Master Class

Hysteroscopic Lysis of Intrauterine Adhesions


 

An important resource for patients with this condition is Asherman's Syndrome International, which is accessible at

http://groups.yahoo.com/group/Ashermans

Intrauterine Adhesions

Intrauterine adhesions continue to plague gynecologists and reproductive endocrinologists. Approximately 70 years ago, Asherman and Toaff came out with their landmark paper on patients who present with intrauterine synechiae and amenorrhea: Asherman's syndrome. The scarring can affect not only menstrual flow, but implantation as well, even in the environment of apparently normal menstruation.

When these adhesions are removed, proper care must be taken to minimize damage to the normal intrauterine cavity. Moreover, strategies must be considered to reduce subsequent postoperative adhesions. This is especially problematic because the intrauterine cavity is a pseudospace. The removal of intrauterine synechiae places traumatized tissue against traumatized tissue. This situation would appear to enable subsequent postoperative adhesion formation.

For this Master Class in gynecologic surgery, I have elicited the help of Dr. Charles March. Dr. March spent 30 years in the department of obstetrics and gynecology at the University of Southern California, Los Angeles, where he became professor in 1987. During his tenure there, Dr. March was a prolific writer, especially in the area of operative hysteroscopy, and was the recipient of numerous awards including many resident-teaching awards. In 2000, Dr. March was given a Pioneer in Hysteroscopy award from the American Association of Gynecologic Laparoscopists.

Since 2003, Dr. March has been in private practice, where he specializes in infertility treatment and sees patients from across the country for operative hysteroscopy secondary to intrauterine synechiae. Even so, Dr. March continues to win teaching awards, now as a voluntary faculty member.

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