Surgical treatment of Asherman syndrome and reproductive outcome

Introduction. Asherman syndrome may be challenging to treat. This study presented the results after hysteroscopic treatment of Asherman syndrome in our clinic focusing on the reproductive outcome. Methods. A total of 43 women were operated in the course of a five-year period. The women were post-operatively treated with hyaluronic acid gel, intrauterine device (IUD) and hormonal supplementation. A second-look minihysteroscopy and removal of the IUD were conducted seven weeks later. Data concerning the results after one or more operations were obtained from a phone interview and from the medical records. Results. The pregnancy rate among the 38 women who wished to conceive was 82%, and the live birth rate was 63%. Among the 31 women who became pregnant, 42% achieved spontaneous pregnancy, whereas 58% became pregnant after fertility treatments. An increased risk of obstetric complications was recorded, especially related to abnormal placentation and impaired placenta function. Conclusions. Hysteroscopic treatment of Asherman syndrome seems to be a safe procedure, but a risk possibly exists of obstetrical complications in the subsequent pregnancies. Pregnancies following hysteroscopic adhesiolysis should be considered high-risk pregnancies.