Hysteroscopic findings in Asherman syndrome show intrauterine adhesions. The MODIFIED American Fertility Society (mAFS) classification grades adhesions based on which parameters?
- A Type of adhesion (filmy, fibromuscular, connective tissue), extent of cavity involvement, and menstrual pattern ✓
- B Location of adhesions (cornual, isthmic, fundal) and patient age
- C Thickness of adhesions on hysteroscopy and endometrial thickness on ultrasound
- D Serum AMH level and antral follicle count as surrogates for adhesion severity
Correct answer: A. Type of adhesion (filmy, fibromuscular, connective tissue), extent of cavity involvement, and menstrual pattern
Explanation
The modified AFS (American Fertility Society) classification of intrauterine adhesions grades severity based on three parameters: (1) extent of cavity involvement (less than 1/3, 1/3–2/3, or more than 2/3), (2) type of adhesion (filmy, filmy and dense, or dense), and (3) menstrual pattern (normal, hypomenorrhea, amenorrhea). Each component is scored 1–4 and totaled: mild (1–4), moderate (5–8), severe (9–12). This guides prognosis and likelihood of reproductive success after hysteroscopic adhesiolysis.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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