(Intrauterine Adhesions, IUA)
Written by Dr. Charles March of HRC Fertility, Pasadena
Although intrauterine scar formation was known to be a complication of uterine surgery for decades, little attention was paid to this condition until Dr. Joseph Asherman’s report in 1948. However, even today, this condition is often referred to as “The Silent Syndrome” or “The Forgotten Syndrome.”
Three misconceptions continue to lead delayed diagnosis and treatment:
1. The condition is rare.
FALSE: Many medical reports have indicated exactly the opposite. The pregnant or recently pregnant uterus is very susceptible to scar formation and the incidence after various types of uterine surgeries,
especially removal of fibroid tumors is increasing.
|Type of Prior Surgery||Frequency of IUA|
|Early D & C for miscarriage||6.4%|
|Delayed D & C for miscarriage||30.9%|
|Multiple D & Cs for repeated miscarriages||48.0%|
|D & C performed any time after delivery||3.7%|
|D & C performed 2-4 weeks after delivery||23.4%|
|Removal of multiple fibroids on the inside of the uterus||45.5%|
2. It is caused by an "over-aggressive" D & C
FALSE: Review of surgical reports of those who developed scarring after a D & C do not suggest that
the surgery was other than routine.
3. Treatment is rarely successful.
FALSE: Over the last 43 years I have treated more than 2,400 patients with uterine scarring and most have gone onto have one or more successful, uncomplicated pregnancies. The keys to success are meticulous surgery, hormonal therapy to promote uterine healing, the use of a specially designed uterine balloon to reduce the chance of scar reformation and follow-up to prove cure prior to recommending that another pregnancy be attempted.
Patients can learn more about this condition visiting the website of the International Asherman’s Association, www.ashermans.org, which is an invaluable resource.