Adhesions and Asherman

  • Narendra Malhotra
  • Jude Ehiabhi Okohue


Intrauterine adhesions are fairly common worldwide.

First described by Henrich Fritsch and characterized by Asherman, this condition can lead to oligomenorrhea, amenorrhea, infertility, and recurrent pregnancy losses.

Hysteroscopy, which has relegated blind curettage, remains the gold standard for evaluating the uterine cavity. With office equipment now readily available, hysteroscopy can be performed as an outpatient procedure. A proper history coupled with a physical examination and investigative modalities such as hysterosalpingography, 3D ultrasound, and saline contrast sonography for uterine cavity evaluation is invaluable in establishing a diagnosis before such patients are taken for surgery.

Various steps have been proposed for preventing adhesion reformation. Assessment of adhesion reformation can be done via office hysteroscopy, saline infusion sonography, and hysterosalpingography.


Asherman syndrome Hysteroscopy Adhesiolysis 

Supplementary material

Movie 8.1

Hysteroscopic adhesiolysis of an ESH classification grade II adhesions with scissors

Movie 8.2

Hysteroscopic adhesiolysis with scissors. The adhesions appeared as normal fundal wall with apparent tubal ostia. A normal cavity can be seen behind the adhesions following adhesiolysis

Movie 8.3

Hysteroscopic adhesiolysis of severe intrauterine adhesions under laparoscopic guidance


  1. 1.
    Asherman JG. Amenorrhoea traumatic (atretica). J Obstet Gynaecol Br Emp. 1948;55:23.CrossRefGoogle Scholar
  2. 2.
    Asherman JG. Traumatic intrauterine adhesions. J Obstet Gynaecol Br Emp. 1950;57:892–6.CrossRefGoogle Scholar
  3. 3.
    Hanstede MM, Van der Meij E, Goedemans L, Emmanuel MH. Results of centralised Asherman surgery (2003–2013). Fertil Steril. 2015;104(6):1561–8.CrossRefGoogle Scholar
  4. 4.
    Hooker AB, Lemmers M, Thurkow AL, Heymans MW, Opmeer BC, Brolmann HA, et al. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long term reproductive outcome. Hum Reprod Update. 2014;20(2):262.CrossRefGoogle Scholar
  5. 5.
    March CM. Asherman’s syndrome. Semin Reprod Med. 2011;29(2):83–94.CrossRefGoogle Scholar
  6. 6.
    Rasheed SM, Amin MM, Abo Ellah AH, Abo Elhassan AM, El Zahry MA, Wahab HA. Reproductive performance after conservative surgical treatment of postpartum haemorrhage. Int J Gynaecol Obstet. 2014;124(3):248–52.CrossRefGoogle Scholar
  7. 7.
    Song D, Liu Y, Xiao YLTC, Zhou F, Xie E. A matched cohort study of intrauterine adhesiolysis for Asherman syndrome after uterine artery embolization or surgical trauma. J Minim Invasive Gynecol. 2014;21(6):1022–8.CrossRefGoogle Scholar
  8. 8.
    Okohue JE. Adhesions and abortion. In: Tinelli A, Alonso Pacheco L, Haimovich S, editors. Hysteroscopy. Cham, Switzerland: Springer; 2018.Google Scholar
  9. 9.
    Sugimoto O. Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions. Am J Obstet Gynecol. 1978;131:539–47.CrossRefGoogle Scholar
  10. 10.
    Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome—one century later. Fertil Steril. 2008;89:759–79.CrossRefGoogle Scholar
  11. 11.
    Kodaman PH, Arici AA. Intrauterine adhesions and fertility outcome: how to optimize success? Curr Opin Obstet Gynecol. 2007;19(3):207–14.CrossRefGoogle Scholar
  12. 12.
    Emmanuel MH, Hanstede M. Hysteroscopic treatment of Asherman syndrome. In: Tinelli A, Alonso Pacheco L, Haimovich S, editors. Hysteroscopy. Cham, Switzerland: Springer; 2018.Google Scholar
  13. 13.
    Hulka JF, Peterson HA, Philips JM, Surrey MW. Operative hysteroscopy: American Association of Gynecologic Laparoscopists 1993. Membership survey. J Am Assoc Gynecol Laparosc. 1995;2(2):131.CrossRefGoogle Scholar
  14. 14.
    Orhue AA, Aziken ME, Igbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet. 2003;82:49–56.CrossRefGoogle Scholar
  15. 15.
    Malhotra N, Bahadur A, Kalaivani M, Mittal S. Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis. Arch Gynecol Obstet. 2012;11:525–30.CrossRefGoogle Scholar
  16. 16.
    AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guideline for management of intrauterine synechiae. J Minim Invasive Gynecol. 2010;17(1):1–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Narendra Malhotra
    • 1
  • Jude Ehiabhi Okohue
    • 2
  1. 1.Global Rainbow Healthcare, Rainbow HospitalAgraIndia
  2. 2.Gynescope Specialist Hospital, Madonna UniversityPort HarcourtNigeria

Personalised recommendations