Asherman Syndrome: Current Understanding and Future Perspectives in Management

Key Content Asherman syndrome (AS) is defined by the presence of intrauterine adhesions (IUA) causing significant reproductive and menstrual dysfunction. AS is overwhelmingly iatrogenic, most commonly resulting from uterine surgery. The mainstay of treatment for AS is hysteroscopic adhesiolysis combined with secondary preventive strategies. A history of AS significantly increases the risk of adverse obstetric and neonatal outcomes. Learning Objectives To understand the pathophysiology of AS and its impact on reproductive potential. To review the current treatment strategies and interventions used to mitigate the high recurrence rate of IUA. To highlight the increased risk of obstetric and neonatal complications in women with AS. Ethical Issues Consent prior to uterine surgery, particularly surgical evacuation procedures where the risk is highest, should include a discussion of IUA/AS and the potential impact on future fertility. A low threshold for investigation and referral should be considered for women with subfertility and previous uterine surgery to reduce physical and psychological morbidity associated with diagnostic delay.