Comprehensive treatment for infertile women with severe Asherman syndrome

Objective: Many preoperative, intraoperative, and postoperative methods have been described that improve the outcomes of women with severe Asherman syndrome, and it is likely that an integrated application of all of these methods may provide better reproductive outcomes; however, there is as yet no report on this type of integrated approach. Materials and methods: The cases of four infertile women with severe Asherman syndrome were analyzed retrospectively. The comprehensive therapeutic plan for the four women included (1) preoperative office hysteroscopy to confirm the diagnosis and evaluate the severity of disease; (2) the use of ultrasound-guided intraoperative abdominal procedures during the surgical procedure, including hysteroscopic adhesiolysis to ensure the entire the hysteroscopic dissection, and placement of a Hyalobarrier (R) gel and an intrauterine balloon catheter at the end of the surgery; (3) postoperative oral estrogen supplementation to enhance endometrial proliferation, removal of the balloon catheter, and a second-look office hysteroscopy; and (4) in vitro fertilization and embryo transfer (IVF & ET) for three of the four patients. Result: After treatment, the endometrium was significantly thicker than at baseline (median endometrial thickness, 7.5 mm versus 3.0 mm, p < 0.05). All the women (100%, 4/4) conceived successfully (three undergoing IVF & ET, and one had a spontaneous pregnancy), but only two patients had a term pregnancy with cesarean section (one placenta previa and the other placental abruption), contributing to 50% of successful term pregnancies. One patient had the complication of abortion after amniocentesis. The last one woman underwent an abortion because of thyroid problems. Conclusion: Comprehensive management offers promising reproductive outcomes for infertile women with severe Asherman syndrome. Copyright (C) 2014, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. All rights reserved.