In reproductive medicine, there is a metaphorical concept of “seed” and “soil.” The “seed” refers to the fertilized egg, while the “soil” refers to the uterine lining. When there is intrauterine adhesion, the uterine lining becomes thin, and some areas may lack lining altogether. The “soil” is barren, making it difficult for the poor fertilized egg to find a suitable place to implant.
What tests are needed for intrauterine adhesions?
Usually, pelvic ultrasound and hysteroscopy are performed for intrauterine adhesions, and an uterine iodine contrast examination can also be done. While ultrasound is easy to understand, let’s focus on the other two procedures.
1. Hysteroscopy Examination
This helps to identify the presence of intrauterine adhesions and determine their location, extent, severity, and the tissues involved in the adhesion.
Each type of adhesion has its characteristics: endometrial adhesion is similar to the surrounding endometrium, myofiber adhesion is the most common with a thin layer of endometrium covering it and numerous gland openings, while connective tissue adhesion has no endometrial tissue.
2. Uterine Iodine Contrast Examination
In cases where the uterus affected by adhesions is highly bent forwards or backwards, the cavity and cervical images often overlap. The uterus appears olive-shaped.
To resolve this, cervical forceps can be used to traction the cervix, causing the uterus to stretch, transforming the image from olive-shaped to triangular. Water-soluble contrast agents can also be used to prevent chronic inflammation caused by oily clots or agents. Mild adhesions can be separated through contrast imaging.
How should intrauterine adhesions be treated?
The goal of treating intrauterine adhesions is to restore the normal shape of the uterine cavity, prevent reformation of adhesions, promote endometrial regeneration, and restore normal reproductive capacity.
The main objectives are to restore the shape and size of the uterus, establish effective communication among the uterine horns, fallopian tube openings, cervical canal, and uterine cavity. Treatment addresses other symptoms such as infertility, recurrent miscarriage, and adhesion recurrence.
Intrauterine adhesions are a global health concern, and the treatment of moderate to severe cases remains challenging. The prognosis for severe adhesions is not always ideal, especially for families seeking conception. Minimizing damage under the skilled guidance of experienced physicians is crucial for postoperative recovery and prompt conception.
For patients with intrauterine adhesions, doctors typically require hysteroscopy examination and treatment during the initial fertility assessment phase before proceeding with in vitro fertilization (IVF). This is because intrauterine adhesions generally do not meet the conditions for IVF.
IVF involves fertilizing the egg and sperm outside the body, cultivating the embryo, and then implanting it into the uterine cavity for gestation. In cases of uterine adhesions, where the endometrium may be damaged to some extent, it is not conducive to embryo implantation in the uterine cavity. Therefore, patients must first cure the intrauterine adhesions before undergoing IVF.
