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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