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

Abstract

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.