Childlessness in marriage is one of the most significant social problems. Scientists have proved the equal role of each of the potential parents in unsuccessfully resolving this issue. However, the bearing of the child and delivery fall on the shoulders of the mother. Only a mature female body can complete these tasks. In the past few years, there has been an increase in diseases of the reproductive organs, which provoke infertility. In our country, the leading position is occupied by chronic endometritis. One of its manifestations is Asherman's syndrome. Is pregnancy possible with this disease?
Pathology Description
Asherman syndrome refers to a pathological condition, as a result of which adhesions form in the uterus. They lead to partial or complete overgrowth of its cavity. The disease got its name by the name of the gynecologist Joseph Asherman. For the first time, the syndrome was described in detail in 1894 by Heinrich Fritsch. In the medical literature there are several names of this pathology: intrauterine synechia, traumatic atrophy and endometrial sclerosis.
Asherman's syndrome is diagnosed in women, regardless of their age and social status. Intrauterine synechiae are connective tissue splices that weld together the walls of the organ and cause their deformation. As a result of the pathological process, a variety of disorders develop that lead to menstrual dysfunction. The main symptoms of the syndrome are expressed in the form of spontaneous abortion and infertility.
What does statistics say about the spread of this disease? After curettage in women giving birth, the risk of developing the syndrome is 25%. With a frozen pregnancy, the likelihood of adhesions increases and is up to 30% of cases. A usual miscarriage practically does not threaten a woman’s health. In this case, the risk of the disease barely exceeds 7%.
Main reasons
The uterus is a hollow muscle organ. Outside it is covered with a peritoneum. The inside is lined with endometrium, which consists of two layers - functional and basal. Depending on the phase of the menstrual cycle and under the influence of sex hormones, the endometrium undergoes cyclic changes. Closer to the time of ovulation, when the probability of conceiving a child is highest, the uterine mucosa thickens. In the elements of the endometrium, the active production of biologically active substances occurs. After fertilization of the egg, it enters the uterus, where implantation occurs. The contact of the membranes of the embryo with a healthy endometrium is the main condition for a successful conception. If fertilization has not occurred, the functional layer is rejected, as evidenced by menstruation. With the beginning of each cycle, the endometrium grows anew.
Synechiae is the outgrowths or adhesions of the inner layer of the uterus that violate the physiology of the mucous membrane. Asherman's syndrome develops as a result of damage or trauma to the basal layer of the endometrium during gynecological procedures. This can be a curettage after an abortion, a cesarean section or any other operation. Another common cause of the disease is endometritis. Synechiae are formed against the background of numerous foci of inflammation on the uterine mucosa.
The clinical picture of the syndrome
Symptoms of the disease are caused by an adhesion process and its effect on the functioning of the reproductive system. Among them, the following are most often found:
- menstrual dysfunction (abundant / meager discharge, severe pain);
- miscarriage ;
- reduction in the number and duration of menstruation;
- secondary infertility;
- accumulation of blood secretions in the uterine cavity.
What other symptoms of Asherman syndrome? The disease is often accompanied by endometriosis of varying severity. Pathology is characterized by ectopic growth of the functional layer of the endometrium, extending beyond the uterine cavity. This combination negatively affects the prognosis and prospects of treatment.
Three degrees of severity
Given the damage to the basal layer of the endometrium, doctors offer the following classification of Asherman's syndrome:
- mild degree (adhesions occupy no more than 25% of the volume of the uterus, are easily destroyed by mechanical damage);
- medium degree (adhesions tightly soldered to the uterine mucosa);
- severe degree (adhesions consist mainly of sclerotic connective tissue, block the mouth of the uterine tubes and the bottom of the organ).
Timely determination of the degree of the pathological process allows you to quickly cure Asherman syndrome.
Is pregnancy possible?
Doctors' reviews indicate that the probability of having a baby in this disease depends on its causes and stage. With Asherman's syndrome, the reproductive system is seriously affected. The walls of the uterus stick together, the patency of the tubes is impaired. As a result, the embryo cannot be implanted. In addition, the endometrium loses its ability to respond to changes in estrogen levels. Secondary infertility gradually develops , and with it amenorrhea. Adhesions in the cervix provoke the accumulation and delay of menstrual flow. Violation of the cycle usually indicates a severe degree of pathology. Pregnancy in a natural way is permissible, if Asherman syndrome is cured in a timely manner.
Is IVF possible? Reviews of doctors confirm that in vitro fertilization makes sense when the disease is at the initial stage of development. In this case, the number of adhesions cannot exceed 25% of the volume of the uterus, they must be localized in a limited area of the cavity.
It is impossible to give a single answer to the questions presented, because each case is individual. Depending on the severity of the pathological process, there are several options for the course of pregnancy. In some women, bearing does not cause concomitant problems, while in others it is accompanied by numerous complications. A third option is also possible - spontaneous abortions, miscarriages, secondary infertility. That is why every woman should monitor her health, periodically undergo examinations by a gynecologist, and timely treat all diseases.
Medical examination
To diagnose the disease, instrumental methods are used to visualize the uterine cavity. Without fail, the doctor studies the obstetric history of the patient (the number of pregnancies, abortions, miscarriages, etc.). Ultrasound examination is considered the most affordable and at the same time minimally invasive method for the diagnosis of pelvic organs. Asherman's syndrome on ultrasound can be confirmed, but to obtain accurate results, you must repeat the procedure several times during the cycle.
The hysteroscopy is considered the gold standard for detecting synechia. Such a study of the uterine cavity involves the use of a special device. It is injected through the cervical canal, due to which the state of the organ can be assessed in real time on a computer screen. Hysteroscopy allows you to determine the severity of the pathological process, the size and localization of adhesions. The results of a full examination of the patient must be combined with an obstetric history and previous treatment attempts. This approach allows us to predict the positive dynamics of therapy.
Treatment methods
A mild to moderate disease can be treated well. The neglected forms of pathology and pregnancy are incompatible. In this case, surrogacy comes to the rescue. When adhesions are localized in a limited area of the uterine cavity, the IVF method helps. However, even in this case, not all women with a diagnosis of Asherman’s syndrome can try on the role of swearing.
Treatment involves the removal of adhesions by hysteroscopy. The operation does not require general anesthesia, has no complications. Technically, this is a rather complicated procedure. The removal of synechia is carried out with micro scissors due to the high probability of repeated injury. In the postoperative period, antibiotic treatment is prescribed to prevent infectious complications. Drug therapy is necessarily supplemented with hormonal. The use of estrogens and progestins is indicated to stimulate the growth of the endometrium.
Forecast
With a mild degree of the pathological process and timely treatment, pregnancy is observed in 93% of patients, with an average of only 78%. Proper treatment of women with an advanced form of the disease makes it possible to conceive a baby in 57% of cases. However, a successful pregnancy with Asherman's syndrome does not guarantee the birth of a child without pathologies. The age of the patients is also taken into account in the prognosis. For example, 66% of patients under the age of 35 with a severely diagnosed syndrome are capable of conception. For the fair sex over 35 years, this figure barely exceeds 24%.
Preventive actions
Is Asherman's Syndrome Preventable? Curettage or vacuum aspiration - the specialist performs these two procedures almost blindly, relying only on his own experience. Endometrial tissues during pregnancy are soft, so they are easily injured. As a result, any diagnostic or therapeutic curettage is always accompanied by trauma to the basal layer.
An alternative to these abortion procedures is medical abortion. It implies the stimulation of labor through the use of drugs. However, the effectiveness of this method is only 80%. In 10% of cases after medical abortion, infection of the membranes is observed, which requires curettage. Thus, it is possible to prevent Asherman’s syndrome if, for medical reasons, medical abortion is chosen. On the other hand, this procedure does not give a 100% guarantee of a positive result.