A new study of intrauterine synechiae

This study is based on a series of 37 hysteroscopies performed in the knee-chest on patients undergoing culdoscopy as part of an infertility work-up. Local anesthesia was used for the two procedures. All the patients had a thorough infertility work-up that was completely negative. Ruled-out by hysterogram prior to the procedure were congenital abnormalities of the uterus, endometrial polyps, and submucous myomas. There were several different types of endometrial scars in nine patients and this was the only intrauterine pathology discovered. They were intrauterine synechiae typical of the Asherman's syndrome in four cases, cesarean section scars in two, adhesions due to an infected IUD in two, and in one patient there were vertical linear scars secondary to an endometrial biopsy. In this study, the hysterogram was particularly accurate in predicting major endometrial abnormalities, but specific evidence as to the type of minor intrauterine pathology had to be obtained with a hysteroscope. The firmer adhesions that were not of the Asherman's type were difficult to remove and could not be broken up with a hysteroscope. The types of scar visualized are described in some detail. Intrauterine synechiae probably derive ultimately from any type of trauma to a decidual or predecidual endometrium and need not be pregnancy related.