Results of centralized Asherman surgery, 2003–2013

Abstract

In 95% of women with Asherman syndrome, a healthy uterine cavity was restored with hysteroscopic adhesiolysis, in 1-3 attempts, with a 28.7% recurrence rate of spontaneous IUAs.

Prevention of postoperative adhesion reformation by intermittent intrauterine balloon therapy: a randomised controlled trial

“…The high recurrence rate of adhesions following hysteroscopic adhesiolysis in IUA remains one of the most difficult challenges in reproductive surgery . It is reported that increasing severity of disease is associated with lower pregnancy rate and a higher chance of requiring repeat surgery. Several studies have reported various methods to prevent adhesion reformation.…”

Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study

“…IUAs can also result in infertility and miscarriage, and increase the risks of intrauterine growth restriction and disorders of placental implantation in subsequent pregnancies . The treatment of IUAs poses a challenge, and the prognosis of severe disease remains poor . Thus the prevention of IUAs is of great importance, and should focus on the management of any retained products of conception …”

AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE)

“…This technique is costly, exposes the patient to ionizing radiation, and is technically challenging. Its advantages include use of a narrow hysteroscope, reduced risk of uterine perforation, and reduced risk of visceral damage should perforation occur, because no energy source is applied [65, 68]. A similar technique is described in an ambulatory setting using local anesthesia [69], with described success in mild adhesions only.…”

“…A retrospective cohort of 683 women with moderate to severe adhesions treated surgically with postoperative adjuvants including one or a combination of IUD, balloon, estrogen, and hyaluronic acid reported a pregnancy rate of 314/475 (66%) with 201/314 (61%) resulting in a live birth [102]. A national referral center in the Netherlands reported menstrual outcomes for 638 consecutively treated women over a 10-year period [68]. The success rate, defined as normal menstruation, was 95%.…”