Techniques and instrumentation
Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome

https://doi.org/10.1016/j.fertnstert.2007.03.070Get rights and content

Objective

To evaluate the outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome.

Design

Retrospective clinical study.

Setting

Hysteroscopic center of Fuxing Hospital in Beijing, China.

Patient(s)

Patients with Asherman's syndrome who presented with a history of infertility or recurrent pregnancy loss were included in the study.

Intervention(s)

The adhesions were divided hysteroscopically by electrode needle or loop under direct vision. A second look hysteroscopy was performed after 3 months.

Main Outcome Measure(s)

The menstrual pattern, the time interval to conceive, and the reproductive outcome were recorded.

Result(s)

A total of 109 operative procedures were performed in 85 cases. Uterine perforation occurred on one occasion (0.9%). After hysteroscopic adhesiolysis, the chances of conception in women who remained amenorrheic (2 out of 11; 18.2%) were significantly lower than those who continued to have menses (37 out of 74; 50%). At second look hysteroscopy, the conception rate in women who had reformation of intrauterine adhesions (2 out of 17; 11.8%) was significantly lower than that of women who had a normal cavity (26 out of 44; 59.1%).

Conclusion(s)

The outcome of hysteroscopic adhesiolysis for Asherman's syndrome is significantly affected by recurrence of intrauterine adhesions. Further research in Asherman's syndrome should be directed toward reduction of adhesion reformation with a view to improving outcome.

Section snippets

Subjects

The study was carried out at the hysteroscopic center of Fuxing Hospital in Beijing, China. Institutional Review Board approval was obtained before the study. From January 1998 to June 2005, a total of 122 women with Asherman's syndrome (intrauterine adhesions) who presented with a history of infertility or recurrent pregnancy loss were initially included in the study.

Investigations

Before treatment, all of the patients underwent preoperative evaluations, including pelvic ultrasonography, biphasic basal body

Patient Characteristics

The age of the 85 patients included in the final analysis ranged from 22 years to 43 years (mean 31.1 years). Among them, six patients (7.1%) had a history of curettage on postpartum uterine cavity; 13 patients (15.3%) had a history of curettage for miscarriages; 36 patients (42.4%) had a history of terminations of pregnancies; five patients (5.9%) had a history of curettage on nongravid uterus; 4 patients (4.7%) had a history of hysteroscopic surgery, including polypectomy (n = 1), myomectomy

Classification of Disease and Selection of Cases

In the present study, we have reported on the outcome of a consecutive series of 85 cases of hysteroscopic adhesiolysis for Asherman's syndrome. Although there have been a number of reports on the subject in the literature, it is difficult to directly compare the results for several reasons. First, the classification of the severity of the intrauterine adhesions is not uniform even though it is well recognized that the outcome of treatment depends on the severity of the disease 1, 7, 11, 12.

References (23)

  • P. Roge et al.

    Intrauterine adhesions and fertility: results of hysteroscopic treatment

    Gynaecol Endosc

    (1997)
  • Cited by (143)

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