This is another exciting first for DITM. I previously posted about my award winning research presented on the development of autofluorescent laparoscopy. Now here is information about my latest research just presented at the AAGL 35th Global International Congress on Gyn Endoscopy.
The study was the first human clinical and primate data supporting the development of a new surgical device to treat abnormal uterine bleeding (AUB) It also describes what would be a new form of uterine infertility that forms the basis for the device development. The study consisted of a human clinical case series of women with a rare form of “Asherman’s Syndrome” or intrauterine scarring and a non-human macaque primate model designed to replicate this disease for the first time.
This study represents an amazing opportunity to help women. We have uncovered a potential new form of uterine infertility that would be missed by traditional diagnostic methods. While I am working to cure this uterine condition, A start-up medical company is working to develop these discoveries into a treatment to help women with excessive bleeding. Their device is in human feasibility clinical trials.
Current surgical treatments are primitive because they destroy the entire uterus to stop bleeding. This would represent the first treatment confined to a tiny portion of the uterus that causes it to simply and reversibly shut its own function off. For the diseae of Asherman’s Syndrome this is an important opportunity to better understand what is happening to help cure women with the disease.
In Asherman’s Syndrome, scar tissue forms inside the uterus causing cessation of menstrual bleeding and infertility. It has been believed that the cessation of bleeding is directly due to the scar tissue damaging the normal endometrial lining tissue. I have a large international referral practice of difficult cases of Asherman’s Syndrome and observed that a subset of women with the disorder has a relatively small amount of scarring confined to the opening of the uterus inside the cervix that reflexively causes menses to stop. What was so interesting is that traditional theories say that when the flow of menses out of the uterus is blocked the uterus will fill up with blood- called a hematometria. We found this is not the case at all in this situation. In fact the opposite occurs. The uterus downregulates its lining which “shuts itself off”. The lining become thin and atrophic. We are conducting further studies to define the mechanism by which this occurs.
The clinical findings support the discovery of a new cause of the cessation of menses. There is potentially a milder form of the disorder that would lead to infertility or miscarriage. Any partial impediment to blood flowing freely out of the uterus could lead to a mild form of the uterus shutting itself off.
Noninvasive ultrasound imaging followed by hysteroscopic examination and correction of scarring demonstrated that the entire upper functional portion of the uterine fundus was normal and that the scar was confined to the lower cervical opening only.
We also presented data from a non-human primate study designed to replicate these findings. Monkeys were treated with hormones (estradiol and progesterone) to induce artificial menstrual cycles. The animals underwent focal surgical attachment of the inner uterine surfaces just above the cervix to partially close the uterus. The uterus was then examined after 5 menstrual cycles. The amount of menstruation was recorded and endometrial thickness under the microscope. Menstrual bleeding reduced 77% with some animals having complete absence of menstruation. Endometrial thickness was also significantly reduced. The findings exactly matched out human cases with the disease!
Why This is Significant:
1) Even women who seem “normal” may suffer from a mild form of this newly-discovered cause of infertility
2) This is the first discovery of a disease where the human reproductive system ”shuts itself off” in response to an injury
3) Abnormal heavy menstrual bleeding is a huge problem for women worldwide leading to D&C’s and hysterectomies. A company is working to make the shut off condition into a reversible treatment. This would be the first nondestructive treatment for heavy uterine bleeding.
Thanks to my coauthors on the study: Jim Coad, MD of the Department of Pathology West Virginia University Medical School and Ov Slayden PhD at the Oregon National Primate Regional Center/Oregon Health Sciences University.
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11 users responded in this post
[…] Add to this my interest in the technology aspect of medicine and it isn’t surprising that I some good stuff over at DocintheMachine. Steven (Palter, MD) has discovered a new reason for uterine infertility caused by the uterus literally shutting itself down. […]
I was sent this report from the Ashermans web site. I was diagnosed with Ashermans 15 years ago following the birth of my daughter and a ‘thorough’ ERPC. I have very little menstral bleeding each month but of late, and there is no pattern to this, I am getting severe left sided Iliac fossa pains. I am now about to have another laparoscopy and hysteroscopy as it is thought the cause of the pains maybe due to scar tissue.
Any research for Ashermans is a good thing as I feel even today very few Dr’s really understand what it is or the problems people can have from it.
[…] Thanks to Dr. RW for an excellent Grand Rounds. I especially like this one for including a series of purely clinical posts. There has been a discussion running about the purpose of GR and some think it should only be literary pieces aimed at the lay public. I think the best of themedical blogosphere can excel with diversity and love the clinical and technical pieces. Of course I am also delighted that my post (shameless self-plug) was included! This is the post of my original research that identified a new form of uterine infertility - however the findings suggest that in cases of abnormal bleeding we may actually WANT to cause this disease to trick the uterus in shutting it own menses off. Our “From Bench to Blogosphere” segment features docinthemachine with some original research he recently presented before the American Association of Gynecological Laparoscopists on a little appreciated variant of Asherman’s Syndrome along with discussion about potential applicability to the treatment of other gynecological disorders. […]
Hello,
I have read the above text in regards to “Scar tissue”.
I am living in canada and you are only a number in a clinic for the doctors who do not read your file properly before they direct their medication.
Let me tell my unfortunate story:
I am 34 years ald and we have been trying to b pregnant for almost last two years, I spent my 1 year time in the fertility clinic doing the standard procedure for artificial insemination up to 5 times. result is “Negative”.
My doctor made an artificial insemination before my laporoskopy surgery. he knew that I had addhessive problems and also mucus problem. He made the sugery on 31st of March 2006 and a complication occured with anestisia, I ended up in the critical care. I was almost dying. The doctor messed up my eating tube because of difficult intubuation and he made a hole in my eating tube than he gave me gas and gas leaked from this hole, it was all swallen and my chest was filled with air going to my lungs. He wanted me to go home that day in that terrible condition. After 2 ambulances and one personal trials, I insisted the doctor to take me to the hospital to watch, then I was in critical care for 12 days loosing 8 kilos in 1 week. I was luck to survive.
My ferility doctor forgot everything. Can you believe , he told me that I did not have a surgery!! Anyways according to him I have the following problems:
1- scar tissue - I asked him if he did not fix it during the surgery he toild me that it takes time to heal and sometimes laser does not work. Of course I do not beleive in him he might have made it up as he did not read my file.
2- Mucus problem. It does not allow sperm to swim.
3- He started saying I have endo which he did not mention before.
He tried artificial insemination, mostly the nurses did for me -even not himself.
His solutuons:
a-artificial ins+clomid
b- artificial ins+ injection
c- IVF
It is extermely expensive around 10.000 cad here in canada. Where I come from, Turkey, it is half price.
I am loosing my hope, Shall I get pregnant?
I am changing my fertility doctor.
Please make an advise. I really need it since I am pretty hopless after I had these experiences.
Thanks very much!
Mel
Dr. Palter,
What is being described here sounds exactly like what I am enduring. I had strictly cervical scarring, yet now my lining is consistently extremely thin despite estrace/other fertility medications. Have you had any luck with any other methods to build the lining? I am actively trying to conceive with the help of a fertility specialist.
Thank you and best to you in your research!
[…] More original research from DITM on new cause of infertility « How The Autofluorescence System Works- Description | DITM Returns from Conferences- Let the Posts Begin! » […]
Origianlly I had ammenorrhea for two and a half years following the ERPC aftr the birth of my child and have never had a ‘normal’ period since. It was post laparoscopy and hysteroscopy that they put in a coil (IUD) to try and keep the cervical os open and I had a course of hormonal injections to try and kick start the bleeding. I was told post op my uterus looked like a child of twelve years and not of a woman who had had children (2)
Long term, the pain I am now getting is the same as it was all those years ago, but it is always on the left. There isn’t a pattern to it, but it is so severe I feel faint and have to lie down.
I am having a laparoscopy and hysteroscopy this month to see what is going on.
If this was endometriosis wouldn’t there be a pattern with the pain?
Dr. Palter,
My Asherman’s was caused by repeated endometial ablations (2) for excessive bleeding. The past three years the pain I suffered during the time I would have been having my period increased dramatically. It was only after my former-ob/gyn realized I had an “obstruction” and attempted a D&C (the procedure was not completed because he perforated my uterus while trying to dilate my cervix), that I found out that the ablations only succeeded in scarring my cervix. I have recently had the scar tissue removed and am now experiencing bleeding at it’s pre-ablative levels.
If your theory is correct, my bleeding should have at least been curtailed, if not stopped. As it is, it appears I have been bleeding internally for the past three years. Why would my case be different?
Thank you.
Camille
I was diagnosed with a severe case of Asherman’s Syndrome after several tests revealed the condition. The condition was the direct cuase of the termination of my very much wanted first pregnancy at 35 years old. On April 21th, 2006 I painfully and much more terminated a 5 month and 2 weeks pregnancy becuase my baby girl had a Rare Monosomy Chromosome 21 Disorder. After a second amnio it was confirmed that my baby had a Ring Chromosome 21 disorder. With all the anguish and tormoil month’s of tests and then an infertity dr performed a laporoscopy & hystoroscopy and found that my cervical canal is distroyed and much more. Now my pain has trippled, cuadruppled with the loss of my pregnancy my baby girl and my fertility.
It’s great that understanding Asherman’s syndrome (intrauteirne adhesions) is helping to cure the opposite problem- excessive bleeding. And it’s reassuring to know that people are studying how subtle forms of Asherman’s lead to infertility.
However, Asherman’s is almost always preventable in the first place. Over 75% of cases are caused by a medical procedure -D&Cs or D&Es whether for miscarriage, retained placenta postpartum, or abortion- so isn’t it about time this form of reproductive mutilation is replaced by safer methods which are already available??
I read a recent article that said that gynecology is the slowest area to pick up on new less invasive procedures. Why do doctors still perform D&C/D&Es when there exist pills that can do the same thing without the need for surgery? Misoprostol, mifepristone, methotrexate- these should be the first line of call.
Apparently the reason for this lag in medical improvement in women’s healthcare is because women don’t demand enough. So ladies it’s time to wake up and start demanding non-invasive techniques from our doctors or risk the consequences.
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