Total adhesions treated by hysteroscopy Must we stop at two procedures

Capsule:
It is often appropriate to propose more than two hysteroscopic procedures to treat severe Asherman syndrome to restore fertility.

Authors:
Hervé Fernandez, M.D., Ph.D., Sarah Peyrelevade, M.D., Guillaume Legendre, M.D., Erika Faivre, M.D., Xavier Deffieux, M.D., Ph.D., André Nazac, M.D.

Volume 98, Issue 4, Pages 980-985, October 2012

Abstract:

Objective:
To study the anatomical and fertility results after treatment for Asherman syndrome involving more than two separate surgical procedures.

Design:
Retrospective case series.

Setting:
Tertiary center.

Patients:
Twenty-three women who had Asherman syndrome and required more than two hysteroscopic operative procedures.

Intervention:
Third or higher-order operative hysteroscopy procedure.

Outcome measure(s):
Fertility rate.

Results:
The women’s mean age was 34 years (+5.8) when treatment for adhesions began. All women initially had adhesions classified as severe with total amenorrhea. Twelve patients had three separate procedures to treat the adhesions, nine had four treatments, and two had five treatments. One woman was lost to follow-up. At the conclusion of treatment, more than 80% of the women had either no adhesions at all or only mild adhesions. The overall pregnancy rate was 40.9%; there were 9 pregnancies and 6 term infants (27.2%). All but one of these pregnancies were spontaneous. The mean time to pregnancy was 10.5 months (±4.7).

Conclusion:
The number of hysteroscopic procedures envisioned to treat Asherman syndrome should not be a limiting factor. It is appropriate to treat women, especially those younger than 35 years, until uterine anatomy permits the visualization of both ostia.

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