*6.2.3 Uterine synechiae/Asherman syndrome*

The prevalence of uterine synechiae ranges from 0.5 to 28% in patients with RPL [47]. Women with RPL are more likely to have uterine synechiae as they often undergo curettage or manual vacuum aspiration. The probable pathophysiology of abortion occurs due to a reduction in the amount of functional endometrium which may interfere with the invasion and normal development of the placenta [47]. The gold standard exam for the diagnosis of synechiae is hysteroscopy and should be the exam of choice in the cases of suspicion [2]. ESHRE concludes that there is insufficient evidence to recommend adhesiolysis in women with RPL as there are only small observational studies. ESHRE reinforces that treatment should focus on preventing recurrence of adhesions [2, 3]. However, ASRM points out that surgical correction of significant uterine cavity defects should be considered [3]. Nonsurgical experimental techniques for the treatment of uterine synechiae and endometrial fibrosis, such as stem cell therapy, should be further studied before being indicated in clinical practice [2].
