A Matched Cohort Study Comparing the Outcome of Intrauterine Adhesiolysis for Asherman's Syndrome After Uterine Artery Embolization or Surgical Trauma

Study Objective: To compare the outcome of hysteroscopic adhesiolysis in women who had Asherman's syndrome after uterine artery embolization (UAE) with those who had Asherman's syndrome caused by surgical trauma. Design: A retrospective cohort study matched for age and intrauterine adhesion score (Canadian Task Force classification II-2). Setting: A tertiary hysteroscopic center in a teaching hospital. Patients: Nineteen women with Asherman's syndrome after UAE and 57 women with Asherman's syndrome caused by surgical trauma. Interventions: Hysteroscopic adhesiolysis was followed by a second-look hysteroscopy 1 month later. The scoring system proposed by the American Fertility Society was used to evaluate intrauterine adhesion during hysteroscopy. Measurements and Main Results: In the UAE group, only 42.1% of women experienced improvement in menstruation defined as a subjective increase in menstrual flow after surgery, which was significantly lower than that of 86.0% observed in the non-UAE group. In the UAE group, the reduction of the American Fertility Society (AFS) score after intrauterine adhesiolysis was 30%, which was significantly lower than that of 80% in the non-UAE group. The pregnancy rate and live birth rate in the UAE group (5% and 0%, respectively) were significantly lower than the corresponding rates in the non-UAE group (33% and 25%, respectively). Conclusion: The outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome after UAE was worse than in women with Asherman's syndrome caused by surgical trauma. (C) 2014 AAGL. All rights reserved.