Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 9 2026 09 02 621 625 Farahnaz Ahmady Golestan UMS.GYN Mahboubeh Tajaldini Ischemic Disorders Research Center, Jorjani Clinical sciences Research Institute, Golestan University of Medical Sciences, Gorgan, iran marjan Ghaemi Obstetrician and Gynecologist, vali-e-asr reproductive health research center, family health institue, Tehran university of medical sciences, Tehran, Iran 2025 12 16 2026 05 19 Background: Severe Asherman’s syndrome, characterized by extensive intrauterine adhesions and endometrial fibrosis, poses a significant challenge to fertility restoration. In cases where the uterine cavity is non-visualized, surrogacy is often considered the only viable option. Case Presentation: We report a rare and successful case of fertility restoration in a 30-year-old woman with severe Asherman’s syndrome and multiple comorbidities. Following secondary amenorrhea post-curettage, imaging revealed a completely obliterated uterine cavity. Despite initial recommendations for surrogacy, the patient underwent three serial hysteroscopic adhesiolysis procedures. Gradual anatomical reconstruction and endometrial regeneration were achieved, culminating in a receptive cavity and near-normal menstruation. IVF was performed, resulting in a twin pregnancy. Despite a high-risk gestation complicated by PPROM and preterm delivery at 30+6 weeks, both infants were discharged in good health. Conclusion: This case underscores the transformative potential of staged hysteroscopic intervention in restoring fertility, even in the most severe presentations of Asherman’s syndrome. It challenges traditional prognostic assumptions and highlights the importance of individualized, persistent surgical care. https://acta.tums.ac.ir/index.php/acta/article/view/11934 https://acta.tums.ac.ir/index.php/acta/article/download/11934/6107