Asherman syndrome caused by genital tuberculosis is unique compared to post-curettage Asherman's in that:
- A The adhesions are always fibromuscular and respond well to distension media
- B Hormonal priming with estrogen reliably restores endometrial thickness
- C The endometrium is destroyed and cannot regenerate even after adhesiolysis, making pregnancy rates after hysteroscopy very low ✓
- D Laparoscopic adhesiolysis is preferred over hysteroscopic resection
Correct answer: C. The endometrium is destroyed and cannot regenerate even after adhesiolysis, making pregnancy rates after hysteroscopy very low
Explanation
Asherman syndrome due to genital TB differs critically from post-traumatic Asherman's because TB destroys the basal endometrial glands — the regenerative layer. Even after successful hysteroscopic adhesiolysis of the intrauterine synechiae, the residual endometrium lacks regenerative capacity and cannot develop a receptive endometrium; pregnancy rates remain very low (5–10% vs. 40–80% in post-curettage Asherman's). This has important counselling implications.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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