Successful clinical pregnancy in a case of severe Asherman syndrome: a case report

Abstract

Asherman syndrome presents significant reproductive challenges due to intrauterine adhesions and impaired endometrial receptivity. We report a 36-year-old woman with primary infertility and recurrent adhesion formation who underwent serial hysteroscopic adhesiolysis. While endometrial thickness (EMT) is traditionally pivotal for predicting embryo implantation success, our findings indicate that endometrial receptivity extends beyond thickness alone. Factors such as endometrial morphology, type, and blood supply play crucial roles. Because previous attempts failed to yield viable embryos a donor ovum embryo transfer was planned, before which she received three subcutaneous injections of recombinant granulocyte-colony stimulating factor (G-CSF) followed by ultrasound-guided intrauterine platelet-rich plasma (PRP) infusions for improving endometrial quality, vascularity and ultimately receptivity, Following the sequential regenerative protocol with optimized hormonal support, she achieved a viable singleton pregnancy. This case demonstrates that hysteroscopic adhesiolysis followed by multiple (here minimum 3) systemic G-CSF followed by local PRP may synergistically enhance endometrial regeneration in severe Ashermans syndrome. Controlled studies are needed to evaluate the efficacy and safety of this combined approach and optimising the dosage and sessions of the same.