Background
The diagnosis of Asherman syndrome, or ‘intra‐uterine adhesions’ is often overlooked when the symptoms of amenorrhea and hematometra are missing.

Aims
This audit reviews the clinical data of a large cohort of patients treated by a single operator.

Materials and Methods
From July 1998 till the end of December 2017, 423 patients with intra‐uterine adhesions were treated by a single operator. Clinical information was obtained by review of the medical files and phone interviews.

Results
Amenorrhea was recorded in 163/423 patients (38.5%), 225/423 (53.2%) patients did not have amenorrhea and for 35/423 (8.3%) patients the information was missing. A hematometra was documented in 19/423 (4.5%) patients. Pregnancy was achieved in 215/246 (87.4%). Patients with stage II disease did best with a pregnancy rate of 94.5% (P = 0.029).

Conclusion
Asherman syndrome should be considered in any woman with a history of miscarriage or postpartum curettage who then fails to conceive again.