Hysteroscopic treatment of severe Asherman's syndrome and subsequent fertility

In a retrospective case report series, we evaluated the efficacy of hystero scopic. adhesiolysis in patients with severe Asherman's syndrome. In 31 pat ients with permanent severe adhesions, hysteroscopic treatment was performe d. In all patients, uterine cavity with at least one free ostial area was r estored after one (n = 16), two (n = 7), three (n = 7), and four (n = 1) su rgical procedures. All previously amenorrhoeic patients (n = 16) had resump tion of menses, Twenty-eight patients were followed-up with a mean time of 31 months (range 2-84), Fifteen pregnancies were obtained in 12 patients an d the outcomes were the following: two first trimester missed abortions, th ree second trimester fetal losses, one second trimester termination of preg nancy for multiple fetal abnormalities and nine live births in nine differe nt patients. Pregnancy rate after treatment was 12/28 (42.8%) and live birt h rate was 9/28 (32.1%), In patients less than or equal to 35 years, 10 out of 16 conceived (62.5%) versus two out of 12 (16.6%) in patients >35 years (P = 0.01). Three patients were lost to follow-up and their results omitte d. In nine patients with live births, one Caesarean hysterectomy for placen ta accreta and one hypogastric arteries ligation for severe haemorrhage and placenta accreta were performed. Hysteroscopic treatment of severe Asherma n's syndrome appeared to be effective for the, reconstruction of a function al uterine cavity with a 42.8% pregnancy rate. However, these pregnancies w ere at risk for haemorrhage with abnormal placentation.