The pathology of uterine adhesions is characterized by extensive adhesions in the uterine cavity, most often after abortion and uterine clearance procedures, and occasionally after acute cervicitis. Do uterine adhesions cause infertility? Is your infertility the cause of cervical adhesions? How much does uterine adhesion affect pregnancy? The uterus, as the name implies, is the “palace of the offspring”. The normal uterus is a slightly flattened inverted pear shape, surrounded by thick muscles, with a cavity in the middle, and the tissue covering the surface of the cavity is the endometrium. When the endometrium is damaged by mechanical injury or infection and other pathological factors, resulting in localized loss or fibrosis of the endometrium, resulting in adhesions between the anterior and posterior walls of the uterine cavity and loss of the normal shape of the uterine cavity, it is called uterine adhesions. Uterine adhesions were first described by Heinrich Fristch (1894), who recognized that the disease could lead to secondary amenorrhea, and it was not until 1948 that Joseph Asherman published a series of articles describing the etiology, symptoms, and imaging pictures of uterine adhesions, which led to the naming of the disease as Asherman syndrome. Since then, there has been an increase in the number of reports of cervical adhesions worldwide. Uterine adhesions are not simply morphological changes. Histologically, they are characterized by the absence of a normal endometrium, which is fibrotic, covered by non-secretory columnar epithelial cells, with the possibility of calcification or ossification of some mesenchyme, the glands becoming very sparse or inactive, and most of the endometrial tissue lacking blood vessels and scarred and unresponsive to hormonal stimulation. The endometrium is the “soil” where the fertilized egg takes root. The sperm and egg are combined and fertilized to form the embryo, while the endometrium is actively preparing for the arrival of the embryo; when the development of the embryo and the endometrium are at the same pace, the embryonic blastocyst and the endometrium in a receptive state come into further intimate contact, and eventually the embryonic blastocyst burrows into the endometrial layer The embryonic trophoblast and the endometrium establish a close connection and begin to take root, which is the implantation of the embryo. In addition, the lack of blood supply and hormonal support will prevent the endometrium from providing sufficient nutrients for the embryo, resulting in repeated implantation failure, embryonic arrest, miscarriage and other adverse pregnancy outcomes. The relationship between uterine adhesions and infertility The main causes of uterine adhesions are injuries, such as repeated uterine scraping during abortion, cessation of embryonic development or clearance after induction of labor; followed by infections such as uterine tuberculosis. The literature reports that the incidence of uterine adhesions due to multiple abortions and scrapings is as high as 25% to 30%, and has become the main cause of reduced menstrual flow and secondary infertility. There is also a relationship between the degree of uterine adhesions and infertility, and it is sometimes difficult to predict the occurrence of infertility and miscarriage. A healthy and strong embryo will seek out the relatively poor “soil” of the uterus and find a small remnant oasis to take root and grow. Thus, occasional pregnancies have been reported in patients diagnosed with moderate to severe intrauterine adhesions or endometrial scarring, but of course it is only by luck. To date we are still unable to accurately assess and predict the chances of pregnancy and embryo implantation, which makes it impossible to either dismiss the chances of pregnancy with a blanket statement or to give patients too high expectations. Diagnosis and treatment of hysterocutaneous adhesions The common ancillary tests used to diagnose hysterocutaneous adhesions are ultrasound (3D ultrasound is recommended), hysterosalpingography and hysteroscopy, which is the gold standard for diagnosis. Under the direct view of hysteroscopy, not only the location and extent of adhesions can be clarified, but also the nature and degree of adhesions can be inferred, which provides a basis for estimating the ease of surgery and judging the prognosis. The conventional treatment for hysteroscopic adhesions is hysteroscopic separation of hysteroscopic adhesions. In cases of moderate or severe adhesions, postoperative estrogen sequential therapy, intrauterine stenting, placement of anti-adhesion biomaterials in the uterine cavity, and amniotic membrane transplantation are used to prevent re-adhesions after separation. It has been reported that the rate of re-adhesion after hysteroscopic adhesion separation for severe cavity adhesions is as high as 62.5%, and the pregnancy success rate is only 22.5% to 3.3%. Even if the anatomical structure is satisfactorily reconstructed, it does not guarantee normal fertility, just like deserted soil, where it is difficult to grow grass. Therefore, it is important to restore the normal tissue structure and function of endometrium to improve the uterine fertility of patients with uterine adhesions. In recent years, stem cells have played an important role in various tissue repair, and there have been reports of successful induction of undifferentiated stem cells into corresponding cells in vivo after transplantation into injured bone and joint, liver, and heart muscle. The existence of endometrial stem cells has been successively confirmed by scholars at home and abroad. Therefore, introducing stem cells to repair the severely damaged endometrium and restore its normal tissue structure and function can turn the desert into an oasis and is expected to treat uterine adhesions at the root.