Asherman’s syndrome means scar tissue (adhesions) has formed inside the uterus, usually after a procedure that disturbed the uterine lining. It can make periods lighter or stop them, and it can make it harder for the lining to support an embryo. It’s diagnosed and treated with hysteroscopy, and treatment often needs to come before an embryo transfer. If you’re planning IVF in Colombia, that affects the order of steps and possibly the number of trips.
- Adhesions most often follow a D&C or other uterine surgery, especially after a miscarriage or delivery. Infection can also play a role.
- Hysteroscopy is the gold standard for diagnosis. A saline sonogram or HSG can raise suspicion but can’t fully map the adhesions.
- Treatment is hysteroscopic adhesiolysis, which means cutting the scar tissue under direct view. Some patients need more than one procedure.
- Egg retrieval and freezing embryos can often go ahead, but transfer usually waits until the cavity is repaired and the lining responds.
What Asherman’s syndrome is
The uterus has an inner lining, the endometrium, that thickens and sheds each cycle. Its deepest layer, the basal layer, regenerates the lining after each period. When that layer is injured, the walls of the uterus can heal stuck together, forming bands of scar tissue called intrauterine adhesions. When the adhesions cause symptoms such as menstrual changes, infertility or pregnancy loss, the condition is often called Asherman’s syndrome.
Adhesions range from thin, filmy bands that are easy to separate to dense scarring that closes off large parts of the cavity. Surgeons grade severity using several published classification systems. The grade matters because it shapes treatment and the outlook for the lining.
Causes and risk factors
The most common trigger is curettage of a recently pregnant uterus. That includes a D&C after a miscarriage, for retained tissue after delivery, or after a pregnancy termination. The lining is especially vulnerable in the weeks after pregnancy. Other contributors include:
- Repeat uterine procedures
- Hysteroscopic surgery, such as removing fibroids or a septum
- Cesarean delivery or other uterine surgery
- Infection of the uterine lining, including genital tuberculosis in regions where it’s common
Many people with these histories never develop adhesions, and some people develop them after a single procedure. If you have a history of uterine surgery, especially a D&C after a pregnancy, tell your fertility specialist even if your periods seem normal.
Symptoms that raise suspicion
- Periods that became much lighter or stopped after a uterine procedure
- Cyclic pelvic pain without bleeding, which can mean blood is trapped behind adhesions
- Trouble conceiving after a previous pregnancy (see secondary infertility)
- Recurrent miscarriage
- A thin lining on ultrasound that doesn’t respond well to estrogen
- Failed embryo transfers with good-quality embryos
Some people have mild adhesions and no symptoms. That’s one reason many clinics evaluate the cavity before IVF.
How it’s diagnosed
| Test | What it shows | Limitations |
|---|---|---|
| Transvaginal ultrasound | Lining thickness and pattern. It may suggest scarring. | Can miss adhesions, especially mild ones |
| Saline infusion sonogram | Fluid outlines the cavity and can show filling defects or bands | Suggestive, not definitive |
| HSG (dye X-ray) | The shape of the cavity and whether the tubes are open | Filling defects can be adhesions, polyps or other findings |
| 3D ultrasound | A more detailed view of the cavity, depending on the operator’s skill | Not available everywhere |
| Hysteroscopy | Direct view of the cavity. Adhesions can often be treated during the same procedure. | A procedure, usually outpatient |
Hysteroscopy is the gold standard because it shows the adhesions directly and lets the surgeon grade them. Our guide to hysteroscopy before IVF explains what the procedure involves.
Treatment: hysteroscopic adhesiolysis
The standard treatment is hysteroscopic adhesiolysis. The surgeon passes a thin camera through the cervix and cuts the scar tissue, usually with fine scissors or an energy device, to restore the normal shape of the cavity. Mild adhesions can sometimes be treated in a single outpatient procedure. Severe adhesions are technically harder, carry more risk and often need repeat procedures.
Preventing re-formation
Adhesions can re-form after surgery, so surgeons often use strategies to help the lining heal apart. These vary by surgeon and by severity, and the evidence for each approach is still being studied. They may include:
- Estrogen therapy after surgery to encourage the lining to regrow
- A barrier, such as a temporary balloon catheter or an intrauterine device, placed for a short period
- Gels designed to separate the walls of the uterus
- A follow-up, or second-look, hysteroscopy a few weeks later to check for and treat new adhesions
Treatment is very individual, so experienced surgeons often differ in how they approach it. Ask your surgeon which strategy they recommend for your situation and why.
Watch out: Severe Asherman’s is a specialist problem. If you’ve been told you have moderate-to-severe adhesions, ask for a surgeon with substantial experience treating them, whether at home or in Colombia. Repeat surgery by an inexperienced surgeon can worsen scarring.
How Asherman’s affects IVF planning
Asherman’s affects the uterus, not the ovaries, so it usually doesn’t change how your ovaries respond to stimulation. It mainly affects whether and when an embryo can be transferred. Common approaches include:
- Freeze-all first. Some specialists recommend doing stimulation and retrieval, freezing all embryos, and treating the uterus separately. Embryos wait safely while the cavity heals.
- Repair first. Others prefer to restore the cavity before stimulation, especially if severity is uncertain.
- Frozen transfer once the lining responds. Transfer is generally planned for a frozen cycle after the cavity is confirmed healthy and the lining develops adequately. See frozen vs fresh embryo transfer.
If the lining stays thin after the adhesions are treated, your specialist may discuss additional options. Our guides to thin endometrium treatment options and uterine PRP infusion evidence cover these, including where the evidence is still limited. In severe cases where the lining can’t be restored, some patients discuss gestational carriers with their specialist. The legal and practical issues around that are complex and vary by country.
How likely treatment is to lead to a pregnancy depends heavily on how severe the adhesions were and how well the lining recovers. Your specialist can give you a more personal estimate after seeing the cavity.
Planning your Colombia trips around Asherman’s
- Get your cavity evaluated at home first. If your history suggests risk, a saline sonogram or hysteroscopy before you travel tells you whether repair is needed. Send the report and images to the Colombian clinic.
- Decide where the surgery happens. Some patients have adhesiolysis at home with a surgeon they trust. Others have hysteroscopy in Colombia as part of the treatment plan. Recovery from an outpatient hysteroscopy is usually quick, but follow-up hysteroscopies and lining checks add time.
- Expect more than one trip. A common pattern is one trip for retrieval and embryo freezing, then a later trip for frozen transfer once the cavity is confirmed healthy. Some patients need a second-look hysteroscopy in between. Our guide to two-trip vs one-trip protocols explains the tradeoffs.
- Arrange lining checks at home. Ultrasounds to see how the lining responds to estrogen can often be done by a local doctor and shared with the clinic. That can shorten your stay for transfer.
- Plan for flexibility. If the lining isn’t ready, transfer may be postponed. Avoid nonrefundable travel bookings around transfer dates.
Our guide to coordinating your home and Colombian clinic covers how to divide these tasks. For cost planning, including possible extra procedures, see the IVF cost in Colombia guide.
Tip: Ask for your operative report and hysteroscopy photos or video after any procedure. These show any future surgeon exactly what was found and treated, which is especially valuable when your care spans two countries.
Frequently asked questions
Can you do IVF with Asherman’s syndrome?
Often, yes, but the adhesions usually need to be treated and the lining shown to respond before transfer. Egg retrieval and embryo freezing can often go ahead. A reproductive endocrinologist and an experienced hysteroscopic surgeon should plan the sequence together.
Can Asherman’s come back after surgery?
Yes. Adhesions can re-form, especially after severe scarring. That’s why surgeons often use post-operative strategies and may recommend a second-look hysteroscopy.
Will an HSG or ultrasound always detect adhesions?
No. Imaging can suggest adhesions, but it can miss mild ones or mistake other findings for adhesions. Hysteroscopy gives a direct view and is the definitive test.
Should I have adhesiolysis at home or in Colombia?
Either can work. The main factors are the surgeon’s experience with adhesions, how many follow-up procedures you may need, and how easily you can get follow-up care. Share your records with both teams before deciding.
Does Asherman’s affect pregnancy after a successful transfer?
It can be linked to pregnancy complications, including placental problems, so your pregnancy care team should know your history. Make sure your obstetric provider receives your surgical records.
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