How Asherman Syndrome Impacts Fertility
The endometrium is a crucial part of the female reproductive system, comprising cells within the uterus that support pregnancy. Each month, these cells build up to accommodate an embryo, and if pregnancy does not occur, they are shed during menstruation. This cycle is essential for protecting, supporting, and nourishing the early embryo.
Asherman syndrome is a condition where this vital uterine lining becomes scarred or excessively thin, inhibiting its ability to support an embryo. This condition most commonly arises after a pregnancy due to hormonal changes, bleeding, or inflammation that causes scarring, explains Hugh Taylor, MD, chair of Yale Medicine Obstetrics, Gynecology, and Reproductive Science. The scarring can lead to the walls of the uterus adhering to each other, preventing the endometrium from growing adequately.
The first indication of Asherman syndrome might be a significant reduction in menstrual flow or its complete absence. More subtly, patients may continue to experience bleeding during their period, but the lining remains insufficient to support pregnancy, leading to infertility or even recurrent miscarriages.
"It's so important to be able to offer them some treatment and hope,” Dr. Taylor says.
Currently, the mainstay treatments are surgical. Yale School of Medicine offers a unique clinical trial that may benefit patients for whom surgery is not successful. The surgical procedure involves hysteroscopy, where a small telescope is used to visualize and remove the scar tissue.
For the clinical trial, before surgery, the patient receives a medication that mobilizes stem cells. “Stem cells are these undifferentiated cells that can travel to an organ and help repair and heal that organ,” Dr. Taylor explains. This medication helps recruit the patient’s own stem cells to the uterus to facilitate repair and enhance the growth of the endometrial lining.
Yale Medicine takes a comprehensive approach to treating infertility, including a robust IVF program and ongoing research in specialized conditions leading to infertility, Dr. Taylor adds.
In the video above, Dr. Taylor talks more about treatments and the ongoing efforts to better understand and treat Asherman syndrome.
