Asherman's Syndrome: Uterine Scarring and Fertility

What is Asherman's syndrome?

Asherman's syndrome is the formation of scar tissue, or adhesions, inside the uterine cavity that can partly or completely stick its walls together. The scarring can thin the lining, shrink the usable space for a pregnancy, and block the normal shedding of the endometrium.

Symptoms often include very light or absent periods, cramping when menstrual blood cannot escape, and trouble conceiving. Severity ranges from a few thin bands to dense scarring that seals much of the cavity. Because the lining is the tissue an embryo must attach to, extensive scarring can also produce a thin uterine lining that resists implantation. The condition is named after Joseph Asherman, who described it in detail in the 1940s.

How does a D&C lead to scar tissue?

Scarring develops when a procedure or infection injures the basal layer of the endometrium, the layer that regenerates the lining each month. A dilation and curettage performed after a miscarriage or delivery carries more risk than one done on a non-pregnant uterus, because the tissue is softer and more vulnerable.

Infections and repeated procedures raise the risk further. Miscarriage itself is common, affecting about 10% of clinically recognized pregnancies according to the American College of Obstetricians and Gynecologists, and a D&C is one option for managing it 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 200: Early Pregnancy Loss.ACOG Practice Bulletin No. 200 states early pregnancy loss occurs in about 10% of clinically recognized pregnancies and that dilation and curettage is one management option, the setting in which uterine scarring can arise.. Understanding miscarriage management helps explain when scarring risk comes up. Gentle, ultrasound-guided technique lowers that risk considerably, so scarring is far from inevitable.

How is Asherman's syndrome diagnosed and treated?

Diagnosis usually relies on directly visualizing the uterine cavity, since scarring is hard to confirm from the outside. A saline-infusion ultrasound or a hysterosalpingogram can raise suspicion, but hysteroscopy, a thin camera passed into the uterus, is the reference standard.

Treatment is also done by hysteroscopy: the surgeon carefully cuts and removes the adhesions to restore the cavity. According to the American Society for Reproductive Medicine, evaluating the uterine cavity is a core part of a fertility assessment 2Ref 2Practice Committee of the American Society for Reproductive Medicine (2021).Fertility evaluation of infertile women: a committee opinion.ASRM committee opinion establishing that evaluation of the uterine cavity is a core part of the fertility assessment, the workup that detects intrauterine adhesions.. Afterward, clinicians often use measures to keep the walls from re-adhering and to help the lining regrow, though scarring can return, especially in severe cases. Timing the check for the second half of the cycle, when the lining is thickest, improves what a scan can show.

Can you get pregnant after treatment for Asherman's?

Many people conceive after adhesions are removed, particularly when the scarring was mild to moderate. Restoring a normal cavity and a healthy lining improves the chance that an embryo can implant and a pregnancy can grow.

Outcomes depend on how severe the scarring was and whether it returns. Severe cases may need more than one procedure, and pregnancies after significant scarring are watched more closely for placental problems. Because infertility affects about 1 in 6 people of reproductive age according to the World Health Organization, Asherman's is one of several causes a workup considers, and treating it can remove a real obstacle for the right person 3Ref 3World Health Organization (2025).Infertility (fact sheet).WHO fact sheet states about 1 in 6 people of reproductive age experience infertility, framing Asherman's syndrome as one of several causes considered in a workup.. Those with repeated losses may also pursue recurrent pregnancy loss testing. A well-restored cavity gives many people a realistic path to pregnancy.

When uterine scarring needs a specialist

A gynecologist or reproductive surgeon experienced in hysteroscopy is the right person to confirm and treat suspected adhesions. If your periods became very light or stopped after a D&C or uterine infection, or you are struggling to conceive or carry a pregnancy, an evaluation of the cavity is reasonable 2Ref 2Practice Committee of the American Society for Reproductive Medicine (2021).Fertility evaluation of infertile women: a committee opinion.ASRM committee opinion establishing that evaluation of the uterine cavity is a core part of the fertility assessment, the workup that detects intrauterine adhesions.. Trying for 12 months, or 6 months if you are over 35, without success is a common threshold for that step 2Ref 2Practice Committee of the American Society for Reproductive Medicine (2021).Fertility evaluation of infertile women: a committee opinion.ASRM committee opinion establishing that evaluation of the uterine cavity is a core part of the fertility assessment, the workup that detects intrauterine adhesions.. Scarring can affect anyone with a uterus, but it matters most during the reproductive years when someone hopes to conceive, and symptoms may be masked as periods naturally lighten toward the perimenopausal transition. Care is individualized. Gale can help you prepare for that conversation.