Adhesions of the endometrium develop because of a trauma to the uterine lining. This includes a history of cesarean section and the dilation and the curettage often performed during an elective abortion or because of a pregnancy failure. The dilation and the curettage performed for placental fragment retention also increases the risk of Asherman syndrome (synechiae) development. After the procedure, the damaged endometrial surfaces heal into the adhesion. As a result, the patient may experience fertility problems or recurrent pregnancy loss.
Hysterosonography, hysterosonosalpingography and sonohysterography are similar terms describing the saline injection procedure performed with ultrasound guidance.
Lysis (hysteroplasty) of the uterine synechiae (Asherman syndrome) with a hysteroscope allows a direct treatment of the adhesion. A laparoscope, in conjunction with the hysteroscope, may be used for complicated cases to perform adhesiolysis.
Hysterosalpingography has been a gold standard in diagnosing pathology of the uterine cavity and tubes. This procedure occurs using radiographic fluoroscopy and injection of the contrast material through the cervix into the uterus. To prevent radiation exposure to an early pregnancy, this procedure occurs during the first portion (day 7 to 12) of a woman’s cycle. Complications of this procedure include bleeding, infection, and contrast reaction, perforation of the uterus and radiation exposure of an early pregnancy.
During the hysterosalpingogram, a radiographic procedure, synechiae (Asherman syndrome) appear as filling defects within the uterine cavity. These areas display as darker spots than the surrounding contrast material and can be followed to the uterine wall. Care must be taken to differentiate uterine folds, which appear as linear filling defects parallel to the uterine walls from adhesions.
Removal or rupture of the intrauterine adhesions is under direct visualization through a hysteroscope. This procedure takes the form of adhesion rupture, cutting of adhesions with scissors and excision through electrosurgery or a laser.
Significant uterine abnormalities, including synechiae (Asherman syndrome) and inability to develop a thick, supportive uterine lining are the primary indications for gestational surrogacy.