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Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome.Yu D, Li TC, Xia E, Huang X, Liu Y, Peng X Hysteroscopic Center, Fuxing Hospital Affiliate of Capital University of Medical Sciences, Beijing, China. yudanny2006@yahoo.com.cn OBJECTIVE: To evaluate the outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome. DESIGN: Retrospective clinical study. SETTING: Hysteroscopic center of Fuxing Hospital in Beijing, China. PATIENT(S): Patients with Asherman's syndrome who presented with a history of infertility or recurrent pregnancy loss were included in the study. INTERVENTION(S): The adhesions were divided hysteroscopically by electrode needle or loop under direct vision. A second look hysteroscopy was performed after 3 months. MAIN OUTCOME MEASURE(S): The menstrual pattern, the time interval to conceive, and the reproductive outcome were recorded. RESULT(S): A total of 109 operative procedures were performed in 85 cases. Uterine perforation occurred on one occasion (0.9%). After hysteroscopic adhesiolysis, the chances of conception in women who remained amenorrheic (2 out of 11; 18.2%) were significantly lower than those who continued to have menses (37 out of 74; 50%). At second look hysteroscopy, the conception rate in women who had reformation of intrauterine adhesions (2 out of 17; 11.8%) was significantly lower than that of women who had a normal cavity (26 out of 44; 59.1%). CONCLUSION(S): The outcome of hysteroscopic adhesiolysis for Asherman's syndrome is significantly affected by recurrence of intrauterine adhesions. Further research in Asherman's syndrome should be directed toward reduction of adhesion reformation with a view to improving outcome. Published 11 March 2008 in Fertil Steril, 89(3): 715-22.
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