Uterine synechiae are adhesions or scar tissue that forms within the uterine cavity. These are classified according to their location and extension.
They usually cover a small part of the uterine cavity and do not interfere with fertility or the normal pregnancy development; however, they can sometimes cover too much space and cause the walls of the uterus to stick together.
Main symptoms of uterine synechiae
The actual frequency of uterine synechiae is unknown because they are usually asymptomatic when they are small. If they are serious, however, they can cause:
- Amenorrhea or absence of a menstrual period
- Hypomenorrhea (short or scanty menstrual periods)
- Recurrent pregnancy loss (Recurrent miscarriages)
Uterine synechiae causes
Synechiae are usually a consequence of uterine trauma caused by:
- Prolonged use of intrauterine devices (IUDs)
- Post-miscarriage or postpartum curettage
- Caesarean sections in which there were infection issues
- Myoma or polyp removal procedures
However, there are cases where uterine synechiae have no apparent cause.
How are uterine synechiae diagnosed?
Based on the patient’s medical history, diagnostic procedures for uterine synechiae may include:
A transvaginal (or pelvic vaginal) ultrasound, in which the specialist carefully introduces an ultrasound probe into the patient’s vagina to examine her reproductive organs (uterus and ovaries). The transvaginal ultrasound is simple, painless and generally facilitates a clear diagnosis; however, additional tests may be required in some cases.
Hysteroscopy, which consists in the introduction of a microscopic camera through the vagina and cervix to visualize any possible abnormalities in the uterine cavity. Hysteroscopy is an ambulatory surgical procedure, and if synechiae are found it is easy to remove them during the same procedure.
Treatments to achieve pregnancy in patients suffering from uterine synechiae
Uterine synechiae rarely affect fertility. However, it is advisable for women with mild to severe cases to consider treatments like In-Vitro Fertilization (IVF), especially if they are over 35.
In-Vitro Fertilization (IVF) is a particularly effective treatment to achieve pregnancy. While uterine synechiae usually alters sperm transport and embryo implantation, IVF allows our specialists to obtain the eggs directly from the patient’s ovaries. These eggs are fertilized under controlled laboratory conditions to generate embryos with a higher implantation potential which are then transferred back into the patient’s uterus.
It is important to note that in most cases, women must previously undergo a minor surgery known as hysteroscopy to remove the uterine synechiae before continuing with an In-Vitro Fertilization (IVF) treatment. Hysteroscopy is an ambulatory process performed under anesthesia that consists on the introduction of a small optical system (provided with micro-surgical instruments) through the patient’s cervix to cut the synechiae adhesions.
This surgery must be performed by an experienced specialist as its complications could include bleeding, uterine perforation and pelvic infections.