How to check endometrial adhesions?

Endometrial adhesion is not conducive to the entry of sperm and the combination of eggs, so these have become the cause of infertility in many women. If you want to understand the situation more clearly, you should pay attention to examinations, such as uterine probe examinations and hysteroscopy.

1. Uterine probe examination

Generally, when the uterine probe is inserted about 1-3 cm into the cervix, there will be a sense of resistance, with the most common feeling being around 2 cm. The resistance may vary according to the different adhesion tissues. When only the endometrium is adhered, the probe is easy to insert. When the muscle layer is adhered, a little force must be applied in the direction of the uterus to insert the probe. If the tissue feels tough and hard and the probe is difficult to insert, do not apply force blindly. To avoid uterine perforation. After the probe enters the uterine cavity, it can be swept horizontally in a fan shape to test the size of the uterine cavity and the range of adhesions. In patients with severe adhesions, the uterine cavity may feel like a narrow tube, and the probe has a very small range of motion or cannot be inserted at all.

2. Hysteroscopy

It can help to understand whether there is intrauterine adhesion and determine the location, range, degree and tissue of the adhesion. The characteristics of each group of adhesions are as follows: endometrial adhesions are very similar to the surrounding endometrium; myofibril adhesions are the most common, characterized by a thin layer of endometrium covering it with many glandular openings on the surface; and connective tissue adhesions have no endometrial formation on the surface.

3. Uterine iodized oil contrast is characterized by:

(1) There may be one or more filling defect shadows in the uterine cavity with clear outlines, sharp edges, abnormal shapes, and irregular shapes, which are not changed by the pressure or amount of contrast agent injected.

(2) A fine network of blood vessels often appears. This is because the pressure of the iodized oil injected during angiography is too high, so the iodized oil enters the uterine blood vessels from the peeling surface.

(3) The local edges of the uterine cavity are irregular.

(4) In some cases of uterine cavity adhesions, the uterus is highly anteverted or retroflexed, and the images of the uterine cavity and cervix often overlap and become unclear. The uterus is olive-shaped. In this case, the cervical forceps can be used to pull the cervix to stretch the uterus, and the image of the uterus can change from olive shape to triangle. In order to prevent oil plugs and oil agents from causing chronic inflammation, water-soluble contrast agents can also be used. Mild adhesions can be separated by contrast.