Fluoroscopy in the treatment of severe Asherman syndrome

Asherman syndrome is an acquired condition with both subjective symptoms and objective findings. Most cases occur after intrauterine instrumentation shortly after pregnancy. The syndrome may be associated with subfertility, infertility, recurring miscarriage and obstetric complications. The main clinical symptoms are hypomenorrhea or amenorrhea and cyclic pelvic pain. The presence of intrauterine adhesions is crucial for the diagnosis Asherman syndrome. The treatment of Asherman syndrome is hysteroscopic adhesiolysis attempting to improve fertility and obstetric outcome. The procedure may in severe cases be challenging and need guidance in different techniques, e.g. intraoperative fluoroscopy, transabdominal ultrasonography or laparoscopy. In this review, we explore the evidence of benefits and potential risks of the intraoperative fluoroscopic guidance in hysteroscopic adhesiolysis. Embase and Medline were searched from 1974 to February 2026. We found 617 papers in the literature search. Duplicates, conference abstracts and irrelevant papers were excluded. As a result, 26 papers from the search were included in this review. After fluoroscopically guided hysteroscopic adhesiolysis there is high success rate of restoring uterine anatomy and improving menstrual pattern. Reproductive outcomes vary with reported pregnancy rates from 75-87% and live birth rates from 63-68%. Pregnancies after hysteroscopic adhesiolysis are associated with an increased risk of placenta accreta spectrum. Radiation exposure associated with fluoroscopy was found to be minimal, with median exposure times and dose levels well within safe limits.