Hysteroscopy Can Treatment Asherman's Syndrome Infertility: Specialists

New Delhi, March 19:  Hysteroscopic -- a minimally-invasive surgery -- is the best medical procedure to treat Asherman's Syndrome, an acquired uterine condition which causes miscarriages or interferes in conception, said doctors on Saturday.

According to the doctors, hysteroscopy becomes important because if it is delayed, women with Asherman's Syndrome may develop uterine cancer, either before or after menopause. 

Whether Asherman's Syndrome is scarring or synechiae is characterised by the formation of adhesions (scar tissues) inside the uterus and/or the cervix. In many cases, the front and back walls of the uterus stick to one another.

The extent of the adhesions defines whether the case is mild, moderate, or severe. The adhesions can be thin or thick, spotty in location, or confluent. They are usually not vascular, which is an important attribute that helps in treatment.

In hysteroscopy, the surgeon inserts a tiny telescope (hysteroscope) through the cervix into the uterus. 

"During hysteroscope, surgeon can easily visualise interiors of the uterine cavity on a video monitor. Then they inspect the uterine cavity for any abnormality and then examine the shape of the uterus, the lining of the uterus and looks for any evidence of intrauterine pathology.

"The surgeon also attempts to visualise the openings to the fallopian tubes (tubal ostia)," said Arvind Vaid, an IVF expert from city-based Indira IVF Hospital.

Doctors said that hysteroscopy are of two types -- diagnostic hysteroscopy and Operative hysteroscopy.

"Diagnostic hysteroscopy is used to diagnose problems of the uterus. Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy," said Vaid.

According to the health experts, if an abnormal condition is detected during the diagnostic hysteroscopy, an operative hysteroscopy can often be performed at the same time, avoiding the need for a second surgery. 

"During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope," said Sakshi Tyagi, a senior resident doctor associated with the Gynaecology department at Ram Manohar Lohia Hospital.

"Compared with other more invasive procedures, hysteroscopy has a lot more advantages as recovery time is short and a shorter hospital stay is required. Post operative recovery and pain is less," said Tyagi.

The doctors said that during the hysteroscopy, direct visualisation of the uterus through hysteroscopy is the most reliable method for diagnosis.

Stating that there is a lack of awareness on adhesions syndrome leading to increase in cases, Manjula B.C., an Bengaluru based IVF specialist said: "Adhesions have a tendency to reform, especially into more severe cases."

"There are different methods to prevent re-scarring after surgery for Asherman´s Syndrome. Prescription of estrogen supplementation to stimulate uterine healing and placement of a splint or balloon to prevent apposition of the walls during the immediate post-operative healing phase. By this, the uterus/cervix remains scar-free and fertility is restored," said Manjula.