Cervical isthmic adhesions and the endometrium: hysteroscopic study (suggestion for an endometrial inhibiting factor)

Our experience is based on 212 cases of uterine synechiae, 127 of which were located exclusively in the cervical isthmic area, while the entire cavity was free from adhesions. Notwithstanding this, many patients failed to achieve pregnancy until the scar was removed; likewise menstrual flow was improved after hysteroscopic removal of cervical adhesions. Is it possible to hypothesize an isthmic-endometrial reflex suppressing the endometrial response to the hormonal stimuli? In 76 of 127 observations (= 59.8%) the endometrium of otherwise normal cavity failed to be synchronous with the phase, showing the characteristic hysteroscopic patterns of hypo-atrophic or proliferative mucosa. The menstrual changes and pregnancies after adhesiolysis are reported, suggesting the possible explanation for such a phenomenon, pointing out the preliminary significance of our work, and the importance of further microscopic and ultrastructural studies.