The value of 3D ultrasound in the management of patients with suspected Asherman’s Syndrome

Objective: To assess the value of 3D ultrasound in the management of patients with suspected Asherman’s syndrome. Study Design: A case series of 54 infertile patients who presented to a tertiary care center, between 1998-2004, with suspected Asherman’s syndrome and underwent both HSG and 3D ultrasound prior to hysteroscopy. Sensitivity and the ability to attain fertility post-operatively were calculated. Results: Intra-uterine adhesions (IUA) were demonstrated on 3D ultrasound and HSG in all cases and confirmed by hysteroscopy. However, 3D ultrasound had a sensitivity of 100%, while HSG had a sensitivity of 66.7% for correctly grading the extent of IUA. In 61.1% of cases where HSG results were inconsistent with hysteroscopy, lower uterine segment outflow obstruction was present and HSG misclassified findings as severe Asherman’s with complete cavity obstruction. Post-operatively, 90% of patients conceived. Conclusions: 3D ultrasound provides a more accurate depiction of adhesions and extent of cavity damage than HSG in patients with suspected Asherman’s syndrome, particularly when differentiating severe IUA from lower uterine segment outflow obstruction. Therefore, grading systems utilizing HSG to classify severity of disease should be revised to include 3D ultrasound findings.