A Step-By-Step Description of the Hysteroscopic Injection of Platelet-Rich Plasma (PRP) Into the Endo-Myometrial Junction For Patients With Asherman's Syndrome.
Danilo Borrelli, Brunella Zizolfi, Virginia Foreste et al.
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Case in brief
A 42-year-old nulliparous woman developed Asherman’s syndrome after uterine artery embolization for an intramural myoma. She reported hypomenorrhea; ultrasound showed a 2.57-mm endometrium and intrauterine synechiae, while hysteroscopy confirmed extensive adhesions obliterating the cavity. Hysteroscopic adhesiolysis restored visualization of the tubal ostia, followed by PRP injection into the endo-myometrial junction. One week later, ultrasound showed increased endometrial thickness and a more trilaminar appearance; menstrual flow resumed after one month. No complications or adverse effects were reported. The authors also describe similar results in two additional patients.
What made this case unusual
PRP was injected into the endo-myometrial junction after adhesiolysis, targeting each uterine wall regardless of where adhesions had been divided; full-depth penetration was used except at the fundus.
Diagnostic / clinical pearl
In this case, hysteroscopy confirmed cavity-obliterating adhesions when ultrasound showed synechiae and a thin endometrium. The reported endometrial and menstrual changes followed combined adhesiolysis and PRP, so the contribution of PRP alone cannot be determined.
Why it matters
The report describes a procedural approach, but reproductive outcomes such as pregnancy and live birth remain unassessed; the authors call for further study.