Reproductive outcomes after different treatment and secondary prevention options for Asherman syndrome

Abstract

Asherman syndrome is characterized by the appearance of clinical symptoms of pain syndrome, as well as menstrual and reproductive dysfunction, which develop as a result of obliteration of the uterine cavity and/or cervical canal by connective tissue synechiae. It is believed that the leading cause of Asherman syndrome is mechanical damage to the basal layer of the endometrium due to intrauterine interventions performed during pregnancy, the postpartum period, or in the detection of uterine cavity pathologies. They lead to impaired cervico-uterine-tubal sperm transport, fibrotic changes in the endometrium, and resistance to hormonal stimulation.

The primary surgical treatment for Asherman syndrome is hysteroscopic adhesiolysis. It is known that this type of surgical intervention is associated with high risks of synechiae reformation, complicated course of gestation and unsatisfactory reproductive outcomes. For this reason, in the postoperative period, it is advisable to carry out preventive measures aimed at restoring female reproductive function. Most of the currently available methods of secondary prevention have no effect on the pregnancy rate and live birth rate. Low efficacy of the complex therapy creates a need to search for new alternative approaches to the treatment of Asherman syndrome and to develop tactics for postoperative management of patients. Cell therapy with mesenchymal stem cells is of particular interest.

This literature review examines the relationship between various treatment and secondary prevention options for Asherman syndrome and their impact on improving reproductive outcomes.

Keywords

Asherman syndrome / intrauterine adhesion / reproductive outcomes / infertility / secondary prevention / hysteroscopic adhesiolysis / cell therapy

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