Article

Total adhesions treated by hysteroscopy: Must we stop at two procedures?

Université Paris Sud 11, Le Kremlin Bicêtre, France. Electronic address: .
Fertility and sterility (Impact Factor: 4.59). 07/2012; 98(4):980-5. DOI: 10.1016/j.fertnstert.2012.06.032
Source: PubMed

ABSTRACT To study the anatomic and fertility results after treatment for Asherman syndrome involving more than two separate surgical procedures.
Retrospective case series.
Tertiary center.
Twenty-three women who had Asherman syndrome and required more than two hysteroscopic operative procedures.
Third or higher-order operative hysteroscopy procedure. MEAN OUTCOME MEASURE(S): Fertility rate.
The women's mean age was 34 years (±5.8 years) when treatment for adhesions began. All women initially had adhesions classified as severe with total amenorrhea. Twelve patients had three separate procedures to treat the adhesions, nine had four treatments, and two had five treatments. One woman was lost to follow-up. At the conclusion of treatment, more than 80% of the women had either no adhesions at all or only mild adhesions. The overall pregnancy rate was 40.9%; there were nine pregnancies and six term infants (27.2%). All but one of these pregnancies were spontaneous. The mean time to pregnancy was 10.5 months (±4.7 months).
The number of hysteroscopic procedures envisioned to treat Asherman syndrome should not be a limiting factor. It is appropriate to treat women, especially those younger than 35 years, until uterine anatomy permits the visualization of both ostia.

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    • "Characteristics of the included studies are given (Table 1). In our systematic review the classification systems used included (Table 2) those from the American Fertility Society [9, 16, 27, 28, 34–36, 41, 44, 45], European Society of Gynaecological Endoscopy [7, 29, 39], American Society for Reproductive Medicine [11], European Society of Hysteroscopy [29, 38], European Society of Human Reproduction and Embryology [45], modified Sugimoto criteria [13], and the March classification system [18]. Three studies [7, 29, 45] reported the stages of adhesion using 2 classification systems; however, several studies [8, 12, 19, 30–33, 37, 42, 43] did not provide any information of the classification system used. "
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