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, <et al.>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," <Fertile Sterid.> 54,4, Oct 1990, pp. 559-573.
2 Tricopoulos, D., Handiness, N., Danezis, J., Kalandidi, A.,
Kalapothaki, V., "Induced Abortion and Secondary Infertility,"
<British Journal of Obstetrics and Gynecology.> 83, 1976, pp.
645-650.
3 Hogue, C.J.R., Cates, W., Tietze, C., "Impact of Vacuum Aspiration
Abortion on Future Childbearing: A Review," <Family Planning
Perspectives> 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," <New England Journal of
Medicine> 297, 23, 1977, pp. 1241-1245.
5 Koop, C.E., "A Measured Response: Koop on Abortion," <Family
Planning Perspectives> 21, 1989, p. 31.
6 Klein, S.M., Garcia, C.R., "Asherman's Syndrome: A Critique and
Current Review," <Fertile Sterid.> 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," <Obstetrics and Gynecology> 48, 4, 1976, pp.
422-424.
9 Shingawa, S., Nagayama, M., "Cervical Pregnancy as a Possible
Sequela of Induced Abortion. Report of 19 Cases," <American Journal
of Obstetrics & Gynecology> 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," <Journal of Reproductive Medicine>
30, 1, 1985, pp. 25-27.
11 Henshaw, S. K., Koonin, L.M., Smith, J.C., "Characteristics of
U.S. Women Having Abortions, 1987," <Family Planning Perspectives>
23, 2, 1991, pp. 75-81.
Taken from the August 1995 issue of "HLI Reports."
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