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This is a transcription of a portion of a Healthful Woman podcast.

Cassie’s Question

Our last question today is from Cassie. “I was wondering if you could provide a little insight on Asherman’s syndrome and return of fertility. I had an early miscarriage that we found at seven weeks, ended up with me having an MVA,” a mechanical vacuum aspiration, similar to a D&C done in the office. “Nine months later and I still haven’t gotten pregnant. I just had a fertility workup and my HSG showed filling defects that they’re currently presuming to be Asherman’s from my miscarriage, and are going to schedule my hysteroscopy to clear up the scar tissue. I’m wondering if you have experience seeing these types of patients and if you have any advice or thoughts on the ability to get pregnant or any complications that could result from this. I’m 34, otherwise healthy. My fertility workup was unremarkable aside from the HSG.”

Dr. Fox’s Response

I definitely have experience taking care of people with Asherman’s. I do not myself perform the hysteroscopy, but I’ve seen this play out many times.

As background, Asherman’s syndrome describes a condition where, after a miscarriage, C-section, or delivery, the inner lining of the uterus becomes stuck together, almost like glue, usually because of scraping during a D&C. Classically, women stop getting their periods, sometimes have pain, and struggle with infertility, because there’s simply nowhere for an embryo to implant. Nowadays, curettage is done far less often. Most procedures, like your MVA, use gentle suction instead of scraping, which is likely one reason the full-blown version of Asherman’s has become less common.

What we’re diagnosing more often now, using ultrasound, saline sonohysterogram, or HSG imaging like yours, is a smaller amount of scar tissue that doesn’t necessarily come with the full syndrome. Periods might stay normal, there may be no pain at all, and fertility may or may not be affected. It really depends on how much scar tissue there is and where it sits.

For someone in your situation, since you’re trying to conceive, the standard next step is exactly what your doctors have planned: a hysteroscopy to remove the adhesions, followed by something to keep the walls of the uterus from sticking back together, whether that’s extra hormones or a small balloon placed temporarily inside the uterus.

Many women treated this way go on to have successful pregnancies. How smooth that path is depends on how severe the scarring was and whether one procedure clears it or more are needed. There is a downstream consideration worth knowing about: if the placenta implants where scar tissue used to be, it can occasionally stick more than it should, in rare cases leading to retained placenta or something more significant like placenta accreta. That’s not a reason for alarm, just a reason for closer monitoring in a future pregnancy.

For you specifically, assuming the scar tissue is limited and the hysteroscopy goes well, you should absolutely go on to have an uncomplicated pregnancy.

Learn More on the Healthful Woman Podcast

Dr. Fox answers several other questions in this episode, including a chorioamnionitis finding on placental pathology with no clinical symptoms, fertility after 15 years on a Mirena IUD, the history of episiotomies in the U.S. versus abroad, and how much a hospital’s NICU level should matter for a planned VBAC. To learn more, listen to Mailbag 34 on the Healthful Woman podcast, produced by Maternal Fetal Medicine Associates. If a question like Cassie’s applies to you, the Carnegie Imaging team offers genetic counseling and consultation appointments to help you plan next steps.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!