Anatomical outcomes versus clinical outcomes in cases of Asherman‘s Syndrome following Hysteroscopic Adhesiolysis and IUCD insertion : A hospital based comparative study

Rehana Najam; Nivedita Chawla; Astha Lalwani; Prachi Singh

Volume : IX, Issue : II, February - 2020

Anatomical outcomes versus clinical outcomes in cases of Asherman‘s Syndrome following Hysteroscopic Adhesiolysis and IUCD insertion : A hospital based comparative study

Rehana Najam, Nivedita Chawla, Astha Lalwani, Prachi Singh

Abstract :

Background: Hysteroscopy has revolutionised the diagnosis and treatment of Asherman�s syndrome the main challenges being not only correction of anatomical defect but also good outcome in terms of menstrual regularity and conception. The present study was undertaken to assess whether hysteroscopic anatomical correction of uterine cavity translated to a successful reproductive and clinical outcome. Methods: All patients presenting with subfertility, menstrual disorders, recurrent pregnancy loss, and diagnosed with Asherman�s syndrome on hysteroscopy were included in the study. These patients underwent laparohysteroscopy postmenstrually. Adhesiolysis followed by inert IUCD insertion was done. Patients were advised conjugated equine estrogens for 2 months. . Second look hysteroscopy was done after two months of the index procedure, while third look hysteroscopy was done only in cases with reformed or persistent adhesions on second look hysteroscopy. All cases were followed for one year with clinical and radiological and hysteroscopic parameters. Results: Of the 211 patients who were evaluated, 81 had Asherman syndrome . Of these 42% (n=34) had mild, 33% (n=27)moderate and 25% (n=20) had severe adhesions on hysteroscopy. Menstruation was restored in 78.5% (n=33) patients out of 42 patients & cumulative pregnancy rate of 47.4% was found. Out of 70 cases of infertility, 37 patients conceived spontaneously with a pregnancy rate of 52.85% and live birth rate of 29.4% .Spontaneous conceptions were maximum in the mild and moderate category. Conclusions: Women who underwent hysteroscopic adhesiolysis showed significant improvement in anatomical , menstrual pattern and increased rates of conception as well as live birth rate per conception. Recurrence of intrauterine adhesions is an important consideration while performing adhesiolysis and adequate precautions must be taken