It has been more than a century since Heinrich Fritsch (1) firstdescribed a case of posttraumatic intrauterine adhesion. In1927, Bass (2) reported 20 cases of cervical obstruction ina series of 1500 patients who had undergone induced abor-tions. In 1946, Stamer (3) reviewed 37 cases reported in theliterature and added 24 cases of his own with intrauterineadhesions associated with gravid uterus. In 1948, Joseph G.Asherman published a series of papers (47) to describe thefrequency, etiology, symptoms, and roentgenologic pictureof this condition, and Asherman syndrome has been used todescribe the disease ever since. There have been an increas-ing number of cases of this syndrome described worldwide.The focus of research in the initial 50 to 60 years has beenon the prevalence, etiology, and the pathology of this disease.As the understanding of this condition improves, togetherwith the advent of endoscopic technology, the focus of re-search has now been shifted more toward diagnosis, treat-ment, and reproductive outcomes. This review provides an

update on the current knowledge of the etiology, pathology,symptomatology, diagnosis, treatment, and reproductiveoutcomes of Asherman syndrome.

DEFINITION

From Ashermans original definition, the syndrome wasa consequence of trauma to the endometrium, producing par-tial or complete obliteration in the uterine cavity and/or thecervical canal, resulting in conditions such as menstrual ab-normalities, infertility, and recurrent pregnancy loss.

Although the original description of Asherman syndromewas primarily based on a series of cases of intrauterine adhe-sions produced after curettage of the gravid uterus, it is nowunderstood that there are several possible underlying causesof intrauterine adhesions. Consequently, the term Ashermansyndrome should not be confined to only cases followingcurettage of the gravid uterus (see the section on etiology).

The term syndrome in Greek refers to concurrence ofsymptoms, a group of symptoms that collectively indicateor characterize a disease. In this respect, the diagnosis ofAsherman syndrome should be made only in women withclinical symptoms. There are cases in whom the formationof intrauterine adhesions is not associated with any clinicalsymptoms. In these cases, one should avoid using the termAsherman syndrome because there are no symptoms at

Received February 7, 2008; revised and accepted February 7, 2008.

D.Y. has nothing to disclose. Y-M.W. has nothing to disclose. Y.C. has

nothing to disclose. E.X. has nothing to disclose. T-C.L. has nothing

to disclose.

Reprint requests: Dan Yu, M.Med., Hysteroscopic Center, Fu Xing

Hospital, Capital Medical University, Beijing, 100038, Peoples Republic

of China (FAX: 0086-10-63486922; E-mail: yudanny2006@yahoo.

com.cn).

0015-0282/08/$34.00 Fertility and Sterility Vol. 89, No. 4, April 2008 759doi:10.1016/j.fertnstert.2008.02.096 Copyright 2008 American Society for Reproductive Medicine, Published by Elsevier Inc.Asherman syndromeone cDan Yu, M.Med.,a,b Yat-May Wong, MRCOG,c YingTin-Chiu Li, M.D., Ph.D.b

a Hysteroscopic Center, Fu Xing Hospital, Capital Medical Uni

Obstetrics and Gynecology, Jessop Wing, Royal Hallamshire

Kular Lumpar, Malaysia

Objective: To provide an update on the current knowledgDesign: Literature review.Setting: The worldwide reports of this disease.Patient(s): Patients with Asherman syndrome who preserecurrent pregnancy loss.Intervention(s): Hysteroscopy and hysteroscopic surgeryrespectively for this condition.Main Outcome Measure(s): The etiology, pathology, syoutcomes were analyzed.Result(s): This syndrome occurs mainly as a result of tramation of intrauterine and/or intracervical adhesions. Despof moderate to severe Asherman syndrome still presentremains high risk with complications including spontaneoution, placenta accrete or praevia, or even uterine rupture.Conclusion(s): The management of moderate to severe didisease remains poor. Close antenatal surveillance and mtreatment. (Fertil Steril 2008;89:75979. 2008 by Am

Key Words: Intrauterine adhesion, Asherman syndrome, hscopy, amenorrheaentury laterCheong, M.D.,b Enlan Xia, M.B.B.S.,a and

versity, Beijing, Peoples Republic of China; b Department of

Hospital, Sheffield, United Kingdom; and c Private Practice,

e of Asherman syndrome.

nted with amenorrhea or hypomenorrhea, infertility, or

have been the gold standard of diagnosis and treatment

mptomatology, diagnosis, treatment, and reproductive

uma to the gravid uterine cavity, which leads to the for-ite the advances in hysteroscopic surgery, the treatment

s a challenge. Furthermore, pregnancy after treatments abortion, preterm delivery, intrauterine growth restric-

sease still poses a challenge, and the prognosis of severeonitoring are necessary for women who conceive aftererican Society for Reproductive Medicine.)

ysteroscopic adhesiolysis, infertility, synechia, hystero-