A 29-year-old woman with unexplained secondary infertility undergoes diagnostic laparoscopy and hysteroscopy. Hysteroscopy reveals intrauterine adhesions obliterating 50–75% of the uterine cavity. According to American Fertility Society (AFS) classification of intrauterine adhesions, this is:

• A Stage I (Mild): <1/4 of uterine cavity involved
• B Stage III (Severe): >3/4 of cavity involved
• C Stage IV: complete obliteration with cervical os involvement
• D Stage II (Moderate): 1/4 to 3/4 of cavity involved ✓

Explanation

The AFS (American Fertility Society, now ASRM) classification of intrauterine adhesions (Asherman syndrome) is based on the extent of cavity involvement: Stage I (mild) = <1/4 of cavity; Stage II (moderate) = 1/4 to 3/4 of cavity; Stage III (severe) = >3/4 of cavity. Adhesion type (filmy vs. dense) and menstrual pattern (normal vs. hypomenorrhea vs. amenorrhea) also contribute to the score. 50–75% obliteration falls within Stage II (moderate). Treatment is hysteroscopic adhesiolysis followed by estrogen therapy and intrauterine stenting.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.