, certification

[Guest guest]

Ooops,

, the mail I just sent included the certification with corrections

and the old text, so words are double, please, see the following instead,

the last certification version should not be used!!!! This happens when

corrections are written visible.

Correct text:

" To whom it may concern,

in 1948 Dr. Asherman was the first to

describe intrauterine adhesions caused by traumatic injuries of the

endometrium, resulting in menstrual disorder and secondary

infertility.

Intrauterine adhesions lead to a partially or fully closed cavity, thus a

lack of periods, miscarriages or infertility. The so called Asherman´s

Syndrome is a result of the endometrial lamina basalis being injured

(i.e. at a dilation and curettage) during the vulnerable phase of the

uterus post partum or post miscarriage / abortion.

Different severities for the cavity´s occlusion have been found. The most

common score is provided by the American Fertility Society differing

between three stages:

stage I = mild

stage II = moderate

stage III = severe

,.

Asherman´s Syndrome is found with a very low prevalence: only 4% of all

infertile patients with a story of a d & c (dilation and curettage)

post partum or post miscarriage develop Asherman´s Syndrome

2.

There is a German register of gynecological complications which states 19

cases of severe Asherman´s Syndrome in 2001 .

This simply explains why only very few surgeons worldwide can have enough

experience in treating Asherman´s Syndrome.

The lysis of adhesions via hysteroscopy is the best known method for the

treatment of Asherman´s Syndrome, at the same time it is the most

difficult hysteroscopical surgery to perform .

Performing a hysteroscopy usually allows for a view of a normal uterine

cavity, making pathological abnormalities such as a septum or myoma

easily detectable.

A diagnosis of Asherman´s Syndrome on the other hand means that the

surgeon won´t find a normally configured cavity at all. Therefore even

experienced hysteroscopists consider it a very difficult task

to perform surgery on patients with Asherman´s Syndrome

successfully.

The low prevalence rate of Asherman´s Syndrome results in the fact that

it is rarely treated in a standard gynecologic practice or clinic. Most

hysteroscopists have never seen an Asherman´s Syndrome in their entire

career . Again, this clarifies why only very, very few surgeons

have enough experience to perform Asherman´s Syndrome surgery

successfully.

Being an excellent hysteroscopist does not automatically ensure enough

skill to treat Asherman´s Syndrome, since it demands a totally different

approach than any other hysteroscopic surgery.

If the lysis of adhesions via hysteroscopy is done with less competence

than outlined above, the patient faces either the worsening of the

condition (by provoking additional adhesions) resulting in

infertility, or severe complications such as the injury of the urinary

bladder, the rectum or other intestinal areas.

Conclusions: Taking into account the very small number of patients

with Asherman´s Syndrome, there can be no doubt that only very, very few

specialists worldwide are experienced enough to treat this condition

hysteroscopically with a successful outcome. "