Hysteroscopic adhesiolysis, prevention of re-adhesion (barriers, balloons, oestrogen), regenerative therapy for thin or scarred endometrium.
This page is written for clinicians and referrers and is not advice for individual patients. If you are a patient, the plain-language page is Asherman's syndrome .
Each week the literature is searched for new papers on asherman's and intrauterine adhesions, screened to the few that meet the evidence bar, and each one is verified on PubMed before it is summarised. I read every entry and give one verdict: whether the paper changes what I tell patients or do in theatre, supports current practice, or leaves it unchanged. Papers appear here newest first, grouped by the week they were found, with the study design, the main result and its effect size, and the reason for the verdict. Abstracts are not reproduced; the summaries are my own.
Digest of 19 October 2026
Search window 13 to 19 October 2026
Thin endometrium lowers live birth on a gradient, and a trilaminar pattern partly offsets it: 45,729 transfer cycles
Retrospective cohort of 45,729 embryo transfer cycles (16,566 fresh, 29,163 frozen-thawed) between January 2018 and August 2022; the setting is not named in the abstract.
Finding
Live birth rose steeply with endometrial thickness, the slope flattening at about 11-12 mm in fresh and 9-10 mm in frozen cycles. A non-trilaminar (type B/C) pattern lowered adjusted live birth (fresh aRR 0.880, 95% CI 0.832-0.930; frozen aRR 0.892, 95% CI 0.863-0.923), and the pattern mattered most below 10 mm: in frozen cycles live birth ranged from 16.7% (under 7 mm, non-trilaminar) to 44.7% (14 mm or more, trilaminar), about 17 in 100 to about 45 in 100, and in some comparisons a thinner trilaminar lining outperformed the next thicker non-trilaminar one. Thickness and pattern varied with the stimulation protocol in fresh cycles and the preparation regimen in frozen ones.
Supports current practicemoderate evidence
Useful numbers for counselling Asherman's and thin-endometrium patients before transfer, confirming thinness is a graded rather than a threshold problem and that the trilaminar pattern carries weight; observational, so it cannot say whether treating the lining improves outcomes.
What it means
For a woman with a thin lining after Asherman's treatment, the chance of a live birth per frozen transfer rises steeply with thickness up to about 9 to 10 mm and then flattens, and below 10 mm a three-layer (trilaminar) pattern does better at any thickness.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Fluoroscopy-guided adhesiolysis for severe Asherman's: what 26 papers show
Danish literature review with a systematic search of Embase and Medline from 1974 to February 2026: 617 records, 26 papers included on fluoroscopy-guided hysteroscopic adhesiolysis for severe Asherman's syndrome; no pooled analysis and no comparison with ultrasound or laparoscopic guidance.
Finding
After fluoroscopy-guided adhesiolysis the series report a high rate of restored cavity anatomy and improved menstruation, pregnancy rates of 75-87% and live birth rates of 63-68%, an increased risk of placenta accreta spectrum in later pregnancies, and minimal radiation exposure, with median exposure times and doses well within safe limits.
No changeweak evidence
Series-level evidence that supports fluoroscopy as an option for severe cases, not a reason to change the ultrasound guidance used now; the accreta risk belongs in every post-adhesiolysis pregnancy letter.
What it means
For a woman with severe Asherman's syndrome, this confirms that dense adhesions can be divided safely under imaging guidance and that pregnancy after adhesiolysis carries a higher risk of the placenta growing too deeply, which the Asherman's page and my letters already say.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Every paper on this site's evidence pages is also available as open data at /evidence/papers.json. The search and screening rules are on the evidence index.
Last reviewed .Reviewed by Mr Haider Jan, Consultant Gynaecologist.
For patients: Asherman's syndrome
The plain-language page on what the condition is, how I assess it and the choices, written for the women I see.
