Abstract
Intrauterine adhesions (IUA) can occur after mechanical or infectious injury to the
endometrium. Normal endometrial repair occurs without scar formation; however, in
some women, these normal repair mechanisms are aberrant, resulting in IUA formation.
The exact alteration in repair mechanisms is not well understood; however, it likely
involves hypoxia, reduced neovascularization, and altered expression of adhesion-associated
cytokines. The prevalence of IUA varies by the type of injury and ranges from 16 to
24% in women undergoing pregnancy-related curettage and 31 to 45% after hysteroscopic
myomectomy. The presence of IUA may result in infertility and/or pregnancy complications;
thus, hysteroscopic adhesiolysis is typically recommended before conception. Sharp
dissection rather than cautery to resect adhesions and postoperative treatment with
an IUA barrier and estrogen may decrease the likelihood of recurrence. Menstrual history
before hysteroscopic repair and endometrial thickness after surgical repair may be
useful in assessing endometrial receptivity and the likelihood of conception.
Keywords
intrauterine adhesion - Asherman syndrome - hysteroscopy - endometrial receptivity
