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.

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Publisher Full Text

Authors

Roy KK, Baruah J, Sharma JB, Kumar S, Kachawa G, Singh N

Institution

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Room No. 3085, Teaching Block, 3rd Floor, New Delhi, India. drkkroy2003@yahoo.co.in

Source

Archives of gynecology and obstetrics 281:2 2010 Feb pg 355-61

MeSH

Adult
Female
Fertilization
Gynatresia
Humans
Hysteroscopy
Infant, Newborn
Infertility, Female
Menstrual Cycle
Pregnancy
Retrospective Studies
Tissue Adhesions

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19455349