Comparison of operative and fertility outcome between groups of women with intrauterine adhesions after adhesiolysis

We evaluated intraoperative difficulty and fertility outcome in women with intrauterine synechiae of different severity after hysteroscopic adhesiolysis. The 86 women were recruited before fertility treatment, during hysterosalpingogram (HSG) or diagnostic hysteroscopy, over 3 years. Fifty-eight women had a history of pregnancy terminations or miscarriages, and 28 had undergone myomectomy or correction of congenital uterine anomalies by conventional surgical procedures. Group A (11 women) had over 50% of the fundal cavity obliterated by fibrous tissue, and no tubal ostia could be seen; group B (26 women) had less than 50% of the fundal cavity obliterated by fibrous tissue, and one tubal ostium could be seen; group C (49 women) had a single adhesion thicker than 1 cm. Postoperative hemorrhage requiring treatment occurred in three women from group A and two from group B. All had subsequent HSGs, and three from group A (with previous myomectomies) required a second operation and still failed to achieve an adequate fundal cavity. All patients subsequently received in vitro fertilization. Three women from group A became pregnant. Ten in group B became pregnant, eight of whom delivered or have a continuing pregnancy. In group C, 17 became pregnant, of whom 13 delivered or have a continuing pregnancy. Adhesions after suturing the uterine cavity after open myomectomy or corrective surgery seem to cause maximum damage and yield poor results in both hysteroscopic correction and reproductive performance.