Infertility Caused by Uterine Adhesions The lining of the human uterus is the place where the embryo is placed and where it can grow and develop further. If uterine adhesions occur, the lining will be damaged and the embryo will not be able to implant or develop further, resulting in infertility or miscarriage. With the increased use of curettage, the incidence of uterine adhesions has increased. As a result, the percentage of infertility due to uterine adhesions is also increasing. At present, domestic and foreign data show that any surgery of the uterine cavity can increase the incidence of uterine adhesions and become one of the common main causes of infertility. Common causes: 1, caused by scraping damage, such as: abortion, mid-term induction of labor, after full-term delivery, cesarean section, diagnostic scraping and other post-surgical procedures. 2, caused by infection, such as: bacteria, virus, tuberculosis and other infections. 3, gynecological surgery damage caused by, such as: uterine fibroid removal surgery, cervical surgery, deformed uterus corrective surgery, endometrial resection and other surgical procedures. 4, the cervix of cauterization, freezing, drug corrosion, radiation therapy can cause cervical adhesion atresia. Second, the mechanism of causing uterine adhesions: 1, endometrial repair disorders endometrial trauma repair mechanism has two: 1) endometrium and the corresponding small blood vessel regeneration and repair; 2) fibrous tissue hyperplasia, scar tissue formation to cover the wound. If the endometrium is traumatized endometrial fibroblast lysozyme activity in the endometrium is reduced, there is a temporary collagen fiber overgrowth, and endometrial hyperplasia is inhibited, as a result, scar formation, adhesion occurs. 2.Injury and infection destroys the integrity of the endometrium, resulting in scarring of the uterine wall tissues and adhesion healing, which leads to uterine atresia, making the uterine cavity smaller or even disappearing. 3, endometrial histological changes in the endometrium tissue phase of secretion phase accounted for 80%, hyperplasia phase accounted for 12%, atrophy phase accounted for 5%, hyperplasia phase accounted for 3%; scraping out the endometrium accounted for 65%, fibrous tissue accounted for 25%, cervical endothelium accounted for 12.5%, endothelial basal lamina accounted for 6%, uterine smooth muscle tissue accounted for 4%. The histologic changes of the endometrium are not conducive to the implantation of the pregnant egg, the implantation of the placenta and the development of the embryo. Pathological features: Cervical adhesions can occur in the endocervix or the uterine cavity, or both, the endocervical adhesions can occasionally have a small amount of blood in the uterine cavity, dark red. Endocervical adhesions are characterized by a filling defect or fibrous tissue at the endocervical opening on hysteroscopy. Connective tissue is seen floating like flocculent in the filling fluid of the uterine cavity, or connective tissue hardens the uterine cavity like a pale scar in the form of an island between the normal endometrium, and in severe cases, the adhesive tissue forms a bundle of varying thicknesses. Fibrous tissue, smooth muscle, degeneration, mechanized chorionic tissue and fibrous calcification are common in the endometrium. Fourth, the classification of uterine adhesions: according to the site of adhesion can be divided into complete, partial and marginal three; according to the integrity of the endometrial cavity and tissue phase can be divided into the endometrial adhesion, scar connective tissue adhesion and smooth muscle tissue adhesion, and its histological changes are related to clinical symptoms. Fifth, the classification of uterine adhesions Hysteroscopy is the most reliable diagnostic method for diagnosing uterine adhesions. According to the degree of occlusion of the uterine cavity, especially both sides of the tubal opening and the uterine fundus adhesion grading, can be divided into three degrees: 1, mild: less than 1/4 of the uterine cavity, there is dense adhesions, the uterine fundus and tubal openings are only a little adhesion or not wave; 2, moderate: about 3/4 of the uterine cavity has adhesions, but the wall of the palace is not adherent, the uterine fundus that is the opening of the tubes partially atretic bilaterally; 3, severe: 3/4 or more of the uterine cavity of the thick adhesion, the uterine wall Adhesion, tubal opening and fundus adhesion. Clinical manifestations: 1. Menstrual disorders Amenorrhea accounts for 37%, scanty menstruation and scanty menstruation accounts for 33%, dysmenorrhea accounts for 2.5%, menorrhagia accounts for 1%, and normal menstruation accounts for 6%. 2. Primary or secondary infertility accounts for 43%. 3, Post-pregnancy complications: such as recurrent (habitual) miscarriage, placenta previa, preterm labor and so on. 4, combined with the cervical canal adhesion can cause: menstrual blood retention, blood, fluid or pus accumulation in the uterine cavity. 5, most of the cervical adhesions are amenorrhea after abortion. Diagnosis 1, history, symptoms and signs: history of scraping, gynecological surgery, gynecological infection, infertility, miscarriage and menstrual disorders. 2.Imaging examination: ultrasound, HSG, etc. 3.Hysteroscopy: the most reliable means of diagnosis. 4.Repeated failure of embryo transfer VIII.Treatment 1.Separation surgery for uterine adhesion: for those who have fertility requirements, hysteroscopic separation surgery is used, and the birth control ring is put in after the surgery to prevent re-adhesion and antibiotic treatment is given to prevent infection. The sterilization ring is removed 3 months after the insertion of the ring and antibiotic treatment is given to prevent infection. Severe patients need repeated treatments to have an effect. Stimulate the growth of endometrium: give high dose estrogen-progestin cycle treatment. Nine, prevention: 1, gynecological examination or cervical-uterine treatment, avoid violent injury or infection. 2, Avoid gynecological infection. 3.Minimize or avoid abortion. 4, pay attention to menstrual hygiene. Prohibit unclean sex. X. Prognosis After hysteroscopic separation of uterine adhesions + IUD removal and several cycles of estrogen-progestin replacement therapy in most patients, the endometrium of some patients regained its function and continued pregnancy. If the uterine adhesions are found to continue to exist after IUD removal, the treatment can be continued according to the above program until the uterine adhesions disappear.