Hysteroscopy pp 709-718 | Cite as

Hysteroscopic Treatment of Asherman Syndrome

  • Mark Hans Emanuel
  • Miriam Hanstede


Diagnostic and operative hysteroscopy have become standards in gynaecologic practice. Many hysteroscopic procedures have replaced old, invasive techniques like dilatation and curettage. Now, as instruments become smaller than before, office hysteroscopy is replacing operating-room procedures. An overview of the different kinds of hysteroscopical techniques to intrauterine adhesiolysis will be presented. The pros and cons of simultaneous imaging guidance will be discussed; however, there is a significant lack of evidence.

The reasons for adjuvant measures and postoperative medical adjuvant treatment will be mentioned, and outcomes reported in the literature will be discussed and compared with data collected after treatment and follow-up of referred patients after national concentration of Asherman Syndrome (AS) care in the Netherlands.


Intrauterine adhesiolysis Asherman syndrome Diagnostic and operative hysteroscopy Fertility Sterility Surgical complications 


  1. 1.
    Fritsch H. Ein Fall von völligen Schwund der Gebärmutterhöhle nach Auskratzung. Zentralbl Gynaekol. 1894;18:1337–42.Google Scholar
  2. 2.
    Asherman JG. Amenorrhoea traumatica (atretica). J Obstet Gynaecol Br Emp. 1948;55:23–30.CrossRefPubMedGoogle Scholar
  3. 3.
    Asherman JG. Traumatic intrauterine adhaesions. J Obstet Gynaecol Br Emp. 1950;57(6):892.CrossRefPubMedGoogle Scholar
  4. 4.
    Asherman JG. Traumatic intrauterine adhaesions and their effects on fertility. Int J Fertil. 1957;2:49–54.Google Scholar
  5. 5.
    Levine RU, Neuwirth RS. Simultaneous laparoscopy and hysteroscopy for intrauterine adhesions. Obstet Gynecol. 1973;42:441–5.PubMedGoogle Scholar
  6. 6.
    Polishuk WZ, Sadovsky E. A syndrome of recurrent intrauterine adhesions. Am J Obstet Gynecol. 1975;123:151–8.CrossRefPubMedGoogle Scholar
  7. 7.
    March CM, Israel R. Intrauterine adhesions secondary to elective abortion. Hysteroscopic diagnosis and management. Obstet Gynecol. 1976;48(4):422.PubMedGoogle Scholar
  8. 8.
    Sciarra JJ, Valle RF. Hysteroscopy: a clinical experience with 320 patients. Am J Obstet Gynecol. 1977;127:340–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Sugimoto O. Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions. Am J Obstet Gynecol. 1978;131:539–47.CrossRefPubMedGoogle Scholar
  10. 10.
    Hamou J, Salat-Baroux J, Siegler AM. Diagnosis and treatment of intrauterine adhesions by microhysteroscopy. Fertil Steril. 1983;39:321–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Emanuel MH. New developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol. 2013;27:421–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Betjes HE, Hanstede MM, Emanuel MH, Stewart EA. Hysteroscopic myomectomy and case volume hysteroscopic myomectomy performed by high- and low-volume surgeons. J Reprod Med. 2009;54:425–8.PubMedGoogle Scholar
  13. 13.
    Bhattacharya S, Parkin DE, Reid TM, Abramovich DR, Mollison J, Kitchener HC. A prospective randomised study of the effects of prophylactic antibiotics on the incidence of bacteraemia following hysteroscopic surgery. Eur J Obstet Gynecol Reprod Biol. 1995;63:37–40.CrossRefPubMedGoogle Scholar
  14. 14.
    Hanstede MMF, van der Meij E, Goedemans L, Emanuel MH. Results of centralized Asherman surgery, 2003–2013. Fertil Steril. 2015;104(6):1561–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Broome JD, Vancaillie TG. Fluoroscopically guided hysteroscopic division of adhesions in severe Asherman syndrome. Obstet Gynecol. 1999;93:1041–3.PubMedGoogle Scholar
  16. 16.
    Bellingham R. Intrauterine adhesions: hysteroscopic lysis and adjunctive methods. Aust NZ J Obstet Gynaecol. 1996;36:171–4.CrossRefGoogle Scholar
  17. 17.
    Deans R, Abbott J. Review of intrauterine adhesions. J Minim Invasive Gynecol. 2010;17:555–69.CrossRefPubMedGoogle Scholar
  18. 18.
    Valle RF, Sciarra JJ. Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol. 1988;158:1459–70.CrossRefPubMedGoogle Scholar
  19. 19.
    McComb PF, Wagner BL. Simplified therapy for Asherman syndrome. Fertil Steril. 1997;68:1047–50.CrossRefPubMedGoogle Scholar
  20. 20.
    Capella-Allouc S, Morsad F, Rongieres-Bertrand C, Taylor S, Fernandez H. Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility. Hum Reprod. 1999;14:1230–3.CrossRefPubMedGoogle Scholar
  21. 21.
    Pabuccu R, Atay V, Orhon E, Urman B, Ergun A. Hysteroscopic treatment of intrauterine adhaesions is safe and effective in the restoration of normal menstruation and fertility. Fertil Steril. 1997;68:1141–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Wamsteker K. Intrauterine adhesions (synechiae). Chapter 15. In: Brosens I, Wamsteker K, editors. Diagnostic imagine and endoscopy in gynaecology. London: WB Saunders; 1997. p. 171–84.Google Scholar
  23. 23.
    Jansen FW, Vredevoogd CB, Ulzen van K, JBMZ T, GCM T-K. Complications of hysteroscopy: a prospective multicenter study. Am J Obstet Gynecol. 2000;96:266–70.Google Scholar
  24. 24.
    Hulka JF, Peterson HA, Phillips JM, Surrey MW. Operative hysteroscopy: American Association of Gynecologic Laparoscopists’ 1993 membership survey. J Am Assoc Gynecol Laparosc. 1995;2(2):131.CrossRefPubMedGoogle Scholar
  25. 25.
    Fedele L, Vercellini P, Viezzoli T, Ricciardiello O, Zamberletti D. Intrauterine adhaesions: current diagnostic and therapeutic trends. Acta Eur Fertil. 1986;17:31–7.PubMedGoogle Scholar
  26. 26.
    Pace S, Stentella P, Catania R, Palazzetti PL, Frega A. Endoscopic treatment of intrauterine adhesions. Clin Exp Obstet Gynecol. 2003;30:26–8.PubMedGoogle Scholar
  27. 27.
    Fernandez H, Al Najjar F, Chauvenaud-Lambling A, et al. Fertility after treatment of Asherman's syndrome stage 3 and 4. J Minim Invasive Gynecol. 2006;13:398–402.CrossRefPubMedGoogle Scholar
  28. 28.
    Preutthipan S, Linasmita V. Reproductive outcome following hysteroscopic lysis of intrauterine adhaesions: a result of 65 cases at Ramathibodi Hospital. J Med Assoc Thail. 2000;83:42–6.Google Scholar
  29. 29.
    Zikopoulos KA, Kolibianakis EM, Platteau P, de Munck L, Tournaye H, Devroey P, Camus M. Live delivery rates in subfertile women with Asherman's syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system. Reprod Biomed Online. 2004;8:720–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Yasmin H, Nasir A, Noorani KJ. Hysteroscopic management of Asherman’s syndrome. J Pak Med Assoc. 2007;57:553–5.PubMedGoogle Scholar
  31. 31.
    Thomson AJ, Abbott JA, Kingston A, Lenart M, Vancaillie TG. Fluoroscopically guided synechiolysis for patients with Asherman’s syndrome: menstrual and fertility outcomes. Fertil Steril. 2007;87:405–10.CrossRefPubMedGoogle Scholar
  32. 32.
    Robinson JK, Swedarsky Colimon LB, Isaacson KB. Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman’s syndrome). Fertil Steril. 2008;90:409–14.CrossRefPubMedGoogle Scholar
  33. 33.
    Fernandez H, Peyrelevade S, Legendre G, Faivre E, Deffieux X, Nazac A. Total adhesions treated by hysteroscopy: must we stop at two procedures. Fertil Steril. 2012;98:980–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Westendorp ICD, Ankum WM, Mol BW, Vonk J. Prevalence of Asherman’s syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum Reprod. 1998;13:3347–50.CrossRefPubMedGoogle Scholar
  35. 35.
    Hooker AB, Lemmers M, Thurkow AL, Heymans MW, Opmeer BC, Brölmann 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;20:262–78.CrossRefPubMedGoogle Scholar
  36. 36.
    Nappi C, Di Spiezio Sardo A, Greco E, Guida M, Bettocchi S, Bifulco G. Prevention of adhesions in gynaecological endoscopy. Hum Reprod Update. 2007;13:379–94.CrossRefPubMedGoogle Scholar
  37. 37.
    Emanuel MH, Wamsteker K. The intra uterine morcellator: a new hysteroscopic operating technique to remove intrauterine polyps and myomas. J Minim Invasive Gynecol. 2005;12:62–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Hamerlynck TW, Blikkendaal MD, Schoot BC, Hanstede MM, Jansen FW. An alternative approach for removal of placental remnants: hysteroscopic morcellation. J Minim Invasive Gynecol. 2013;20:796–802.CrossRefPubMedGoogle Scholar
  39. 39.
    San Fillipo J, Fitzgerald D. Asherman’s syndrome: a comparison of therapeutic methods. J Reprod Med. 1982;27:328–30.Google Scholar
  40. 40.
    Lin X, Wei M, Li TC, Huang Q, Huang D, Zhou F, Zhang S. A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study. Eur J Obstet Gynecol Reprod Biol. 2013;170:512–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Lin XN, Zhou F, Wei ML, Yang Y, Li Y, Li TC, Zhang SY. Randomized, controlled trial comparing the efficacy of intrauterine balloon and intrauterine contraceptive device in the prevention of adhesion reformation after hysteroscopic adhesiolysis. Fertil Steril. 2015;104:235–40.CrossRefPubMedGoogle Scholar
  42. 42.
    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.CrossRefPubMedGoogle Scholar
  43. 43.
    Mensitieri M, Ambrosio L, Nicolaris L, Bellini D, O’Reaan M. Viscoelastic properties modulation of a novel auto-cross-linked haluronic acid polymer. J Mater Sci Mater Med. 1996;7:695–8.CrossRefGoogle Scholar
  44. 44.
    Amer MI, Abd-El-Maeboud KH. Amnion graft following hystero- scopic lysis of intrauterine adhesions. J Obstet Gynaecol Res. 2006;32:559–66.CrossRefPubMedGoogle Scholar
  45. 45.
    Wood J, Pena G. Treatment of traumatic uterine synechias. Int J Fertil. 1964;9:405–10.PubMedGoogle Scholar
  46. 46.
    Abbott J, Thomson A, Vancaillie T. SprayGel following surgery for Asherman’s syndrome may improve pregnancy outcome. J Obstet Gynaecol. 2004;24:710–1.CrossRefPubMedGoogle Scholar
  47. 47.
    Cervelló I, Santamaría X, Miyazaki K, Maruyama T, Simón C. Cell therapy and tissue engineering from and toward the uterus. Semin Reprod Med. 2015;33(5):366–72.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Gynaecology and Reproductive MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.University Hospital GhentGhentBelgium
  3. 3.Department of Obstetrics and Gynaecology, Spaarne Gasthuis HoofddorpHoofddorpThe Netherlands

Personalised recommendations