Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome

Objective To evaluate the outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome. Design Retrospective clinical study. Setting Hysteroscopic center of Fuxing Hospital in Beijing, China. Patient(s) Patients with Asherman's syndrome who presented with a history of infertility or recurrent pregnancy loss were included in the study. Intervention(s) The adhesions were divided hysteroscopically by electrode needle or loop under direct vision. A second look hysteroscopy was performed after 3 months. Main Outcome Measure(s) The menstrual pattern, the time interval to conceive, and the reproductive outcome were recorded. Result(s) A total of 109 operative procedures were performed in 85 cases. Uterine perforation occurred on one occasion (0.9%). After hysteroscopic adhesiolysis, the chances of conception in women who remained amenorrheic (2 out of 11; 18.2%) were significantly lower than those who continued to have menses (37 out of 74; 50%). At second look hysteroscopy, the conception rate in women who had reformation of intrauterine adhesions (2 out of 17; 11.8%) was significantly lower than that of women who had a normal cavity (26 out of 44; 59.1%). Conclusion(s) The outcome of hysteroscopic adhesiolysis for Asherman's syndrome is significantly affected by recurrence of intrauterine adhesions. Further research in Asherman's syndrome should be directed toward reduction of adhesion reformation with a view to improving outcome.