Abstract

Asherman syndrome is the presence of adhesions in the endometrial cavity that can result in infertility or recurrent spontaneous abortion with or without amenorrhea. It can present with pain, menstrual abnormalities, recurrent pregnancy loss and infertility. These synechiae may be detected on a hysterogram or sonohysterogram, but are best shown with diagnostic hysteroscopy. Management includes hysteroscopic guided lysis of adhesions and attempt to restore uterine cavity anatomy. Platelet rich plasma, stem cells, growth factors, tissue engineering are being explored for endometrial regenerative therapy. Preventive measures need to be explored more. Efforts are needed in reducing adhesions post instrumentation especially in gravid uterus.

• 1.   Nazer Sherar, Ranjeet Bhatia Intrauterine adhesions Mala Arora, Neelanjana Mukhopadhyaha Recurrent pregnnancy loss Jaypee thrid edition 2019)
• 2.   Review Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long-term reproductive outcome Angelo B Hooker et al. Hum Reprod Update. 2014 Mar-Apr.
• 3.   Intrauterine Adhesions Following Miscarriage: Look and Learn Ashley R Gilman et al. J Obstet Gynaecol Can. 2016 May.
• 4.   Intrauterine adhesions after hysteroscopic treatment for retained products of conception: what are the risk factors? Oshri Barel et al. Fertil Steril. 2015 Mar.
• 5.   Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery O Taskin et al. J Am Assoc Gynecol Laparosc. 2000 Aug
• 6.   Observational Study Prevalence and Impact of Chronic Endometritis in Patients With Intrauterine Adhesions: A Prospective Cohort Study Yuqing Chen et al. J Minim Invasive Gynecol. 2017.
• 7.   Genital tuberculosis: an important cause of Asherman’s syndrome in India Jai Bhagwan Sharma et al. Arch Gynecol Obstet. 2008 Jan.
• 8.   Total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopic synechialysis O Bukulmez et al. Hum Reprod. 1999 Aug
• 9.   Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage O Poujade et al. BJOG. 2011 Mar.
• 10.   Collin Smikle; Siva Naga S. Yarrarapu1; Shailesh Khetarpal).
• 11.   Office hysteroscopic early lysis of intrauterine adhesion after transcervical resection of multiple apposing submucous myomas JehnHsiahn Yang et al. Fertil Steril. 2008 May.
• 12.   Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol. 2013 Dec 27;11:118. doi: 10. 1186/1477-7827-11-118. PMID: 24373209; PMCID: PMC3880005.
• 13.   Lv H, Nan Z, Jiang P, et al. Vascular endothelial growth factor 165 inhibits pro-fibrotic differentiation of stromal cells via the DLL4/ Notch4/smad7 pathway. Cell Death Dis 2019;) 10:681.
• 14.   Chen Y, Chang Y, Yao S. Role of angiogenesis in endometrial repair of patients with severe intrauterine adhesion. Int J Clin Exp Pathol 2013; 6:1343) 40. Yu D, Wong YM, Cheong Y, et al. Asherman syndrome--one century later. Fertil Steril 2008; 89:759.
• 15.   Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril 1982; 37:593
• 16.   Yu D, Li TC, Xia E, et al. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman’s syndrome. Fertil Steril 2008; 89:715. 3. Deans R, Abbott J. Review of intrauterine adhesions. J Minim Invasive Gynecol 2010; 17:555.
• 17.   Jeffcoate’s Principles of Gynaecology Revised and updated from the Seventh Edition by Narendra Malhotra MD FICOG FRCOG (Honoris Causa).
• 18.   Speroff’s Clinical Gynecologic Endocrinology and Infertility Ninth Edition Hugh S. Taylor, MD Lubna Pal, MBBS, MS Emre Seli, MD.

Data Sharing Statement

Funding