Publications: Etiology, Incidence, Prevention

A selection of publications on Asherman’s syndrome (alternatively called Asherman syndrome, intrauterine adhesions, endometrial adhesions, intrauterine synechiae, formerly traumatic amenorrhea).

Discovery/Characterization of AS
Note: For a historical perspective.

Fritsch, H. Ein Fall von volligem Schwaund der Gebormutterhohle nach
Auskratzung Zentralbl Gynaekol 1894;18:1337-1342.

Asherman, JG. Amenorrhea traumatica (atretica). J Obstet Gynaec Brit Emp

Review articles (expert opinion)

Deans E, Abbot J Review of Intrauterine Adhesions The journal of minimally invasive gynecology 2010:17(5):555-69. Abstract

Thomson AJ, Abbott JA, Deans R, Kingston A, Vancaillie TG. The management of intrauterine synechiae. Curr Opin Obstet Gynecol. 2009 Aug;21(4):335-41. Abstract

Yu, D, Wong, YM, Cheong, Y, Xia, E, and Li, TC. Asherman syndrome--one
century later. Fertil Steril 2008;89(4):759-79. Abstract

Berman JM Intrauterine adhesions. Semin Reprod Med. 2008;26(4):349-355. Abstract

Kodaman, PH and Arici, A. Intra-uterine adhesions and fertility outcome: how to optimize success? Curr Opin Obstet Gynecol 2007;19(3):207-14. Abstract

Fedele, L, Bianchi, S, and Frontino, G. Septums and synechiae: approaches to
surgical correction. Clin Obstet Gynecol 2006;49(4):767-88.

Magos A. Hysteroscopic treatment of Asherman's syndrome. Reprod Biomed Online. 2002;4 Suppl 3:46-51. Abstract  

Al-Inany, H. Intrauterine adhesions. An update. Acta Obstet Gynecol Scand

Darai, E., Deval, B. et al, Synechies uterines. Encycl Med Chir Gynecol, 1996. 155: p. A-30. (in French)

March, CM. Intrauterine adhesions. Obstet Gynecol Clin N Am 1995;22:98-103. Abstract

Chapman, K and Chapman, R. Asherman's syndrome: a review of the literature, and a husband and wife's 20-year world-wide experience. J R Soc Med 1990;83(9):576-80. Free article

Lancet, M and Kessler, I. A review of Asherman's syndrome, and results of modern treatment. Int J Fertil 1988;33(1):14-24.

Fedele, L, Vercellini, P, Viezzoli, T, Ricciardiello, O, and Zamberletti, D. Intrauterine adhesions:current diagnostic and therapeutic trends. Acta Eur Fertil 1986;17:31-7.

Schenker, JG and Margalioth, EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril 1982;37(5):593-610. (Note: Although a detailed and informative review, their statement that preferred treatment of IUA is curretage is outdated and potentially harmful.).

Etiology of AS and studies on incidence rates


Dawood A, Al-Talib A, Tulandi T.Predisposing factors and treatment outcome of different stages of intrauterine adhesions. J Obstet Gynaecol Can. 2010 Aug;32(8):767-70. Abstract

Kuzel D, Horak P, Hrazdirova L, Kubinova K, Sosna O, Mara M."See and treat" hysteroscopy after missed abortion. Minim Invasive Ther Allied Technol. 2010. Abstract
Adriana Salzani; Daniela Angerame Yela; José Roberto Erbolato Gabiatti; Aloísio José Bedone; Ilza Maria Urbano Monteiro. Prevalence of uterine synechia after abortion evacuation curettage 2007 Sao Paulo Med. . vol.125 no.5 Abstract

Abiodun OM, Balogun OR, Fawole AA. Aetiology, clinical features and treatment outcome of intrauterine adhesion in Ilorin, Central Nigeria. West Afr J Med. 2007 Oct-Dec;26(4):298-301. Abstract

Dalton, VK, Saunders, NA, Harris, LH, Williams, JA, and Lebovic, DI. Intrauterine adhesions after manual vacuum aspiration for early pregnancy failure. Fertil Steril 2006;85(6):1823 e1-3.

Beuker JM, Erwich JJ, Khong TY. Is endomyometrial injury during termination of pregnancy or curettage following miscarriage the precursor to placenta accreta? J Clin Pathol. 2005 Mar;58(3):273-5.  Abstract

Westendorp, IC, Ankum, WM, Mol, BW, and Vonk, J. Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum Reprod 1998;13(12):3347-50 Free article:

Schenker, JG. Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol 1996;65(1):109-13.

Romer, T. Post-abortion-hysteroscopy--a method for early diagnosis of congenital and acquired intrauterine causes of abortions. Eur J Obstet Gynecol Reprod Biol 1994;57(3):171-3.

Friedler, S, Margalioth, EJ, Kafka, I, and Yaffe, H. Incidence of post-abortion intrauterine adhesions evaluated by hysteroscopy--a prospective study. Hum Reprod 1993;8(3):442-4.

Golan, A, Schneider, D, Avrech, O, Raziel, A, Bukovsky, I, and Caspi, E. Hysteroscopic findings after missed abortion. Fertil Steril 1992;58(3):508-10.

Adoni, A, Palti, Z, Milwidsky, A, and Dolberg, M. The incidence of intrauterine adhesions following spontaneous abortion. Int J Fertil 1982;27(2):117-8.

Taylor, PJ, Cumming, DC, and Hill, PJ. Significance of intrauterine adhesions detected hysteroscopically in eumenorrheic infertile women and role of antecedent curettage in their formation. Am J Obstet Gynecol 1981;139(3):239-42.

Rochet, Y, Dargent, D, Bremond, A, Priou, G, and Rudigoz, RC. [The obstetrical future of women who have been operated on for uterine synechiae. 107 cases operated on (author's transl)]. J Gynecol Obstet Biol Reprod (Paris) 1979;8(8):723-6.

Jensen, PA and Stromme, WB. Amenorrhea secondary to puerperal curettage (Asherman's syndrome). Am J Obstet Gynecol 1972;113(2):150-7.

Eriksen, J and Kaestel, C. The incidence of uterine atresia after post-partum curettage. A follow-up examination of 141 patients. Dan Med Bull 1960;7:50-1.

Other intrauterine surgery
Taskin, O, Sadik, S, Onoglu, A, Gokdeniz, R, Erturan, E, Burak, F et al. Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am Assoc Gynecol Laparosc 2000;7(3):351-4.

Leung, PL, Tam, WH, and Yuen, PM. Hysteroscopic appearance of the endometrial cavity following thermal balloon endometrial ablation. Fertil Steril 2003;79(5):1226-8.

Davies, C, Gibson, M, Holt, EM, and Torrie, EP. Amenorrhoea secondary to endometrial ablation and Asherman's syndrome following uterine artery embolization. Clin Radiol 2002;57(4):317-8.

Roman, H, Sentilhes, L, Cingotti, M, Verspyck, E, and Marpeau, L. Uterine devascularization and subsequent major intrauterine synechiae and ovarian failure. Fertil Steril 2005;83(3):755-7.

Goojha CA, Case A, Pierson R. Development of Asherman syndrome after conservative surgical management of intractable postpartum hemorrhage. Fertil Steril. 2010;94(3):1098. Abstract


Netter, AP, Musset, R, Lambert, A, and Salomon, Y. Traumatic uterine synechiae: a common cause of menstrual insufficiency, sterility, and abortion. Am J Obstet Gynecol 1956;71(2):368-75.

Sharma, JB, Roy, KK, Pushparaj, M, Gupta, N, Jain, SK, Malhotra, N et al. Genital tuberculosis: an important cause of Asherman's syndrome in India. Arch Gynecol Obstet 2008;277(1):37-41.

Bukulmez, O, Yarali, H, and Gurgan, T. Total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopic synechialysis.Hum Reprod 1999;14(8):1960-1.

Krolikowski, A, Janowski, K, and Larsen, JV. Asherman syndrome caused by schistosomiasis. Obstet Gynecol 1995;85(5 Pt 2):898-9.

Polishuk, WZ, Anteby, SO, and Weinstein, D. Puerperal endometritis and intrauterine adhesions. Int Surg 1975;60(8):418-20.

Rabau, E. and A. David, Intrauterine Adhesions: Etiology, Prevention, and Treatment. Obstet Gynecol, 1963. 22: p. 626-9. (Note: this article is the basis for the theory that subclinical infections can lead to AS yet note that it shows NO data to support its conclusions. Incredibly it has been cited by 15 publications).

Prevalence of AS in women with infertility or recurrent miscarriage

El-Mazny A, Abou-Salem N, El-Sherbiny W, Saber W. Outpatient hysteroscopy: a routine investigation before assisted reproductive techniques? Fertil Steril. 2010 Abstract

Dendrinos, S, Grigoriou, O, Sakkas, EG, Makrakis, E, and Creatsas, G. Hysteroscopy in the evaluation of habitual abortions. Eur J Contracept Reprod Health Care 2008;13(2):198-200. Abstract

Ventolini, G, Zhang, M, and Gruber, J. Hysteroscopy in the evaluation of patients with recurrent pregnancy loss: a cohort study in a primary care population. Surg Endosc 2004;18(12):1782-4. Abstract

Hinkely, M and Milki, A. 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. JSLS 2004;8:103-7. Abstract  Free article

La Sala, GB, Montanari, R, Dessanti, L, Cigarini, C, and Sartori, F. The role of diagnostic hysteroscopy and endometrial biopsy in assisted reproductive technologies. Fertil Steril 1998;70(2):378-80. Abstract

Dicker, D, Ashkenazi, J, Dekel, A, Orvieto, R, Feldberg, D, Yeshaya, A et al. The value of hysteroscopic evaluation in patients with preclinical in-vitro fertilization abortions. Hum Reprod 1996;11(4):730-1. Abstract  Free article

Raziel, A, Arieli, S, Bukovsky, I, Caspi, E, and Golan, A. Investigation of the uterine cavity in recurrent aborters. Fertil Steril 1994;62(5):1080-2. Abstract

Prevention of AS (D&C alternatives etc.)

 Note: Although there are hundreds of studies on misoprostol efficacy, it is both remarkable and unfortunate that there is only ONE comparative study on the incidence of Asherman’s syndrome after misoprostol versus D&C . Misoprostol is non-invasive and has an inherently lower potential to cause endometrial injury. The lack of interest in this area is undoubtedly due to ignorance about the prevalence and etiology of AS.

Tam, WH, Lau, WC, Cheung, LP, Yuen, PM, and Chung, TK. Intrauterine adhesions after conservative and surgical management of spontaneous abortion. JAm Assoc Gynecol Laparosc 2002;9(2):182-5. Abstract

Li YT, Yin CS, Chen FM. Rectal administration of misoprostol for the management of retained placenta- a preliminary report. Chinese Medical Journal (Taipei) 2001;64:721-4. Abstract


Tsapanos, VS, Stathopoulou, LP, Papathanassopoulou, VS, and Tzingounis, VA. The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial synechiae. J Biomed Mater Res 2002;63(1):10-4. Abstract


Nicopoullos JDM, Treharne A, Raza A and Richardson R. The use of a hysteroscopic resectoscope for repeat evacuation of retained products of conception procedures: a case series. Gynecological Surgery. 2010; 7(2):163-6. Abstract

M.H. Emanuel, F.W. Jansen and D. Schoot The Hysteroscopic Morcellator, an Effective Technique for the Removal of Residual Trophoblastic Tissue Journal of Minimally Invasive Gynecology Volume 16, Issue 6, Supplement 1, 2009, Page S85.

Faivre E, Deffieux X, Mrazguia C, Gervaise A, Chauveaud-Lambling A, Frydman R, Fernandez H. Hysteroscopic management of residual trophoblastic tissue and reproductive outcome: a pilot study. J Minim Invasive Gynecol. 2009 Jul-Aug;16(4):487-90. Abstract

T. Dankert & M. Vleugels. Hysteroscopic resection of retained placental tissue:a feasibility study Gynecol Surg . 2008; 5:121–124. Free article  

F. Leone, T. Bignardi, C. Marciante, E. Bertazzoli, P. Mustoni, E. Ferrazzi and L. DSC 74: Hysteroscopy for Selective Removal of Residual Trophoblastic Tissue. Journal of Minimally Invasive Gynecology 2005;12(5), Supplement 1: 30-1.

Cohen SB, Kalter-Ferber A, Weisz BS, Zalel Y, Seidman DS, Mashiach S, Lidor AL, Zolti M and Goldenberg M. Hysteroscopy May Be the Method of Choice for Management of Residual Trophoblastic Tissue. The Journal of the American Association of Gynecologic Laparoscopists 2001;
8(2):199-202. Abstract

Goldenberg, M, Schiff E, Achiron, R. Lipitz, S. Mashiach, S. Managing residual trophoblastic tissue. Hysteroscopy for directing curettage. J Reprod Med. 1997;42(1)26-8. Abstract

Ultrasound guidance during curettage

Wolman I, Altman E, Fait G, Har-Toov J, Gull I, Amster R, Jaffa A. Evacuating retained products of conception in the setting of an ultrasound unit. Fertility and Sterility, 2009 91(4), Supplement 1:1586-1588. Abstract

Mitwally MF, Albuarki H, Diamond MP, Abuzeid M, Fakih MM. Gestational sac aspiration: a novel alternative to dilation and evacuation for management of early pregnancy failure. J Minim Invasive Gynecol. 2006;13(4):296-301. Abstract

Fait G, Amster R, Tugendreich D, Dreval D, David A, Wolman I. Use of ultrasonography to guide first-trimester pregnancy terminations obviates the need for sharp curettage 2002 78(5):1131-2. Abstract

Accurate diagnosis of RPOC/reducing unnecessary D&C

Wolman I, Altman E, Faith G, Har-toov J, Amster R, Gull I, Jaffa AJ. Combined clinical and ultrasonographic work-up for the diagnosis of retained products of conception Fertility and Sterility, Volume 92, Issue 3, 2009, Pages 1162-1164. Abstract

Pather, S, Ford, M, Reid, R, and Sykes, P. Postpartum curettage: an audit of 200 cases. Aust N Z J Obstet Gynaecol 2005;45(5):368-71. Abstract

Maslovitz, S, Almog, B, Mimouni, GS, Jaffa, A, Lessing, JB, and Many, A. Accuracy of diagnosis of retained products of conception after dilation and evacuation. J Ultrasound Med 2004;23(6):749-56. Abstract

Sadan, O, Golan, A, Girtler, O, Lurie, S, Abraham, D, Sagiv, R et al. Role of sonography in the diagnosis of retained products of conception J Ultrasound Med 2004;23(3):371-4.  Abstract

Wolman I, Gordon D, Yaron Y, Kupferminc M, Lessing JB, Jaffa AJ. Transvaginal sonohysterography for the evaluation and treatment of retained products of conception. Gynecol Obstet Invest 2000;50:73-6. Abstract

Ballagh, SA, Harris, HA, and Demasio, K. Is curettage needed for uncomplicated incomplete spontaneous abortion? Am J Obstet Gynecol 1998;179(5):1279-82. Abstract

Alcazar JL. Transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler to detect residual trophoblastic tissue. Ultrasound Obstet Gynecol 1998; 11:54-8. Abstract

Achiron R, Goldenberg M, Lipitz S, Mashiach S. Transvaginal duplex Doppler ultrasonography in bleeding patients suspected of having residual trophoblastic tissue. Obstet Gynecol1993;81:507-11. Abstract