n<p>Asherman&#8217;s syndrome has only one treatment: <strong>cutting and removing scar tissue <\/strong>so that the uterus regains its normal shape and size.<\/p>\n<p>The surgical procedure is performed by hysteroscopy, using small instruments and a camera inserted into the uterus through the cervix.<\/p>\n<p>Once the adhesions have been removed, <strong>the uterine cavity must be kept expanded<\/strong> (we must not forget that this syndrome occurs when the normal healing process in the uterus is triggered) using various methods:<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Foley catheter<\/strong>: It is a kind of &#8220;balloon&#8221; inserted into the uterus to keep the uterine walls separated while the wounds heal.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Placement of an IUD<\/strong>.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><strong>Application of a specific gel<\/strong> to prevent the formation of new scars.<\/li>\n<\/ul>\n<p>The success of Asherman&#8217;s syndrome treatment depends on the severity of the condition; the more severe it is, the more likely adhesions and scars may reoccur.<\/p>\n<h2>Is a pregnancy viable with Asherman&#8217;s syndrome?<\/h2>\n<p>Yes, a pregnancy is possible with Asherman&#8217;s syndrome. However, while Asherman&#8217;s syndrome does not prevent fertilization, the presence of adhesions and limited space in the uterus can compromise both embryo implantation and development, <strong>increasing the risk of miscarriage<\/strong>.<\/p>\n<p>Furthermore, in a pregnancy with Asherman&#8217;s syndrome, <strong>there is a higher likelihood of placental problems<\/strong> (placenta previa and placenta accreta) or cervical incompetence even after treatment, posing risks to both the mother and the baby.<\/p>\n<p>When adhesions in the uterine cavity are detected, the general recommendation is to <strong>undergo surgical intervention before attempting pregnancy<\/strong> or starting assisted reproduction treatment.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Some uterine pathologies, such as Asherman&#8217;s syndrome, fibroids, congenital abnormalities, or endometrial polyps, can be the cause of  [&#8230;]<\/p>\n","protected":false},"author":20,"featured_media":59551,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","footnotes":""},"categories":[66],"tags":[],"class_list":["post-60401","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/posts\/60401","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/comments?post=60401"}],"version-history":[{"count":2,"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/posts\/60401\/revisions"}],"predecessor-version":[{"id":60403,"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/posts\/60401\/revisions\/60403"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/media\/59551"}],"wp:attachment":[{"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/media?parent=60401"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/categories?post=60401"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.old.juanacrespo.es\/en\/wp-json\/wp\/v2\/tags?post=60401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}