Intrauterine Adhesion (Synechia, Asherman's Syndrome)

Asherman syndrome is the name given to intrauterine adhesions that cause infertility due to intrauterine damage. The adhesions inside the uterus disrupt the uterine inner membrane, preventing the embryo from settling in the uterus. Among the most common causes are previous intrauterine surgical interventions, of which the most frequent previous abortions are responsible. In addition, infections, intrauterine surgery can cause this disease, making it difficult to conceive.

The most typical complaint is the decrease in menstrual bleeding after abortion or surgery. If the patient complains or is aware of this, it must be evaluated for intrauterine adhesion. Diagnosis of Asherman syndrome can be made by gynecologic ultrasonography, cervical film called HSG, SIS, or hysteroscopy. Adhesions may involve a small portion of the uterus as well as the entire uterus. The entire uterus can adhere and completely closed. 

Treatment is performed by hysteroscopy. First of all, adhesions are detected by entering the uterus with the camera and the adhesions are opened until the inside of the uterus is as normal as possible. In severe adhesions this may not always be possible and the possibility of complications such as uterine perforation increases. Recurrent adhesions may occur after hysteroscopy. In order to prevent this, things like intrauterine device (Spiral), balloon after surgery into the uterus are not very effective on the console. Today, a special Gel is commonly used, although the cost is slightly higher. 

The success of treatment depends entirely on the extent of damage to the uterus. Hysteroscopy will usually suffice if it covers a small portion of the uterus and there is slight adhesion. However, estrogen treatment will be tried after hysteroscopy in cases where the injury is severe and severe, this treatment may last for months and sometimes no results can be obtained. Recently, g-CSF has been used for the healing of the endometrium of the uterine lining, but its efficacy has not yet been established. In addition, stem cell studies are carried out on this subject. In severe Asherman's Syndrome, treatment may not always be pleasing.