What is uterine scarring?

A woman may have fertility problems for a variety of reasons. The key is to understand why you are not conceiving and then discuss the course of action with your fertility consultant

Tests will help your consultant see if you have any of the following conditions:

PCOS (polycystic ovary syndrome), endometriosis, blocked fallopian tubes, a thyroid issue, difficulty ovulating, scarring of the cervix or vagina, tubal disease, antibodies to sperm, age, prolactinoma, polyps and fibroids.

In this fact sheet, we learn more about Uterine Scarring

Uterine scarring (also known as synechiae, intrauterine adhesions, or simply as scar tissue) can make it difficult for a woman to conceive naturally, and is a commonly cited cause of female infertility. Here, we explain everything you need to know about intrauterine adhesion.

What are Intrauterine Adhesions?

Intrauterine adhesions are bands of scar tissue in the uterus that have many different causes, and affect sufferers to varying degrees of severity. This fibrous scar tissue damages and interferes with the functional lining of the uterus.

Uterine scarring can occur in any of the three layers of the uterus: the outer layer (serosa), the muscular middle layer (myometrium), and the innermost layer (endometrium). The endometrium is shed once a month when you menstruate, and is the area where an embryo implants during pregnancy.

What causes Intrauterine Adhesions?

Uterine scarring has a variety of causes, usually from a surgical procedure or an infection/inflammation.

Surgical causes:

A previous caesarean section

Dilation and curettage (D&C) for a miscarriage, abortion, or for retained placenta after delivery

Myomectomy (a procedure that removes uterine fibroids (leiomyomas)

Inflammation / infection causes:

An infection of the uterine cavity (endometritis)

Infections, such as Schistosomiasis, Chlamydia, and Tuberculosis

Endometriosis inflammation during which endometrial implants bleed and scar

Symptoms of Intrauterine Adhesions

Asherman Syndrome is the name for uterine scarring that causes noticeable symptoms. These symptoms include:

Lighter periods than usual (hypomenorrhea)

No period (amenorrhea)

Cyclic pelvic pain caused by trapped menstrual blood in the uterus.

Recurrent pregnancy loss

An inability to conceive

How are Intrauterine Adhesions Diagnosed?

Uterine scarring can be diagnosed in one of a few different imaging scans, including a hysterosalpingogram (a pelvic X-ray), during a pelvic ultrasound, or with a saline sonogram (an ultrasound with sterile water). However, it is best diagnosed and assessed with a hysteroscopy, a minor surgical procedure in which a tiny camera is used to look inside the uterus.

How do Intrauterine Adhesions cause Infertility?

In many cases, uterine scarring decreases the blood flow to the inner endometrial lining. This prevents pregnancy because a healthy endometrium layer is needed for an embryo to implant successfully. In more severe cases, a build-up of scar tissue becomes a physical barrier that prevents the sperm from entering the upper uterus, thus preventing fertilisation of the ovulated egg.

Treatment of Intrauterine Adhesions

In some cases, a hysteroscopy (the surgery involving a diagnostic camera) can be combined with the treatment for the issue. After the camera is withdrawn, a balloon catheter is then placed inside the uterus. Oestrogen therapy is given at the same time in order to prevent the reformation of scars. It is reasonably successful, with recurrence rates of 33% in mild and moderate cases, and up to 66% with severe adhesions. The treatment will be performed by a surgeon or fertility specialist and has excellent results for future pregnancy.

Read more about infertility causes here:

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