Skip to main content

Advertisement

SpringerLink
Log in

Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the outcome of hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome.

Materials and methods

This was a retrospective clinical analysis of 89 patients who underwent hysteroscopic adhesiolysis by monopolar electrode knife. A second-look office hysteroscopy was performed in all cases after 2 months. On second-look hysteroscopy, 12 patients showed reformation of adhesions and needed a repeat procedure.

Results

The mean age of the patient was 28.4 years. In the majority (64%) of patients, the possible cause of Asherman’s syndrome was previous curettage on gravid uterus. The overall conception rate was 40.4% after hysteroscopic adhesiolysis. The mean conception time after surgery was 12.8 months. There was no conception in patients who needed repeat adhesiolysis. The conception rate was higher (58%) in mild Asherman’s syndrome compared to 30% conception rate in moderate and 33.3% conception rate in severe cases. There was no significant association between conception rate and preoperative menstrual pattern. There was significant higher likelihood of conception rate (44.3%) in those who continued to have improved menstrual pattern compared to only 10% likelihood of conception in those who continued to have amenorrhea after adhesiolysis. The live birth rate was 86.1% and miscarriage rate was 11.1%. Cumulative pregnancy rate showed that 97.2% patients conceived within 24 months. There was increased incidence (43.8%) of cesarean section. Four (12.5%) patients had postpartum hemorrhage for adherent placenta.

Conclusion

Hysteroscopic adhesiolysis for Asherman’s syndrome is a safe and effective method of choice for restoring menstrual function and fertility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Asherman JG (1948) Amenorrhoea traumatica (alretica). J Obstet Gynaecol Br Emp 55:22–30

    Google Scholar 

  2. Asherman JG (1950) Traumatic intra-uterine adhesions. J Obstet Gynaecol Br Emp 57:892–896

    CAS  PubMed  Google Scholar 

  3. Schenker JG (1996) Etiology and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol 65(1):109–113. doi:10.1016/0028-2243(95)02315-J

    Article  CAS  PubMed  Google Scholar 

  4. Thomson AJM, Abbott JA, Meegan Lenart RN, Vancaillie TG (2007) Fluoroscopically guided synechiolysis for patients with Asherman’s syndrome: menstrual and fertility outcome. Fertil Steril 87(2):405–410. doi:10.1016/j.fertnstert.2006.06.035

    Article  PubMed  Google Scholar 

  5. Roge P, D’Ercole C, Cravello L, Boubli L, Blanc B (1996) Hysteroscopic management of uterine synechiae: a series of 102 observations. Eur J Obstet Gynecol Reprod Biol 65:189–193. doi:10.1016/0301-2115(95)02342-9

    Article  CAS  PubMed  Google Scholar 

  6. Feng ZC, Yang B, Shao J, Liu S (1999) Dagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions after induced abortions: clinical analysis of 365 cases. Gynaecol Endosc 8:95–98. doi:10.1046/j.1365-2508.1999.00245.x

    Article  CAS  Google Scholar 

  7. Capella-Allouc S, Morsad F, Rongieres-Bertrand C, Taylor S, Fernandez H (1999) Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility. Hum Reprod 14:1230–1233. doi:10.1093/humrep/14.5.1230

    Article  CAS  PubMed  Google Scholar 

  8. Preutthipan S, Linasmita V (2000) Reproductive outcome following hysteroscopic lysis of intrauterine adhesions: a result of 65 cases at Ramathibodi Hospital. J Med Assoc Thai 83:42–46

    CAS  PubMed  Google Scholar 

  9. Zikopoulos KA, Kolibianakis EM, Platteau P, de Munek L, Tournaye H, Devroey P, Camus M (2004) Live delivery rates in subfertile women with Asherman’s syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system. Reprod Biomed Online 8:720–725

    Article  PubMed  Google Scholar 

  10. Wamsteker K, De Block S (1998) Diagnostic hysteroscopy: technique and documentation. In: Sutton C, Diamond M (eds) Endoscopic surgery for gynecologists. Saunders, London, pp 511–524

    Google Scholar 

  11. Al-Inany H (2001) Intrauterine adhesions: an update. Acta Obstet Gynecol Scand 80:986–993. doi:10.1034/j.1600-0412.2001.801103.x

    CAS  PubMed  Google Scholar 

  12. Soares SR, Barbosa dos Reis MM, Camargos AF (2000) Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril 73:406–411. doi:10.1016/S0015-0282(99)00532-4

    Article  CAS  PubMed  Google Scholar 

  13. Sharma JB, Roy KK, Pushparaj M, Gupta N, Jain SK, Malhotra N, Mittal S (2008) Genital tuberculosis: an important cause of Asherman’s syndrome in India. Arch Gynecol Obstet 277:37–41. doi:10.1007/s00404-007-0419-0

    Article  PubMed  Google Scholar 

  14. Yu D, Li TC, Xia E, Huang X, Liu Y, Peng X (2008) Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman’s syndrome. Fertil Steril 89(3):715–722. doi:10.1016/j.fertnstert.2007.03.070

    Article  PubMed  Google Scholar 

  15. Nasr AL, Al-Inany HG, Thabet SM, Aboulghar M (2000) A clinicohysteroscopic scoring system of intrauterine adhesions. Gynecol Obstet Invest 50:178–181. doi:10.1159/000010305

    Article  CAS  PubMed  Google Scholar 

  16. Femandez H, Al-Najjar F, Chauveaud Lambling A (2006) Fertility after treatment of Asherman’s syndrome stage 3 and 4. J Minim Invasive Gynecol 13:398–402. doi:10.1016/j.jmig.2006.04.013

    Article  Google Scholar 

  17. Valle RF, Sciarra JJ (1988) Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol 158:1459–1470

    CAS  PubMed  Google Scholar 

  18. Pabuccu R, Atay V, Orhon E, Urman B, Ergiin A (1997) Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation. Fertil Steril 68:1141–1143. doi:10.1016/S0015-0282(97)00375-0

    Article  CAS  PubMed  Google Scholar 

  19. Bukulmez O, Yarali H, Gurgan T (1999) Total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopic synechialysis. Hum Reprod 14:1960–1961. doi:10.1093/humrep/14.8.1960

    Article  CAS  PubMed  Google Scholar 

  20. Fedele L, Bianchi S, Frontino G (2006) Septums and synechiae: approaches to surgical correction. Clin Obstet Gynecol 49:767–788. doi:10.1097/01.grf.0000211948.36465.a6

    Article  PubMed  Google Scholar 

  21. Chapman R, Chapman K (1996) The value of two stage laser treatment for severe Asherman’s syndrome. Br J Obstet Gynaecol 103:1256–1258

    CAS  PubMed  Google Scholar 

  22. Chen FP, Soong YK, Hui YL (1997) Successful treatment of severe uterine synchiae with transcervical resectoscopy combined with laminaria tent. Hum Reprod 12:943–947. doi:10.1093/humrep/12.5.943

    Article  CAS  PubMed  Google Scholar 

  23. Protopapas A, Shushan A, Magos A (1998) Myometrial scoring: a new technique for the management of severe Asherman’s syndrome. Fertil Steril 69:860–864. doi:10.1016/S0015-0282(98)00036-3

    Article  CAS  PubMed  Google Scholar 

  24. Broome JD, Vancaillie TG (1999) Fluoroscopically guided hysteroscopic division of adhesions in severe Asherman’s syndrome. Obstet Gynecol 93:1041–1043. doi:10.1016/S0029-7844(99)00245-8

    Article  CAS  PubMed  Google Scholar 

  25. Lindheim SR, Kavic S, Shulman SV, Sauer MV (2000) Operative hysteroscopy in the office setting. J Am Assoc Gynaecol Laparosc 7(1):65–69. doi:10.1016/S1074-3804(00)80011-0

    Article  CAS  Google Scholar 

  26. Kodaman PH, Arici A (2007) Intrauterine adhesions and fertility outcome: how to optimize success? Curr opin Obstet Gynaecol 19:207–214

    Article  Google Scholar 

  27. Touboul C, Fernandez H, Deffieux X, Berry R, Frydman R, Gervaise A (2009) Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility. Fertil Steril. doi:10.1016/j.fertnstert.2008.080108

  28. Guida M, Acunzo G, Sardoa Di Spiezio A, Bifulco G, Piccoli R, Pellicano M (2004) Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. Hum Reprod 19:1461–1464. doi:10.1093/humrep/deh238

    Article  CAS  PubMed  Google Scholar 

  29. Acunzo G, Guida M, Pellicano M, Tommaselli GA, Sardo Di Spiezio A, Bifulco G et al (2003) Effectiveness of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic adhesiolysis: a prospective, randomized, controlled study. Hum Reprod 18:1918–1921. doi:10.1093/humrep/deg368

    Article  CAS  PubMed  Google Scholar 

  30. Schenker JG, Margalioth EJ (1982) Intrauterine adhesions: an updated appraisal. Fertil Steril 37:593–610

    CAS  PubMed  Google Scholar 

  31. Polishuk WZ, Weinstein D (1976) The Soicher intrauterine device in the treatment of intrauterine adhesions. Acta Eur Fertil 7:215

    CAS  PubMed  Google Scholar 

  32. Orhue AAE, Aniken ME, Igbefoh JO (2003) A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet 82:49–56. doi:10.1016/S0020-7292(03)00030-4

    Article  CAS  PubMed  Google Scholar 

  33. Farhi J, Bar-Hava I, Homburg R, Dicker D, Ben-Rafael Z (1993) Induced regeneration of endometrium following curettage for abortion: a comparative study. Hum Reprod 8:1143–1144

    CAS  PubMed  Google Scholar 

  34. Goldenberg M, Sivan E, Sharabi Z, Maskiach S, Lipitz S, Seidman DS (1995) Reproductive outcome following hysteroscopic management of intrauterine septum and adhesions. Hum Reprod 10:2663–2665

    CAS  PubMed  Google Scholar 

  35. Roge P, Cravello L, D’Ercole C, Brussse M, Boubli L, Blanc B (1997) Intrauterine adhesions and fertility: results of hysteroscopic treatment. Gynaecol Endosc 6:225–228. doi:10.1046/j.1365-2508.1997.1050522.x

    Article  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Room No. 3085, Teaching Block, 3rd Floor, New Delhi, India

    K. K. Roy, Jinee Baruah, Jai Bhagwan Sharma, Sunesh Kumar, Garima Kachawa & Neeta Singh

Authors
  1. K. K. Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinee Baruah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jai Bhagwan Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sunesh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Garima Kachawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Neeta Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. K. Roy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roy, K.K., Baruah, J., Sharma, J.B. et al. Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome. Arch Gynecol Obstet 281, 355–361 (2010). https://doi.org/10.1007/s00404-009-1117-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-009-1117-x

Keywords

Search

Navigation