Total adhesions treated by hysteroscopy Must we stop at two procedures

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

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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.

Vol 98, Issue 4, Pages 980-985

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.

Read the full text at: http://www.fertstert.org/article/S0015-0282(12)00685-1/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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