Hystroscopic management of Ashermans syndrome

To confirm the diagnosis of Asherman's syndrome in patients with scanty menses/amenorrhoea or infertility and to assess the effectiveness of hysteroscopy in the treatment of Asherman's syndrome.

A hospital based descriptive study conducted on 20 patients presenting with amenorrhoea, oligomenorrhoea, or infertility from Jan 2004 to June 2005. They were selected after excluding hormonal imbalances, premature ovarian failure and congenital uterine abnormalities. All patients underwent diagnostic hysteroscopy and resection of adhesions. Specimens were sent for Histopathology and bacterial culture.

A total of 20 patients were included in this study, the median age was 26 years, 65% had presented with scanty menses with secondary infertility, 20% with secondary ammenorrhoea, and 15% with primary infertility alone. Hysteroscopic findings showed thick fibrous adhesions in 45% patients, 40% had flimsy adhesions and 15% had muscular adhesions. It was seen that 65% had adhesions in the body of uterus, 25% at the site of internal os and 1% had adhesions in the cervical canal as well as the body of the uterus. Normal menstrual cycle was resumed in 95% patients, whereas two patients conceived and were followed to term. Dense fibrous tissue with few patches of calcification and no signs of secretory or proliferative cells was found in 35% patients. In 45% endometrium showed proliferative changes and collagen fibers. Only 1 patient had a positive AFB culture and the histopathology showed few graulomas with epitheloid cells most of the tissue replaced by necrotic tissue with patchy areas of caseation.

Hysteroscopy is an effective procedure for not only diagnosing Ashermans Syndrome, but is equally effective for treating it..