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Intrauterine Adhesions

Destruction of the endometrium, or uterine lining, can cause intrauterine adhesions or fibrous scars and distortion, or even obliteration of the cavity (inside) of the uterus. This condition is called Asherman’s Syndrome, which can cause menstrual abnormalities, fertility and pregnancy issues. Our New Jersey IVF center can diagnose intrauterine adhesions and provide the proper treatment.

New Jersey IVF Center Experienced in Intrauterine Adhesions

Fertility doctor Jane Miller explains to her patients how a healthy, triangular-shaped uterine cavity is necessary for an embryo to implant, grow and produce a healthy, ongoing pregnancy. This “cavity” inside the uterine muscle is really just a potential space: the uterine walls lie in opposition to one another. They are lined with endometrium – tissue that builds up, or grows, during the first part of the menstrual cycle and then sheds off or bleeds an average of 14 days after ovulation, unless there is a pregnancy.

If an embryo implants and a pregnancy ensues, the uterine walls will gradually separate from one another as the pregnancy grows inside this space. However, if the woman has a period, the lining will regrow once the bleeding ends, and the building-up and bleeding-off cycle will be repeated. That is – unless there has been trauma to the endometrium that interrupts this process. The endometrial lining consists of two distinct layers: the functional layer which is shed during periods and a deeper, basalis layer, which, with its rich blood supply, is responsible for the regrowth of the functional layer.

Dr. Jane Miller Explains Intrauterine Adhesions

Fertility doctor Jane Miller explains that trauma to this underlying layer, usually from a too-vigorous D&C (dilation and curettage) can be responsible for intrauterine scarring, which can obliterate some or all of the uterine cavity. A patient may report that since a D&C was performed after a delivery, miscarriage or pregnancy termination, her periods are lighter and of shorter duration. Intrauterine adhesions are prime suspects in such a situation and must be diagnosed. Another common culprit is myomectomy. Intrauterine adhesions may be a consequence when surgery is done to remove uterine fibroids in the uterine muscle or the uterine cavity.

Testing for Intrauterine Adhesions

At our New Jersey IVF Center, testing for intrauterine adhesions consists of imaging (hysterosalpingography or sonohysterscopy) and hysteroscopy to look directly into the uterine cavity. Intrauterine adhesions may appear as white strings or columns that connect the uterine walls to each other and, in so doing, partially or completely obliterate the cavity. Asherman’s Syndrome, however, may also appear as a normal triangular uterine cavity that is smooth, shiny, and lacks normal-appearing pink endometrial tissue.

During a hysteroscopy, the columnar adhesions can be cut with special scissors, and a balloon catheter is then placed in the cavity for seven days to keep the uterine walls apart while healing takes place. The patient is treated for two months with high-dose estrogen and progesterone every three to four weeks to re-establish a normal menstrual flow. The smooth, shiny, but scarred, uterine cavities are similarly treated with several months of hormonal “cycling.” Repeated hormonal treatments may allow 70%-80% of patients to achieve a successful pregnancy.

Contact our New Jersey fertility center for proper diagnosis and treatment of intrauterine fibroids.