Intrauterine synechia and Asherman’s syndrome: a comprehensive approach to diagnosis and treatment

Abstract

Objective. To study the efficacy of different treatment options for patients with intrauterine synechia. Patients and methods. The results of the observation and treatment of 1218 patients of reproductive age with intrauterine synechia and Asherman’s syndrome were analyzed. Patients were retrospectively divided into 4 groups depending on the treatment option (mechanical dissection of synechiae, laser destruction without or under ultrasound or laparoscopic control). Results. The role and diagnostic value of office hysteroscopy for determining treatment tactics were defined; high efficacy of complex treatment (laser surgery, anti-adhesion gels, postoperative care and rehabilitation) for patients with uterine factor infertility was established: there was no relapse in 98% of patients, and pregnancy occurred in 57% of patients. Intraoperative ultrasound monitoring of patients with Asherman’s syndrome allowed to avoid intraoperative complications in all patients; menstrual cycle was restored in 97.5%, pregnancy occurred in 24%, repeated intervention was necessary in 18%. Conclusion. A comprehensive method including hysteroscopy, laser destruction of synechiae, administration of anti-adhesion gels, postoperative laser therapy, and rehabilitation with the use of chlorophyll-containing medications allows to achieve high efficacy in the treatment of patients with uterine infertility caused by intrauterine synechiae. The results of the analysis indicate the advisability of intraoperative ultrasound monitoring in the surgical treatment of Asherman’s syndrome. Key words: intrauterine synechiae, Asherman’s syndrome, laser destruction, uterine factor infertility