Asherman's Syndrome: A Consequence of Abortion

ASHERMAN'S SYNDROME: A CONSEQUENCE OF ABORTION

by Lawrence F. Roberge, M.S.

Although long overlooked as the abortion debate has unfolded, the health effects (or complications) of the abortion procedure itself have now become a serious topic. A review by Huggins and Cullins examined abortion effects on fertility[1] and found that the most commonly used methods of abortion often harm fertility.

The authors state that abortions performed by poorly trained physicians or illegal abortions may result in infertility problems, especially due to infections. Earlier studies by Trichopoulos[2] stated that in Greece about 45 percent of the cases of secondary infertility may be due to prior induced abortions. Studies by Hogue, et al.[3] and Daling and Emanuel[4] do not agree with this assertion.

Former U.S. Surgeon General C. Everett Koop recommended in a report to President Reagan in 1987 that adverse effects of abortion on the mental and physical health of the woman require further study.[5] One infertility problem that is clearly appearing as a post-abortion complication is Asherman's Syndrome. Asherman's Syndrome is the presence of intrauterine synechiae (i.e., tissue adhesions within the uterus) that produce clinical symptoms such as menstrual abnormalities, infertility, and habitual abortion (miscarriage).[6]

Caused by D&C abortions

One of the main causes of Asherman's Syndrome is the surgical technique of dilation and curettage (commonly referred to as D&C). The incidence of Asherman's Syndrome due to D&C becomes even more pronounced if a pre-existing or post-operational infection occurs.

The diagnosis of Asherman's Syndrome is not always certain.[6],[7],[8] If the physician suspects Asherman's Syndrome, the best methods of detection are hysteroscopy (endoscopic examination of the uterus) and hysterosalpingography (an X-ray exam of the uterus and the fallopian tubes following injection of a radio-opaque fluid).[6],[7],[8]

Following treatment of Asherman's Syndrome, the rate of fertility restoration is high, but not 100 percent.[7] If not treated, Asherman's Syndrome patients suffer with symptoms including infertility, menstrual irregularities, pelvic pain, miscarriages and ectopic pregnancy.[6] Although the etiology behind how Asherman's Syndrome effects fertility is not totally certain, explanations include: the adhesions block sperm migration up in the uterus; and the embryo cannot implant into the uterine lining, thus it implants in the cervix or fallopian tube (ectopic pregnancy) and/or a miscarriage occurs.

Ectopic pregnancies

Unfortunately, studies by Shinagawa[9] and a more recent study by Dicker[10] indicate that either abortion, Asherman's Syndrome, or even the use of an IUD to treat Asherman's Syndrome will contribute to ectopic pregnancies. A unique (and formerly rare) form of ectopic pregnancy is cervical pregnancy. The incidence of cervical pregnancy varies from 1 per 1,000 pregnancies to 1 per 18,000 pregnancies. Unfortunately, the numbers vary due in part that some cervical pregnancies go unnoticed and are recorded as miscarriages.[10]

Dicker[10] demonstrates evidence that the incidence of cervical pregnancy may be related to induced abortion, Asherman's Syndrome, or IUD treatment of Asherman's Syndrome. Note that the final treatment of cervical pregnancies is usually a total hysterectomy.[9],[10] Thus, a long-term complication of a D&C induced abortion may include Asherman's Syndrome, consequently leading to cervical pregnancy and finally a total hysterectomy. Ismajovich, 7 and March and Israel[8] report cases of Asherman's Syndrome appearing in women that have previously had legal abortions.

It is important to note that D&C is one of the major surgical techniques used in legal abortions." Further long-term studies may demonstrate an increase in the incidence of Asherman's Syndrome and cervical pregnancies, especially among women who have obtained an abortion. Also, although the number of women having multiple abortions (and possibly multiple D&C procedures) is increasing," there are no studies that rule out multiple D&C procedures as another cause for Asherman's Syndrome.

Infertility results

Therefore, at least one possible complication for a woman who obtains an abortion (with D&C as the surgical method) is Asherman's Syndrome, which can result in infertility. This information must be added to the debate of abortion. Women obtaining an abortion must be informed of the possible complication of Asherman's Syndrome and its infertility effects.

ENDNOTES

1 Huggins, G.R., Cullins, VE, "Fertility After Contraception or Abortion," 54,4, Oct 1990, pp. 559-573.

2 Tricopoulos, D., Handiness, N., Danezis, J., Kalandidi, A., Kalapothaki, V., "Induced Abortion and Secondary Infertility," 83, 1976, pp. 645-650.

3 Hogue, C.J.R., Cates, W., Tietze, C., "Impact of Vacuum Aspiration Abortion on Future Childbearing: A Review," 15, 3,1983, pp. 119- 126.

4 Daling, J.R., Emanuel, I., "Induced Abortion and Subsequent Outcome of Pregnancy in a Series of American Women," 297, 23, 1977, pp. 1241-1245.

5 Koop, C.E., "A Measured Response: Koop on Abortion," 21, 1989, p. 31.

6 Klein, S.M., Garcia, C.R., "Asherman's Syndrome: A Critique and Current Review," 24, 9, 1973, pp. 722-735.

7 Ismajovich, B., Lidor, A., Confino, E., David, M.R, Treatment of Minimal and Moderate Intrauterine Adhesions (Asherman's Syndrome), >Journal of Reproductive Medicine> 30, 10, 1985, pp. 769-772.

8 March, C.M., Israel, R., "Intrauterine Adhesions Secondary to Elective Abortion," 48, 4, 1976, pp. 422-424.

9 Shingawa, S., Nagayama, M., "Cervical Pregnancy as a Possible Sequela of Induced Abortion. Report of 19 Cases," 105, 2, 1969, pp. 282-284.

10 Dicker, D., Feldberg, D., Samuel, N., Goldman, J.A., "Etiology of Cervical Pregnancy: Association with Abortion, Pelvic Pathology, IUDs, and Asherman's Syndrome," 30, 1, 1985, pp. 25-27.

11 Henshaw, S. K., Koonin, L.M., Smith, J.C., "Characteristics of U.S. Women Having Abortions, 1987," 23, 2, 1991, pp. 75-81.

Taken from the August 1995 issue of "HLI Reports." To subscribe contact: HLI Reports 7845 Airpark Road, Suite E Gaithersburg, MD 20879

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