Grades of AS

Society for Hysteroscopy, 1989:

I – Thin or filmy adhesions easily ruptured by hysteroscope sheath alone, cornual areas normal;

II – Singular firm adhesions connecting separate parts of the uterine cavity, visualization of both tubal ostia possible, cannot be ruptured by hysteroscope sheath alone;

IIa – Occluding adhesions only in the region of the internal cervical OS. Upper uterine cavity normal;

III – Multiple firm adhesions connecting separate parts of the uterine cavity, unilateral obliteration of ostial areas of the tubes;

IIIa – Extensive scarring of the uterine cavity wall with amenorrhea or hypomenorrhea;

IIIb – Combination of III and IIIa;

IV – Extensive firm adhesions with agglutination of the uterine walls. Both tubal ostial areas occluded

Valle and Sciarra’s 1988 classification

Mild- Filmy adhesions composed of basal endometrium producing partial or complete uterine cavity occlusion;

Moderate – Fibromuscular adhesions that are characteristically thick, still covered by endometrium that may bleed on division, partially or totally occluding the uterine cavity;

Severe – Composed of connective tissue with no endometrial lining and likely to bleed upon division, partially or totally occluding the uterine cavity.

Donnez and Nisolle 1994 classification

I – Central adhesions

1. a) thin filmy adhesions (endometrial adhesions)
2. b) myofibrous (connective adhesions)

II – Marginal adhesions (always myofibrous or connective)

1. a) wedge like projection
2. b) obliteration of one horn

III – Uterine cavity absent on HSG

1. a) occlusion of the internal os (upper cavity normal)
2. b) extensive agglutination of uterine walls (absence of uterine cavity – true Asherman’s)