Follow-Up and Relook Hysteroscopy

Intra-uterine adhesions (IUAs) after initial treatment in patients with Asherman’s Syndrome are one of the main challenging issues in the gynecological practice, since its incidence has been increasing over the last few decades, with a reported recurrence rate up to 30%. Asherman syndrome is characterized by variable scarring inside the uterine cavity that can lead to partial or complete dysfunction of the endometrium with impairment of fertility and menstrual pattern (amenorrhea and hypomenorrhea). The advent of hysteroscopy has revolutionized the diagnosis and the management of IUAs and is therefore considered the most valuable tool in diagnosis and management. Nowadays, there is no clear consensus about management and treatment of Asherman Syndrome (AS). The aim of the therapeutic approach is to re-establish a pear-like shaped uterine cavity and therefore its physiological function. Good surgical practice and technique, together with the choice of the type of energy used during the procedure, are considered the “key points” for avoiding the formation of intrauterine scarring. It is also recommended to perform an “early second look” hysteroscopy a few days after surgery to evaluate the normalization of the uterine cavity and to avoid re-occurrence of adhesions thanks to the immediate lysis of any small persistent synechiae. The use of intrauterine anti-adhesive gels is an effective strategy to reduce re-occurrence of adhesions after surgical treatment of AS. Despite advances in hysteroscopic surgery and various methods for prevention of recurrent adhesive disease, AS recurrence rates remain high and new follow up strategies are required