How Asherman Syndrome Impacts Infertility - Yale Medicine Explains

Transcript

• 00:05The endometrium are those cells
• 00:06in the center of the
• 00:07uterus that normally support pregnancy.
• 00:10They're there to receive an
• 00:12embryo
• 00:13where the embryo will initially
• 00:14grow within the uterus,
• 00:16And each month, they build
• 00:17up to a point where
• 00:18they can accommodate that embryo,
• 00:20and then they're shed with
• 00:21menses and regrown in every
• 00:23menstrual cycle.
• 00:24It's evolved to protect, support,
• 00:26and nourish that early embryo,
• 00:29so it is the basis
• 00:30for all pregnancy.
• 00:35Asherman syndrome is a condition
• 00:37where that lining of the
• 00:38uterus is scarred or very
• 00:40thin and won't grow to
• 00:41that nice lush environment that
• 00:43supports an embryo.
• 00:45The most common time to
• 00:46see it is after a
• 00:47pregnancy. The hormone levels are
• 00:49down from pregnancy,
• 00:50and maybe somebody has some
• 00:52bleeding after pregnancy.
• 00:54Some sort of inflammation or
• 00:56insult to the endometrium
• 00:57causes it to scar, and
• 00:58the walls of the uterus
• 01:00may even attach to one
• 01:01another that prevents that uterine
• 01:04lining, that endometrium from growing.
• 01:07The first sign that somebody
• 01:09may have Asherman syndrome is
• 01:10often that their period becomes
• 01:12either absent or very light.
• 01:14There's less endometrial lining, or
• 01:17sometimes it may be more
• 01:18subtle. They may continue to
• 01:19get bleeding at the time
• 01:20of their period, but the
• 01:22lining may just not be
• 01:23thick enough or appropriate enough
• 01:25to support a pregnancy. So
• 01:26we may have infertility
• 01:28as the first sign, or
• 01:29unfortunately miscarriage may be another,
• 01:32sign of an Asherman syndrome.
• 01:34And this is, just such
• 01:36a heart wrenching,
• 01:38condition when somebody can't get
• 01:39pregnant
• 01:40or is having
• 01:42miscarriages, often recurrent miscarriages,
• 01:44it's so important to be
• 01:45able to offer them some
• 01:47treatment and hope.
• 01:53The mainstay of treatments right
• 01:55now are surgical,
• 01:56and we have a clinical
• 01:57trial going on, the only
• 01:59one in the country that
• 02:00can potentially help patients when
• 02:02surgery hasn't been successful.
• 02:05To repair the Aschterman syndrome,
• 02:06of course, we wanna open
• 02:07up the uterine cavity, so
• 02:09we wanna take care of
• 02:10that scar tissue that may
• 02:11be holding it together.
• 02:13So this procedure involves a
• 02:15hysteroscopy
• 02:16where we're gonna go in
• 02:17with a little telescope, and
• 02:18we
• 02:19cut apart those scarring adhesions
• 02:22that hold the uterine cavity
• 02:23closed to remove the scar
• 02:25tissue.
• 02:26Just before the surgical procedure,
• 02:27we also
• 02:28give a shot of a
• 02:29medication that mobilizes
• 02:31stem cells.
• 02:33One of the ways which
• 02:34this uterine lining heals when
• 02:36it's severely damaged is by
• 02:38recruiting stem cells from other
• 02:40areas of the body.
• 02:42So stem cells are these
• 02:43undifferentiated
• 02:44cells that can travel to
• 02:46an organ and help repair
• 02:47and heal that organ.
• 02:50There aren't usually enough stem
• 02:52cells in the circulation
• 02:54to overcome
• 02:55a large injury to the
• 02:56uterus.
• 02:57So by simply administering a
• 02:59drug that mobilizes one's own
• 03:02stem cells
• 03:03into their blood, at the
• 03:04time we're doing a procedure
• 03:05to the uterus, they'll naturally
• 03:08home towards that area to
• 03:10help repair it and, allow
• 03:12that endometrial lining to grow.
• 03:19We have a really comprehensive
• 03:21approach to patients with infertility.
• 03:23Not only do we have
• 03:24a great IVF program, but
• 03:25we have people involved
• 03:28in research and clinical care
• 03:30covering the spectrum of special
• 03:32conditions that often lead to
• 03:34infertility.
• 03:35We have within our infertility
• 03:37program people with surgical expertise
• 03:39in treating this, which aren't
• 03:41always coupled, that surgical expertise
• 03:43within an infertility center.
• 03:45Plus, we have some active
• 03:47ongoing research to try and
• 03:49understand Asherman syndrome.
• 03:52Twenty years ago,
• 03:53we here at Yale first
• 03:54describe the role of stem
• 03:56cells in the uterus, and
• 03:57it's so nice now twenty
• 03:59years later to finally bring
• 04:00this to the patient that
• 04:01that basic science discovery we
• 04:04made in the laboratory
• 04:05has come all the way
• 04:06to a actual practical approach
• 04:08where we're helping people because
• 04:09of that discovery.