Etiology of and therapeutic approach to synechia uteri

The universal incidence of synechia uteri (Asherman's syndrome) is steadily increasing. The main offender in the etiology of this disorder is trauma to a pregnant uterus, especially after curettage in puerperium or after missed abortion, whereas the role of infection in traumatic intrauterine adhesions should be viewed with caution. Genital tuberculosis is one of the main etiological factors of this condition. The syndrome is expressed by infertility (43%) and menstrual disorders (62%). Pregnancy, when achieved, may be complicated by premature labor, placenta previa and placenta accreta. The diagnosis is made by hystersalpingography, and mainly by hysteroscopy. Preferred treatment is lysis of adhesions by hysteroscopy, followed by immediate insertion of an intrauterine device, combined with a course of estrogens. The success of treatment regarding term deliveries and rate of abortions depends on the severity of the adhesions. We carried out studies regarding regeneration of the endometrium, and intended to induce intrauterine adhesions as a method of treatment in cases of severe uterine bleeding and as a method of contraception.