Asherman's syndrome is the formation of scar tissue (adhesions) inside the uterine cavity, usually after a D&C procedure, uterine infection, or multiple hysteroscopies. It causes absent or very light periods and infertility. Treatment is hysteroscopic adhesiolysis — surgical removal of adhesions through the cervix. At Mother Hospitals, Boduppal, we treat Asherman's syndrome with hysteroscopic surgery and post-operative hormonal support. Call 97059 93366.
Uterine scarring blocking your path to pregnancy? Hysteroscopic adhesiolysis at Mother Hospitals, Boduppal restores your uterine cavity and gives your fertility the best possible chance — with post-operative hormonal support and IVF expertise when needed.
MBBS, DGO, PG Diploma in ART – Kiel University, Germany | 20+ Years Experience | TGMC Reg: 50624
Asherman's syndrome (also called intrauterine adhesions or uterine synechiae) is the development of scar tissue inside the uterine cavity. This scar tissue can partially or completely obliterate the cavity, causing the walls to stick together where they should remain open.
When the inner lining of the uterus (endometrium) is damaged, the healing process can produce fibrous scar tissue rather than normal regenerating endometrium. This scar tissue forms bridges — called adhesions or synechiae — between the front and back walls of the uterine cavity. Depending on the extent, these adhesions can be thin and filmy, or thick and fibrous.
The endometrium has a remarkable regenerative capacity under normal conditions. Asherman's syndrome occurs when that repair process goes wrong — usually after trauma, infection, or repeated instrumentation of the cavity.
The American Fertility Society (AFS) classification grades Asherman's syndrome by extent of cavity involvement:
Any woman who has had uterine instrumentation is potentially at risk. The highest-risk groups are women who underwent D&C after a missed miscarriage, women with post-partum haemorrhage requiring curettage, and women who have had multiple hysteroscopic procedures. Uterine tuberculosis (TB) is an important additional cause, particularly relevant in India.
Asherman's syndrome almost always results from injury to the endometrium combined with a healing response that produces scar tissue instead of normal lining.
The most common cause. Dilation and curettage (D&C) performed during pregnancy or post-partum carries higher adhesion risk than D&C in a non-pregnant uterus. The gravid uterus is more vulnerable because the endometrium is in an active, vascular state and curettage more easily reaches the basalis layer — the stem-cell layer responsible for regeneration.
Myomectomy, polypectomy, or septal resection through hysteroscopy can result in adhesions — particularly when surgery involves opposing walls of the uterus simultaneously. Repeated hysteroscopic procedures increase the cumulative risk.
A significant cause in India. Mycobacterium tuberculosis can infect the endometrium, causing granulomatous inflammation and extensive scarring. TB-related Asherman's is often severe (Grade III–IV) and can be difficult to treat, as the underlying infection must be eradicated before adhesiolysis is attempted.
Post-partum or post-abortion infection can damage the endometrium. Chronic endometritis — even without obvious symptoms — is increasingly recognised as a contributor to both adhesion formation and implantation failure in IVF.
Multiple embryo transfer procedures, particularly with difficult cannulation, can rarely cause minor endometrial trauma. More commonly, repeated IVF failures prompt diagnostic hysteroscopy, during which adhesions are discovered that may have pre-dated IVF or formed after a previously undetected event.
Radiotherapy for gynaecological or pelvic malignancy can damage the endometrium and uterine vasculature, leading to radiation-induced adhesions. This is less common but important to recognise as a distinct entity with a different prognosis.
Symptoms vary considerably with the extent of adhesions. Mild adhesions may be entirely asymptomatic and discovered incidentally. Severe adhesions cause dramatic changes to the menstrual cycle.
When adhesions completely obliterate the uterine cavity, menstrual blood cannot flow out. The woman may experience monthly cyclical pelvic pain — as the uterus attempts to shed the lining — but no actual bleeding. This is called cryptomenorrhoea and is a classic presentation of severe Asherman's syndrome.
Partial adhesions reduce the functional endometrial surface area, resulting in scanty periods. A woman who previously had a normal cycle noticing that periods have become much lighter after a D&C or uterine surgery should be evaluated for adhesions.
Even without visible bleeding, the uterus continues to respond to hormonal changes. When outflow is obstructed by adhesions, this creates internal pressure and cramping pain that follows the menstrual cycle pattern but without external bleeding.
Intrauterine adhesions distort the uterine cavity and impair blood supply to the endometrium. Embryos that implant in scarred areas receive inadequate nutrition. Partial adhesions are a recognised cause of recurrent pregnancy loss even when periods appear relatively normal.
Adhesions prevent sperm from reaching the egg, block embryo implantation, and reduce the functional endometrial lining available for implantation. Many women present for infertility evaluation and are found to have unsuspected intrauterine adhesions as the primary or contributing factor.
Women with recurrent IVF implantation failure despite good-quality embryos should always be investigated for intrauterine adhesions. Even partial adhesions that do not cause obvious menstrual changes can dramatically impair the endometrial receptivity required for successful embryo implantation.
Accurate diagnosis is essential — both to confirm the presence of adhesions and to grade their severity, which determines the surgical approach and expected outcomes.
Diagnostic hysteroscopy allows direct visualisation of the uterine cavity. The surgeon can see the adhesions directly — their location, extent, and consistency (filmy vs. fibrous). Hysteroscopy is the only investigation that simultaneously diagnoses and treats intrauterine adhesions. It is performed as a day procedure under light anaesthesia or sedation.
Sterile saline is instilled into the uterine cavity while performing a transvaginal ultrasound. The fluid distends the cavity and makes adhesions visible as echogenic (bright) bands crossing the cavity. SIS is a useful, minimally invasive screening test — less invasive than hysteroscopy but cannot provide the detail needed for surgical planning.
Magnetic resonance imaging provides excellent soft-tissue detail and can demonstrate the extent of uterine cavity obliteration, endometrial thickness, and uterine wall integrity. MRI is particularly useful in severe Asherman's syndrome (Grade III–IV) where hysteroscopy may be difficult to perform safely without prior imaging guidance.
HSG (X-ray with contrast dye through the uterus and tubes) can show filling defects in the uterine cavity that may represent adhesions. However, HSG has lower sensitivity than hysteroscopy and cannot distinguish adhesions from polyps, fibroids, or air bubbles. It remains a useful initial investigation, especially when combined with tubal assessment.
In India, where genital tuberculosis is prevalent, endometrial biopsy for histology and TB PCR/culture is important when Asherman's syndrome is suspected. Treating underlying TB before adhesiolysis is essential — performing surgery on an active TB uterus will result in recurrence of adhesions.
Three-dimensional transvaginal ultrasound can give a coronal view of the uterine cavity — improving the detection of adhesions, especially in the cornual regions. It is increasingly used as a non-invasive pre-operative assessment tool before proceeding to hysteroscopy.
Hysteroscopic adhesiolysis is the surgical removal of intrauterine adhesions using a hysteroscope passed through the cervix — without any abdominal incision. It is the definitive treatment for Asherman's syndrome.
Under general anaesthesia or spinal anaesthesia, a hysteroscope (a thin telescope with a light and camera) is passed through the cervix into the uterine cavity. The cavity is distended with fluid to allow visualisation. Adhesions are then cut using microscissors, resectoscope, or laser — working carefully to preserve normal endometrium. Simultaneous laparoscopy is sometimes performed in severe cases to guide the hysteroscope and reduce the risk of uterine perforation.
The procedure typically takes 30–60 minutes depending on the extent of adhesions. The patient is usually discharged on the same day or the following morning.
After adhesiolysis, the uterine cavity must be supported to allow normal endometrium to regenerate rather than re-forming scar tissue. This is achieved with high-dose oestrogen therapy for 6–8 weeks post-operatively. Oestrogen stimulates endometrial proliferation and recovery. Progestogen is added at the end of the oestrogen course to induce a withdrawal bleed, confirming the cavity is patent.
The regrowth of a healthy endometrial lining after adhesiolysis is the key to successful fertility outcomes. Endometrial thickness of at least 7mm is generally required before attempting conception or embryo transfer.
Re-adhesion after adhesiolysis is a significant challenge — particularly in Grade III–IV disease. Several strategies are used:
Grade I adhesions are often resolved in a single procedure. Grade II–III adhesions may require 2–3 hysteroscopic procedures with hormonal support between each. Grade IV (complete obliteration) is the most challenging — multiple procedures may be required, and complete restoration of a normal cavity is not always achievable. Realistic counselling about expected outcomes is essential.
Pregnancy outcomes after adhesiolysis depend on the grade of adhesions, the success of surgical restoration, the post-operative endometrial recovery, and the patient's underlying fertility factors.
For women with Grade I–II adhesions, successful adhesiolysis restores menstrual flow and uterine cavity anatomy, allowing natural conception. Published pregnancy rates after adhesiolysis for mild-to-moderate disease range from 50–80%. Women are typically advised to wait for 2–3 normal menstrual cycles after completing post-operative hormonal therapy before attempting natural conception, allowing the endometrium time to fully regenerate.
IVF is recommended when:
IVF with a frozen embryo transfer (FET) in a medicated cycle gives the best chance in Asherman's patients — because the endometrial preparation can be closely monitored and the transfer timed to optimal receptivity. The ERA test (Endometrial Receptivity Analysis) may be used to identify the precise implantation window in patients with a history of implantation failure.
| Grade | Pregnancy Rate Post-Adhesiolysis | Live Birth Rate |
|---|---|---|
| Grade I (Mild) | 70–80% | 60–70% |
| Grade II (Moderate) | 50–65% | 40–55% |
| Grade III (Moderate–Severe) | 30–50% | 25–40% |
| Grade IV (Severe) | 15–30% | 10–25% |
Rates are approximate and vary by age, endometrial recovery, and presence of other fertility factors. TB-related adhesions generally have lower restoration rates.
The cost of hysteroscopic adhesiolysis in Hyderabad varies based on the grade of adhesions, whether a second-look hysteroscopy is required, and the extent of post-operative hormonal support needed.
Initial assessment and grading of adhesions. Includes consultation, anaesthesia, procedure, and recovery. Day procedure — no overnight stay usually required.
Contact us for current pricing
Therapeutic hysteroscopic adhesiolysis with resectoscope or scissors. Includes anaesthesia, operating suite, instruments, and post-operative care. Grade I–II cases often resolved in a single session.
Contact us for personalised estimate
Follow-up hysteroscopy 6–8 weeks after initial treatment to check for re-adhesion and perform early intervention if needed. Often required for Grade II–IV disease.
Separate procedure with its own pricing
For patients requiring both adhesiolysis and IVF after recovery, we offer combined treatment planning. IVF is initiated once endometrial thickness and cavity morphology are confirmed as satisfactory.
Call 97059 93366 for package details
Some health insurance policies cover hysteroscopic surgery as an operative procedure. Please check your policy terms. Our team can provide necessary documentation for insurance claims.
Experience and expertise matter enormously in the management of Asherman's syndrome — particularly for Grade III–IV disease where surgical skill directly determines how much normal cavity can be restored.
Dr. E. Prashanthi Reddy brings 20+ years of operative gynaecology experience and advanced hysteroscopy training. We perform diagnostic and operative hysteroscopy as a core service — not an occasional procedure.
PG Diploma in ART from Kiel University, Germany equips Dr. Prashanthi with an integrated approach — linking uterine cavity restoration directly to optimised IVF outcomes for patients who need both.
We don't just perform the surgery — we manage the complete fertility journey: adhesiolysis, post-operative hormonal support, endometrial monitoring, second-look hysteroscopy, and IVF when needed, all under one roof.
Genital tuberculosis is a significant cause of Asherman's syndrome and endometrial damage in India. We routinely screen for TB when the clinical picture warrants it — preventing treatment failure from undiagnosed active infection.
We provide realistic, grade-specific counselling. Not every Asherman's case will be fully cured — Grade IV disease has limited restoration rates. We help you understand your individual prognosis and plan accordingly.
Easily accessible from Uppal, Nagole, Habsiguda, Chengicherla, Ghatkesar, and LB Nagar. Day-procedure hysteroscopy means minimal time off work or family responsibilities.
For mild (Grade I) and moderate (Grade II) Asherman's syndrome, complete restoration of the uterine cavity is achievable in most cases with hysteroscopic adhesiolysis followed by hormonal support. Moderate-to-severe (Grade III) disease can usually be significantly improved, though some residual scarring may remain. Severe (Grade IV) disease — complete obliteration — is the most challenging: significant improvement is achievable but complete restoration to normal is not always possible. Cure rates depend heavily on the extent of disease, the skill of the surgeon, and compliance with post-operative hormonal therapy.
Most women with Asherman's syndrome recover menstrual flow after successful adhesiolysis. Grade I–II patients can expect return of normal periods in 80–90% of cases. In Grade III disease, periods may return but may remain lighter than before. In Grade IV cases where the endometrium has been severely destroyed, periods may not fully normalise — the cavity structure can be restored but if the endometrial glands have been irreparably damaged, regeneration is limited. Post-operative oestrogen therapy is essential for endometrial recovery.
Grade I adhesions are usually resolved in a single operative hysteroscopy. Grade II may require 1–2 procedures. Grade III typically requires 2–3 procedures. Grade IV (complete obliteration) may require 3 or more procedures, each followed by hormonal support and a second-look procedure. After each operative hysteroscopy, a second-look hysteroscopy 6–8 weeks later checks healing progress and treats any re-adhesion early. Your surgeon will plan the number of procedures based on your specific situation.
Yes — pregnancy after Asherman's syndrome treatment is very possible. For Grade I–II disease, pregnancy rates of 70–80% and live birth rates of 60–70% are reported. Results are lower for more severe grades. Women who achieve pregnancy after Asherman's treatment do have an increased risk of placentation complications (placenta praevia, placenta accreta) and preterm birth compared to the general population, and should be managed as high-risk pregnancies with close antenatal monitoring.
IVF success in Asherman's syndrome depends on the endometrial condition after treatment. If adhesiolysis has restored a normal cavity and the endometrium grows to at least 7mm with a trilaminar pattern, IVF success rates approach those of women without a uterine factor. If endometrial thickness remains persistently thin (below 6mm) despite oestrogen support, IVF success rates are significantly reduced. In these cases, options include prolonged oestrogen priming, PRP infusions, G-CSF (granulocyte colony-stimulating factor), and in some cases, frozen embryo transfer in a natural cycle.
Without treatment, Asherman's syndrome is a permanent condition — the adhesions will not dissolve on their own. However, with appropriate hysteroscopic treatment and post-operative care, significant or complete resolution is achievable for most patients, particularly those with mild-to-moderate disease. The condition requires active medical management; waiting and hoping it resolves spontaneously is not a recommended strategy if fertility is desired.
Thin endometrium (below 7mm at the time of embryo transfer) has several causes: Asherman's syndrome (scar tissue reducing functional lining), inadequate oestrogen support, poor uterine blood flow, previous uterine surgery, chronic endometritis, and in some cases, the use of clomiphene citrate which has an anti-oestrogenic effect on the endometrium. In IVF patients with recurrent thin endometrium, diagnostic hysteroscopy should be performed to exclude intrauterine adhesions as a correctable cause.
Yes — uterine (endometrial) tuberculosis is one of the most important causes of Asherman's syndrome in India. TB causes a granulomatous inflammatory response in the endometrium that results in extensive scarring. TB-related Asherman's is often Grade III–IV because the destruction is diffuse rather than localised. Critically, the underlying TB infection must be fully treated (typically 6 months of anti-TB therapy) before attempting adhesiolysis. Performing surgery on an active TB uterus will result in failure and re-adhesion. If TB is suspected, we test for it before any surgical intervention.
Dr. E. Prashanthi Reddy · TGMC Reg: 50624