Reproductive Outcomes in Patients With Intrauterine Adhesions Following Hysteroscopic Adhesiolysis: Experience From the Largest Women's Hospital in China

Abstract Study Objective To analyze the reproductive outcome of hysteroscopic adhesiolysis and assess the diagnostic accuracy of transvaginal ultrasonography (TVS) in infertile women resulting from intrauterine adhesions (IUAs). Design Retrospective, cross-sectional study (Canadian Task Force classification II-2). Setting University tertiary referral center. Patients Three hundred and fifty-seven patients with mild, moderate, and severe IUAs who underwent hysteroscopic adhesiolysis between January 2012 and December 2015. Interventions Hysteroscopic adhesiolysis in the outpatient analgesic setting for infertility and IUAs. Measurements and Main Results Among the 357 patients (135 with mild IUAs, 116 with moderate IUAs, and 106 with severe IUAs) who underwent hysteroscopic adhesiolysis, 334 (93.6%) experienced a completely restored uterine cavity. The reproductive outcomes of 332 women (93%) were followed for an average duration of 27 ± 9 months, and the overall conception rate after hysteroscopic adhesiolysis was 48.2%, which decreased with increased IUA severity (mild, 60.7%; moderate, 53.4%; severe, 25%). The mean time to conception following hysteroscopic adhesiolysis was 9.7 ± 3.7 months. The miscarriage rate was 9.4%, and the live birth rate was no lower than 85.6%. Eleven patients (7.9%) had postpartum hemorrhage, including 6 (4.3%) due to adherent placenta and 3 (2.1%) due to placenta accreta. Conclusion Hysteroscopic adhesiolysis is a feasible and effective way to improve fertility in patients with Asherman's syndrome.