Intrauterine Adhesions

Intrauterine adhesions was first described by Joseph Asherman in 1948. It is commonly referred to as Asherman›s syndrome and intrauterine synechiae that results in infertility. It is characterized by a spectrum ranging from amenorrhea to menstrual disturbance to normal menses.
It is diagnosed by symptoms, medical history, saline infusion hysterography (SIS), hysterosalpingogram (HSG), ultrasound, and magnetic resonance imaging. Hysteroscopy is employed for the final diagnosis and treatment.
Filling defects and distortion of the uterine cavity are the most important features in HSG. The adhesion is usually seen partial, so it allows intrauterine introduction of the contrast material. Occasionally, synechia obliterate the entire endometrial cavity and obstruct the lower uterine segment. The American Fertility Society has divided the intrauterine synechia into three categories: mild, moderate, and severe; according to whether adhesions involve one-fourth, one–half, three-fourths or more, respectively; of the uterine cavity. In the ultrasound examination, endometrium is irregular and hyperechoic bridges might be seen. Mixed pictures are seen. In some parts no endometrium is seen and in other parts normal endometrium is seen. Three-dimensional ultrasound shows a significant reduction of the endometrial cavity. There is no increase in the vascularity on color doppler examination. SIS would be a good choice to diagnose the synechia. In sagittal plane, a trans versed band can be seen that is called bow tie or butterfly wings. MRI is superior to other imaging methods and it could diagnose the etiology of the synechia. It is able to take images above the adhesions that could not be seen using hysteroscopy. In T2-weighted MR, hypointense bands of fibrous tissue are seen.