As Seen On TV: A Rare Fertility Disorder
If you've never heard of "Asherman's Syndrome," you're not alone. But a recent episode of The Return of Jezebel James (FOX on Friday nights) highlighted this rare...but perhaps under-reported....impediment to fertility.
The character in Jezebel is Parker Posey, an infertile New York book editor using her fertile sister as a surrogate. While the show did highlight a growing--if relatively rare--condition, it only barely touched on the information needed to be imparted to potential sufferers. Basically, Asherman's is what is called an acquired uterine disease, wherein the front and back walls of the uterus stick to each other. These adhesions, in turn, can be thick or thin, spotty or confluent (meaning together). This all reduces critical function of the uterus.
"About 90% of cases are related to curettage," explains Dr. Anne Carlon, a leading gynecologist affiliated with Manhattan's New York Presbyterian Hospital/Weill Cornell Medical Center. (Curettage is the scrapping of the cavity of the uterus, which is itself done because of pregnancy complications, because of events post delivery, or miscarriage.) "But there are also related cases related to operations done inside a non-pregnant uterus, such as "D & C," (which is dilatation and curettage), fibroid removal and removal of polyps."
"Asherman's is most often suspected because of the failure to get pregnant, recurrent early miscarriage, or more rarely, suspected by the indication of scant or no periods, or cyclic pelvic pain," adds Dr. Carlon.
Dr. Carlon indicates that "fertility concerns or pain would suggest treatment, and a diagnosis by HSG (hysterosalpingogram), sonohysterogram or hysteroscopy would follow. Treatment by operative hysteroscopy with sharp resection or electro-surgery or by laser excision of scar tissue under direct vision would be best undertaken."
"Prevention of recurrence of adhesions after surgery by high does of estrogen, by usage of an intrauterine balloon, or by the insertion of an IUD, would be best undertaken if needed," adds Dr. Carlon. "But we always reevaluate the situation later to make sure that the cavity is still viable, by means of HSG, by a sonohysterogram or by a hysteroscopy."
In severe cases, Asherman's leads to infertility. As Parker Posey would relate, infertility due to Asherman's Syndrome might be rare, but can be devastating. It's best left to an informed patient, and enlightened doctor, to inquire further at www.ashermans.org.
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Dear Dr. Rock,
Thank you so much for your article on Asherman’s Syndrome (AS). I have AS from a D&C for a missed miscarriage last year - my only D&C. This was my first pregnancy and I am now faced with the possibility of never having children. As I learn more and more about AS and how not uncommon it is, the lack of awareness and the lack of discussion of the risks by doctors is incredibly frustrating and shocking to me. There are often alternatives to D&Cs and regardless, patients need to be advised of the risk of Asherman's and what to look out for. They are often not advised of the risks and AS is not rare!
We desperately need to draw attention to this not uncommon problem and I am so thankful for your article. Asherman's International Support Group is a great resource (see Ashermans.
Thanks again for getting this information out there!
thank you for posting such an informative piece on ashermans syndrome. It's about time someone did. Recently, The New York Times posted something unbelievable, implying that women themselves are to blame for getting this syndrome!!
"Asherman’s comes from having repetitive D and C’s, the kind that often follow miscarriages or abortions, and if you know that tidbit, you’re left to wonder whether we’re supposed to think of Sarah as someone who never paid much attention in sex ed, a woman suffering from her prior mistakes." NYT
You would think that a newspaper like The NYT would have done their research before publishing anything on Ashermans instead of insulting millions of women around the world. It is correct that Asherman's may be caused by D&C for abortions or following miscarriage, but it can also be caused by the same procedure used very appropriately by physicians to treat retained placenta in childbirth or inappropriately to treat menstrual irregularities. Did you know that you can get Ashermans by having a myomectomy? or by a C-Section? Many women walk around not even knowing that they have this basically because they aren't looking to have another child or their periods which have suddenly got weaker is not an issue for them.
I hope that your article will help educate more women on ashermans and that in the near future, women are given the choice of whether they want their fertility taken away from them because I certainly wasn't!!!
Thank you Dr Positano for helping to raise awareness about this not-so-rare condition. I'm a member of the Asherman's support group after developing Asherman's syndrome (also known as intrauterine adhesions) from a D&C performed after an incomplete miscarriage. The majority of women in our group developed Asherman's from D&Cs performed for miscarriages or retained postpartum placenta. Thank you for pointing out that this can happen. In fact, studies have shown that the risk of developing Asherman's from a D&C is 30% following missed miscarriage and 25% following delivery. Most people who know about Asherman's think it only happens to women who have had abortions, but this is so illogical and untrue! !! I 'm growing weary of seeing this condition being highjacked by people trying to score points for their own politcal agendas. The same procedure, namely D&C, is used not only for abortion but also for evacuating the uterus after miscarriage or childbirth. In fact, the latter two indications are probably much more common. It's time to replace this invasive and potentially harmful procedure with safer drugs that are already available and to stop playing Russian roulettes with women's fertility!
P.S. Dr Positano, I didn't understand the significance of your distinction between D&C and curettage- the only difference is that dilatation is not performed in the latter. However, scarring can occur from either as it is the curettage (scraping) part that leads to injury and subsequent adhesions.
Isn't the procedure that causes this problem (D&C) also used for abortions?
Dr. Rock,
As someone who suffers from Asherman's Syndrome due to a D and C (after the birth of my daughter for retained placenta) I thank you for your article.
Your article is the only one in the world (relating to the Jezebel James show) which correctly addresses the medical condition, Asherman's Syndrome.
Thank you for helping to raise awarness about out condition. I also hope that this information will help others to learn that D and Cs (a blind, invasive, archaic and overused surgery) can rob women of their fertility. More advancements need to be made in the treatment of women and their reproductive organs and less invasive alternatives to D and Cs should be made more available, such as hysteroscopic or ultrasound guidance, or medications to name just a few.
Since it is considered such a rare condition, many women suffer months or years (as I did - 2 years) before diagnosis.
Thank you!
This week, on a very special The Return of Jezebel James...
"If you've never heard of 'Asherman's Syndrome,' you're not alone. But a recent episode of The Return of Jezebel James (FOX on Friday nights)...
They cancelled it? That sucks, I thought it was pretty funny... :-(
Dr. Positano,
I thank you for this information. It is important to be aware of something like this. I must ask, however, since this is still a rare disease, why does a COMEDY show need to explain more about the problem? I'm sorry, but I think that the show would have been much LESS funny had they added all this extra information, and when I'm watching a SitCom, I like to LAUGH, not be informed about rare problems people might have....
Also Dr. Positano you left out the most common indication for a D&C, early term abortion. Your not trying to tip-toe around that are you?
Seboed, I think you'll find that whilst some women have a D&C for early term abortion, the majority of the ladies on our Ashermans support board have had a D&C for retained placenta or early miscarriage. I have had 3 early miscarriages and my AS stemmed from the first D&C.
Abortion happens - and for many women in very traumatic circumstances. However, I think bringing up politically motivated issues following a very positive article on a syndrome that many women are unaware of is unnecessary.
A big thank you to Dr Positano for brining this to the attention of the readers. I would urge all women to read up on this condition in an attempt to reduce the numbers of women suffering potentially infertility like me.
I disagree with LeftRight. A lot of comedies deal with serious issues such as illness or death. Asherman's syndrome isn't that rare and besides a lot of people deal with infertility and surrogacy. It's still possible to laugh at the funny side of a serious situation, I do it myself. Unfortunately as I don't live in the US I didn't get to watch The Return of Jezebel James so I can't comment on it, but it sounds like a plot with potential. The only thing I can say from a clip I saw on youtube about it is that the Dr seemed to have come up with a very negative prognosis very quickly. Asherman's can be treated succesfully although this depends on a lot of factors such as age, severity, and the expertise of the treating doctor, so surrogacy or adoption are not always the only options.
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