Advanced adhesiolysis of dense adhesion in canal and endometrial cavity - #15019
My wife is 30 years old . She is strong and living a normal life and has been diagnosed with primary amenorrhea. She has already completed a six-month course of ATT (anti-tubercular treatment), and her hormonal profile is within normal range. In 2023 she diagnosed through hystero-laparoscopy, dense adhesions were found in cervical canal and endometrial cavity. Partial adhesiolysis was performed, All type of biopsy test done but not found any infection and but doctor (AIIMS RAIPUR) had advised that complete removal could be risky and suggested adoption or surrogacy as safer alternatives. However, we would like to understand if there are any advanced or modern treatment options available that could safely allow complete adhesiolysis or uterine cavity reconstruction, such as advanced hysteroscopic techniques Kindly advise if such options are possible or if you could refer us to any specialized center or expert dealing with complex intrauterine adhesions. We deeply value your guidance in making an informed decision for her future.
100% Anonymously
No sign-up needed.
Doctors’ responses
Hello,
Yes,advanced hysteroscopic techniques do exist, and your wife may be a candidate for further reconstructive attempts, but the outcome depends heavily on how extensive the adhesions are (how much of the cavity is damaged, how thin the endometrium is, how much of the cervical canal is blocked) and on whether the endometrium has good potential to regenerate.
A surgical attempt can still be considered -especially given her age (30) and fertility desire. But it’s important to go in with realistic expectations: restoration may require multiple surgeries, and even after surgery the endometrium may be thin, implantation may be poor, and there may be risk of recurrent adhesions.
So you should discuss this with experienced doctors and then take a wise decision.
Okay regarding specialized centers;
Dr Trivedis total women health care institute,Mumbai Vardhan fertility centre,Delhi Mamata fertility hospital,Hyderabad
These are my suggestions. You can check it out and decide.
Hopefully she will recover soon Thank you
Hello Ratna By going through your history and evaluation of your health status I must say that It sounds like you’re navigating a complex and emotional situation, and it’s great that you’re seeking more information about potential treatment options . In cases of dense intrauterine adhesions, especially when they involve the cervical canal and endometrial cavity, there are indeed advanced techniques that some specialists may use. Here are a few options to consider: 1. Advanced Hysteroscopic Techniques: 2. Laparoscopic Approach 3. Uterine Cavity Reconstruction 4. Specialized Centers and fertility centre I am suggesting you some fertility centre for better evaluation - 1) Dr Prasaan Vij ( st Stephen’s hospital) , delhi 2) indira ivf fertility centre, jaipur
You will get fine soon
Thank you
Addressing complex intrauterine adhesions, especially following conditions like tuberculosis, can indeed present challenges. Modern advanced hysteroscopic techniques do offer some pathways, albeit with their own sets of variables and risks. While partial adhesiolysis can alleviate some of the obstruction, complete removal carries the potential risk of complications like perforation or further adhesion formation, depending on the severity and extent of the adhesions. Recent advancements, though, have focused on improving outcomes in patients with dense adhesions. For instance, some centers employ advanced hysteroscopic techniques with the aid of small-caliber instruments that minimize trauma, coupled with the use of anti-adhesion barriers post-surgery to prevent reformation of adhesions. Adjunctive treatments like intrauterine devices (IUDs) or balloon-like stents may be used to maintain uterine patency during healing. Innovations such as using stem cell therapies are also being explored, albeit mostly in research settings, to potentially improve endometrial regeneration.
Given the complexity and potential variability of both the condition and treatment success, it’s crucial to consult a gynecologist specializing in reproductive surgery, particularly in centers with expertise in managing Asherman’s syndrome or severe intrauterine adhesions. Centers of excellence in reproductive medicine or large teaching hospitals might offer more tailored and innovative approaches. While no specific center comes to mind immediately, you might seek consultation from well-known institutions like CMC Vellore, or Apollo Hospital’s reproductive medicine departments in larger cities, as they often have specialists dealing with complex cases. Prioritizing a second opinion from a specialist who might have access to or experience with the very latest in endoscopic technology and post-operative management strategies might open doors to new possibilities, focusing on personalized assessment and risk mitigation. It’s essential to balance hope with the realistic understanding of the potential and limitations of such procedures, maintaining open discussions about all available reproductive options.
Hello dear See after careful evaluation it seems ahesiolysis can be performed in your case for removing thick adhesive lining. I suggest you to please get below tests done for confirmation Pelvic USG Ct scan Mri Urine analysis Afb stain Hsg Usually the procedure is performed by gynecologist or laproscopic surgeon So I suggest you to please consult gynaecologist or laproscopic surgeon in person for better clarity Regards
Severe intrauterine adhesions (post-tubercular) Goal: Attempt safe uterine cavity reconstruction only at expert endoscopic centre Alternative plan: Surrogacy or adoption if endometrium non-functional Next step: Referral + MRI pelvis + second opinion on advanced adhesiolysis
Hello Ratna, I understand your concern. According to what you have mentioned, my understanding is that there are very few options left now.
You can consider consulting tertiary IVF / reproductive surgery centres with expertise in complex adhesiolysis, such as:
AIIMS New Delhi – Department of Reproductive Biology
Sir Ganga Ram Hospital, Delhi (Endoscopic Surgery Unit)
Christian Medical College (CMC), Vellore
NIMS Hyderabad or Apollo Fertility Centres (advanced reproductive endoscopy)
If any hospital can help you in India, then these might be your options.
Feel free to reach out again.
Regards, Dr. Nirav Jain MBBS, DNB D.Fam.Med
Severe intrauterine adhesions can sometimes be treated with advanced hysteroscopic adhesiolysis, often using ultrasound or laparoscopic guidance and special barriers or hormonal therapy afterward to reduce re-scarring, but success depends on how much healthy endometrium remains. In complex cases, newer options like PRP or stem-cell–based endometrial regenerative therapies may be considered at specialized reproductive endoscopy centers, though they are still limited and not guaranteed. Please seek evaluation from a reproductive medicine or gynecologic endoscopy specialist experienced in Asherman’s syndrome to review risks, chances of success, and alternatives such as surrogacy.
100% Anonymously
Get expert answers anytime, completely confidential. No sign-up needed.
About our doctors
Only qualified doctors who have confirmed the availability of medical education and other certificates of medical practice consult on our service. You can check the qualification confirmation in the doctor's profile.
