Asherman Syndrome and Fertility: What It Is, What Can Be Done

Asherman syndrome — scar tissue forming inside the uterus — is a genuinely treatable cause of reduced fertility, often connected to a prior uterine procedure. Here’s a clear, honest explanation of what it actually is, and what treatment involves.

What Asherman Syndrome Actually Is

Asherman syndrome involves the formation of scar tissue, known as adhesions, inside the uterine cavity. Depending on severity, these adhesions can partially or, in more significant cases, substantially narrow the space within the uterus.

Worth Knowing

This condition is structural, not hormonal — which is part of why it connects so directly to how the endometrium is able to grow and respond during a cycle.

Common Causes

• Most commonly follows trauma to the uterine lining, frequently after a D&C procedure — particularly after a missed miscarriage or postpartum hemorrhage
• Other uterine surgeries, such as a myomectomy for fibroids , or in some cases a cesarean section
• Uterine infections, including genital tuberculosis — a cause worth being aware of, particularly relevant in regions with higher TB prevalence
• Any procedure or condition that damages the deeper (basal) layer of the endometrium can potentially contribute

Common Signs

• Noticeably reduced menstrual flow
• Absent periods (amenorrhea)
• Recurrent pregnancy loss
• Difficulty conceiving, sometimes discovered during a fertility evaluation

How It's Diagnosed

• Hysteroscopy — Direct visualization of the uterine cavity, generally considered a key diagnostic tool.
• Imaging — Such as saline sonohysterography or an HSG, sometimes used alongside or before hysteroscopy.
• Correlating findings — With your symptoms and fertility history.

How It's Treated

Hysteroscopic adhesiolysis — surgically dividing the adhesions under direct visualization — is the established primary treatment approach. This is often followed by measures to help prevent the adhesions from reforming, such as a temporary intrauterine device or balloon, alongside estrogen support to help the endometrium regrow.

Worth Knowing

Many women experience improved menstrual function and fertility after treatment. Outcomes vary depending on the severity and extent of the adhesions, so it’s genuinely worth discussing what’s realistic for your specific case.

Common Myths

• Myth: — Asherman syndrome means the uterus is permanently unusable.
• Fact: — Many cases are treatable, particularly when caught and addressed appropriately — outcomes vary by severity.
• Myth: — It only happens after a very invasive surgery.
• Fact: — Even a routine D&C procedure carries some risk, particularly in certain circumstances like after a missed miscarriage.
• Myth: — Absent periods always mean early menopause.
• Fact: — Absent periods can have several different causes, including Asherman syndrome, which is why proper evaluation matters rather than assuming.
• Myth: — Treatment guarantees restored fertility.
• Fact: — Many women see meaningful improvement, but outcomes depend on severity and extent of adhesions — it isn't a guaranteed fix for every case.

How This Connects to What Else You Might Be Reading About

Scar tissue is a structural problem — and structural problems, in this case, often have a structural fix.

On This Page

• What It Actually Is
• Common Causes
• Common Signs
• How It's Diagnosed
• How It's Treated
• Common Myths, Cleared Up
• Related Reading
• FAQs

Frequently Asked Questions