Asherman’s Syndrome and Thin Endometrium: Assessment and Options

Asherman’s syndrome involves adhesions inside the uterus. A thin endometrium can have several causes and does not by itself establish this diagnosis. Assessment and treatment depend on the findings, previous care and the risks of carrying a pregnancy.

Symptoms

• Very light or absent periods after a procedure
• Repeated miscarriage
• Repeated failure of good-quality embryos to implant
• Pelvic pain around the time of a period

How it is diagnosed

A hysteroscopy — a thin camera inside the uterus — is the main test used to confirm it. It shows the extent of scarring and can treat it in the same procedure. Ultrasound measures endometrial thickness during the cycle.

Treatment first

Mild to moderate scarring may be treated by hysteroscopic surgery, sometimes followed by hormone treatment to support the lining. Some women then conceive or carry a pregnancy successfully. For a thin endometrium without scarring, your doctor may adjust the estrogen protocol; other proposed treatments have varying levels of evidence and are discussed individually.

When is surrogacy recommended?

Gestational surrogacy may be discussed, after individual assessment, when:

• scarring is severe or returns after repeated surgery
• the lining stays too thin despite treatment
• several good-quality embryo transfers have failed
• previous pregnancies ended in serious complications such as placenta accreta

Armenian law requires a medical contraindication to pregnancy; whether your situation meets this is assessed individually by the doctors. See eligibility.

Your eggs, the surrogate’s uterus

Asherman’s affects the uterus rather than the ovaries. If your doctor finds your ovarian reserve suitable, your own eggs may be used with IVF and the embryos transferred to a gestational surrogate. Existing frozen embryos may be shipped to Yerevan, subject to clinic and transport requirements.

Questions to ask your doctor

• How severe is the scarring, and can it be treated again?
• What is my endometrial thickness at its best?
• How many failed transfers suggest it is time to consider surrogacy?

See also: repeated IVF failure · surrogacy for married couples.