Understanding Asherman’s Syndrome and Its Impact on Fertility

What is Asherman’s Syndrome?

Asherman’s syndrome (AS) is characterized by the formation of scar tissue in the uterine lining or cervix, leading to potential infertility. This condition is not congenital; instead, it arises due to trauma inflicted on the uterine lining. Such trauma can occur after procedures like dilation and curettage (D&C), cesarean sections, myomectomies for uterine fibroids, or as a result of pelvic infections, including chlamydia.

Diagnosis of Asherman’s Syndrome

The most effective way to diagnose AS is through hysteroscopy, a minimally invasive procedure that allows direct visualization of the uterine cavity. Unfortunately, AS is often under-diagnosed since it frequently goes unnoticed during routine examinations, and many healthcare providers may not actively screen for it. According to the International Asherman’s Association, AS may impact up to 40% of women who have had a D&C, as well as an estimated 5% to 39% of those who experience recurrent miscarriages.

Effects of Asherman’s Syndrome on Reproductive Health

How AS Influences Fertility

Significant scarring in the uterus can hinder fertility in two primary ways. First, it may disrupt the normal cycle of uterine lining buildup and shedding, leading to lighter menstrual flows or amenorrhea. Second, scar tissue can obstruct the areas where embryos typically implant, complicating natural conception. In extreme cases, extensive scarring may render fertility treatments, such as in vitro fertilization (IVF), impractical.

Treatment Options for Asherman’s Syndrome

Currently, effective treatment for AS remains elusive. Laser treatments are discouraged as they can exacerbate scarring due to heat. Although experienced surgeons can remove scar tissue using specialized instruments, there is a risk of recurrence, particularly in severe cases.

Research on Mesenchymal Stem Cells as a Treatment

Recent Findings

A study published in Stem Cell Research & Therapy explored the potential of stem cell transplantation as a viable treatment for AS when surgical interventions fail. Researchers from Russia conducted experiments using a rat model, transplanting human endometrial mesenchymal stem cells (eMSC) obtained from menstrual blood of a healthy donor. The results indicated that these stem cells could be successfully transplanted in rats, leading to an increased pregnancy rate and larger litter sizes. Notably, eMSC organized into spheroids demonstrated greater therapeutic effectiveness compared to those arranged in a monolayer.

Conclusion

The findings from this study suggest that mesenchymal stem cells may offer a promising avenue for restoring fertility in women affected by Asherman’s syndrome. Further research is needed to validate these results in human subjects and develop effective treatment protocols.

Written by Debra A. Kellen, PhD

References

(1) Domnina, A., Novikova, P., Obidina, J., Fridlyanskaya, I., Alekseenko, L., Kozhukharova, I., … & Nikolsky, N. (2018). Human mesenchymal stem cells in spheroids improve fertility in model animals with damaged endometrium. Stem Cell Research & Therapy, 9(1), 50. https://doi.org/10.1186/s13287-018-0801-9
(2) International Asherman’s Association, http://www.ashermans.org/home/ retrieved on March 8, 2018.