Balloon fluoroscopy as treatment for intrauterine adhesions: a novel approach

Objective: To report a unique fluoroscopically guided approach to treat severe intrauterine adhesions and cervical stenosis using balloon hysteroplasty. Design: Case report. Setting: Military-based fertility center. Patient(s): A 33-year-old woman undergoing assisted reproductive technology whose uterus could not be cannulated because of the development of intrauterine synechiae and cervical stenosis after a post-IUI infection that was further complicated by a prominent lower uterine segment-filling defect in the location of a prior cesarean delivery scar. Intervention(s): Fluoroscopic cannulation and balloon uterine dilation. Main Outcome Measure(s): Resolution of synechiae by hysterosalpingogram and successful uterine cannulation. Result(s): A postprocedure hysterosalpingogram demonstrated a normalized uterine cavity with the exception of a persistent prominent lower uterine segment-filling defect from a prior cesarean delivery. A frozen ET cycle was performed successfully. Conclusion(s): Hysteroplasty, using standard interventional radiographic techniques, may provide an alternative treatment modality for patients with intrauterine adhesions and lower uterine defects from prior cesarean deliveries in select cases. While treating intrauterine adhesions improves pregnancy outcome, the effect of lower uterine segment-filling defects from cesarean deliveries on pregnancy outcome in assisted reproductive technology cycles warrants further investigation. (Fertil Steril (R) 2008; 90: 2005. e15-e17. (C)2008 by American Society for Reproductive Medicine.)