Asherman’s Syndrome and Hysteroscopy

Asherman’s syndrome is an acquired uterine condition and a less frequent though significant cause of infertility in women. Surgical procedures, especially the ones done on gravid uteri and infections, seem to be the major aetiological factor in its development. It manifests pathologically as a combination of endometrial scarring and intrauterine adhesions and clinically as menstrual dysfunction, infertility and various pregnancy complications. Methods to diagnose adhesions are either non-invasive or invasive, and their sensitivity and specificity are measured against the gold standard of hysteroscopy. Hysteroscopic synechiolysis is the primary method of treatment. Blunt, sharp and energy source linked lyses have all been used to obtain the goal of achieving full uterine capacity. One has to be wary of both immediate and late complications associated with lysis in severe cases. Ancillary methods adopted for prevention of adhesion reformation might be successful in reducing the risk and severity of adhesion reformation, but evidence is lacking on their efficacy in improving reproductive outcomes. Reproductive outcomes are mostly improved after hysteroscopic synechiolysis. Future research should focus on more effective ways to prevent adhesion reformation and on therapies to help regenerate functional endometrium.