Hysteroscopic adhesiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes

Abstract

Purpose Most patients with Asherman's syndrome present with infertility and menstrual problems. In this retrospective clinical study, we analyzed patients with Asherman's syndrome who underwent hysteroscopic adhesiolysis to examine their associated symptoms, disease etiologies, and fertility outcomes. Methods Twenty‐seven patients with Asherman's syndrome that were diagnosed using hysteroscopy were recruited. The chief complaints were infertility, hypomenorrhea, and amenorrhea. Each case of Asherman's syndrome was classified according to the American Fertility Society classification. Hysteroscopic adhesiolysis was performed in all cases and concomitant transabdominal ultrasonography was conducted in cases with extensive and dense adhesions. Results There were no complications associated with the hysteroscopic procedure. Normal menstrual cycles resumed in all cases. Of the 16 infertile patients, 9 conceived. Three patients achieved term deliveries and one patient is currently pregnant. None of the patients had obstetric complications. Two patients had spontaneous abortions, one had an ectopic pregnancy, one had an abortion at 16 weeks’ gestation due to cervical incompetence, and one had a molar pregnancy and required uterine artery embolization for uncontrolled hemorrhaging during a dilatation and curettage procedure. Conclusions Hysteroscopic adhesiolysis with transabdominal ultrasonography is a suitable treatment method for Asherman's syndrome. Subfertile patients with Asherman's syndrome undergoing adhesiolysis should be appropriately informed about the risk of associated life‐threatening complications and preterm delivery.

Efficacy of Intrauterine Device in the Treatment of Intrauterine Adhesions

“…Characteristics of the included studies are given ( Table 1 ). In our systematic review the classification systems used included ( Table 2 ) those from the American Fertility Society [ 9 , 16 , 27 , 28 , 34 – 36 , 41 , 44 , 45 ], European Society of Gynaecological Endoscopy [ 7 , 29 , 39 ], American Society for Reproductive Medicine [ 11 ], European Society of Hysteroscopy [ 29 , 38 ], European Society of Human Reproduction and Embryology [ 45 ], modified Sugimoto criteria [ 13 ], and the March classification system [ 18 ]. Three studies [ 7 , 29 , 45 ] reported the stages of adhesion using 2 classification systems; however, several studies [ 8 , 12 , 19 , 30 – 33 , 37 , 42 , 43 ] did not provide any information of the classification system used.…”

<p>Asherman&rsquo;s syndrome: current perspectives on diagnosis and management</p>

“…Few studies have evaluated the outcome after hysteroscopic adhesiolysis. Overall restoration of normal menstruation is observed in 75%–100% 4,38,50,55,56. The effect on fertility is influenced by several other factors, eg, the age of the patient, and whether infertility is primary or secondary.…”

Intracytoplasmic sperm injection following hysteroscopic adhesiolysis in patients with moderate intrauterine adhesions

“…In the literature, the incidence of perforation without ultrasonography reached 9% in severe cases of Asherman's syndrome [24]. It was therefore advised to use ultrasonography to safeguard against perforation of the uterus [25].…”