Asherman's syndrome classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Saud Khan M.D.


Classification of Asherman's syndrome takes into account the amount of functional endometrium present, the menstrual pattern, obstetric history, and more recently the location and severity of adhesions inside the uterus. There is no data showing superiority of one system over the other.

Classification of Intra Uterine Adhesions (IUA)

As severity of the condition correlates with prognosis, classification of IUA is useful for choosing the treatment method and providing a prognosis relating to fertility outcome following treatment.

Several classification systems have been proposed for Asherman’s syndrome, although none of them is currently endorsed universally.

The older systems were based on hysterosalpingography findings however with the advent of hysteroscopy modern classification systems are based on hysteroscopic diagnosis of adhesions. Those of the American Fertility Society [1], the European Society for Hysteroscopy [2]and Nasr's proposed system, based on March et al.'s classification [3] are the most complex, taking into account several criteria. Nasr's point based classification system includes:

Hysteroscopic findings Score
Isthmic fibrosis 2
Filmy adhesions More than 50% of the cavity 1
Less than 50% of the cavity 2
Dense adhesions Single band 2
Multiple bands 4
Tubal ostium Both visualized 0
Only one visualized 2
Both not visualized 4
Tubular cavity (sound less than 6) 10
Menstrual pattern Normal 0
Hypomenorrhea 4
Amenorrhea 8
Reproductive performance Good obstetrics history 0
Recurrent pregnancy loss 2
Infertility 4
Mild 0-4
Moderate 5-10
Severe 11-22

There is some variation between criteria used in these systems but they include

  • type of adhesions,
  • location,
  • extent of the uterine cavity affected,
  • clinical symptoms,
  • menstrual characteristics or history,
  • obstetric history.
  • The boundaries between grade subtypes are sometimes subtle.

It is important to note that none of these classification systems have been validated by clinical studies, and research reporting treatment outcomes often lack details on exact IUA grades in patients. This adds to the difficulties in comparing study outcomes in patients treated for Asherman's syndrome.[3]


  1. American Fertility Society (1988). "The American Fertility Society classification of adnexal adhesions, distal tubal occlusions secondary to tubal ligation, tubal pregnancy, mullerian anomalies and intrauterine adhesions". Fertil Steril. 49 (6): 944–55. PMID 3371491.
  2. {{cite journal |author=Wamsteker K, DeBlok SJ |title=Diagnostic hysteroscopy: technique and documentation. |journal=Endoscopic surgery for gynecologist New York:Lippincott Williams & Wilkins Publishers |pages=263-76 |year=1995
  3. 3.0 3.1 Nasr AL, AL-Inany HG, Thabet SM, Aboulghar M (2000). "A clinicohysteroscopic scoring system of intrauterine adhesions". Gynecol Obstet Invest. 50 (3): 178–81.

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