Childlessness in marriage is one of the most significant social problems. Scientists have proven the same role of each of the potential parents in the unsuccessful solution of this issue. However, the bearing of the child and delivery fall on the shoulders of the mother. Only a mature female body can fulfill these tasks. In the last 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?
Description of pathology
Asherman's syndrome is understood as a pathological condition, as a result of which adhesions form in the uterus. They lead to partial or complete infection of its cavity. The disease got its name from the surname of the gynecologist Joseph Asherman. The syndrome was first described in detail in 1894 by Heinrich Fritsch. In the medical literature, there are several names for this pathology: intrauterine synechia, traumatic atrophy and endometrial sclerosis.
Asherman's syndrome is diagnosed in women regardless of their age and social status. Intrauterine synechia are connective tissue fusions that solder the walls of the organ to each other and cause their deformation. As a result of the pathological process, a variety of disorders develop that lead to disruption of menstrual functions. The main symptoms of the syndrome are expressed in the form of spontaneous abortions and infertility.
What do the statistics say about the spread of this disease? After curettage in women who have given birth, the risk of developing the syndrome is 25%. With a frozen pregnancy, the likelihood of adhesions increases and amounts to up to 30% of cases. An ordinary miscarriage practically does not threaten a woman's he alth. In this case, the risk of the disease barely exceeds 7%.
Main reasons
The uterus is a hollow muscular organ. Outside, it is covered with peritoneum. From the inside it 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 lining of the uterus thickens. In the elements of the endometrium, there is an active production of biologically active substances. After the egg is fertilized, it travels to the uterus, where implantation takes place. Contact of the membranes of the embryo with a he althy endometrium is the main condition for successful conception. If fertilization has not occurred, the functional layerrejected, as evidenced by menstruation. With the beginning of each cycle, the endometrium grows anew.
Sinechia are 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 may be curettage after an abortion, caesarean 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.
Clinical picture of the syndrome
Symptoms of the disease are caused by the adhesive process and its effect on the reproductive system. Among them, the most common are the following:
- disorder of menstrual function (abundant/scanty discharge, severe pain);
- Miscarriage;
- reduce the number and duration of menstruation;
- secondary infertility;
- accumulation of blood secretions in the uterine cavity.
What other symptoms does Asherman's syndrome have? The disease is often accompanied by endometriosis of varying severity. Pathology is characterized by an ectopic growth of the functional layer of the endometrium, extending beyond the uterine cavity. This combination negatively affects the prognosis and prospects for treatment.
Three degrees of severity
Given the damage to the basal layer of the endometrium, doctors suggestthe following classification of Asherman's syndrome:
- mild degree (adhesions occupy no more than 25% of the volume of the uterus, easily destroyed by mechanical damage);
- medium degree (unions are tightly soldered to the uterine mucosa);
- severe degree (adhesions consist mainly of sclerosed connective tissue, blocking the mouths 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's syndrome.
Is pregnancy possible?
Reviews of doctors indicate that the likelihood of conceiving a child with 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 disturbed. As a result, the embryo cannot implant. In addition, the endometrium loses its ability to respond to changes in estrogen levels. Gradually, secondary infertility develops, and with it amenorrhea. Adhesions in the cervical region provoke the accumulation and delay of menstrual flow. Violation of the cycle usually indicates a severe degree of pathology. Natural pregnancy is acceptable if Asherman's syndrome is treated in a timely manner.
Is IVF possible? Reviews of doctors confirm that in vitro fertilization makes sense when the disease is at an early stage of development. At the same time, 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 eachthe 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 he alth, periodically undergo examinations by a gynecologist, and treat all diseases in a timely manner.
Medical examination
To diagnose the disease, instrumental methods are used to visualize the uterine cavity. Without fail, the doctor studies the patient's obstetric history (the number of pregnancies, abortions, miscarriages, etc.). Ultrasound examination is considered the most accessible and at the same time minimally invasive method for diagnosing the pelvic organs. Asherman's syndrome can be confirmed by ultrasound, but the procedure must be repeated several times during the cycle to obtain accurate results.
The gold standard for detecting synechia is hysteroscopy. Such a study of the uterine cavity involves the use of a special device. It is administered through the cervical canal, thanks 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 complete examination of the patient must be combined with an obstetric history and previous treatment attempts. Suchapproach allows predicting the positive dynamics of therapy.
Treatment methods
Mild to moderate disease responds well to treatment. Advanced forms of pathology and pregnancy are incompatible. In this case, surrogate motherhood comes to the rescue. When adhesions are localized in a limited area of \u200b\u200bthe uterine cavity, the IVF method helps. However, even in this case, not all women diagnosed with Asherman's syndrome can try on the role of motherhood.
Treatment involves the removal of adhesions by hysteroscopy. The operation does not require general anesthesia and has no complications. Technically, this is a rather complicated procedure. Removal of synechia is carried out with microscissors due to the high likelihood of re-injury. In the postoperative period, antibiotic treatment is prescribed to prevent infectious complications. Drug therapy must be supplemented with hormonal therapy. 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 therapy, pregnancy is observed in 93% of patients, with an average degree - only in 78%. Competent 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 patients is also taken into account in the prognosis. For example, 66% of patients younger than 35 with a diagnosed syndromesevere degree capable of conception. For women over 35, this figure barely exceeds 24%.
Prevention measures
Can Asherman's syndrome be prevented? 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 miscarriage procedures is medical abortion. It implies the stimulation of labor activity through the use of drugs. However, the efficiency 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 medical abortion is chosen for medical reasons. On the other hand, this procedure does not give a 100% guarantee of a positive result.
