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
To study the anatomic and fertility results after treatment for Asherman syndrome involving more than two separate surgical procedures.
Retrospective case series.
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.
Available from: PubMed Central
- "One study  included IUD as a single ancillary treatment. In 2 studies [44, 45], no therapy was administered after adhesiolysis. Surgical instruments and techniques used for adhesiolysis included uterine sound [19, 39], with uterine dilators [7, 29, 32], mechanical D&C , hysteroscopic scissors [9, 13, 16, 18, 34, 35, 38–40], hysteroscopic, monopolar, or bipolar knife/needle [29, 34, 39, 45], and bipolar electrosurgery system [7, 16, 39, 45]. "
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ABSTRACT: The primary purpose of this paper is to assess the efficacy of the use of the intrauterine device (IUD) as an adjunctive treatment modality, for intrauterine adhesions (IUAs). All eligible literatures were identified by electronic databases including PubMed, Scopus, and Web of Science. Additional relevant articles were identified from citations in these publications. There were 28 studies included for a systematic review. Of these, 5 studies were eligible for meta-analysis and 23 for qualitative assessment only. Twenty-eight studies related to the use of IUDs as ancillary treatment following adhesiolysis were identified. Of these studies, 25 studies at least one of the following methods were carried out as ancillary treatment: Foley catheter, hyaluronic acid gel, hormonal therapy, or amnion graft in addition to the IUD. There was one study that used IUD therapy as a single ancillary treatment. In 2 studies, no adjunctive therapy was used after adhesiolysis. There was a wide range of reported menstrual and fertility outcomes which were associated with the use of IUD combined with other ancillary treatments. At present, the IUD is beneficial in patients with IUA, regardless of stage of adhesions. However, IUD needs to be combined with other ancillary treatments to obtain maximal outcomes, in particular in patients with moderate to severe IUA.
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ABSTRACT: Hysteroscopic adhesiolysis has become the preferred option in the management of Intrauterine Adhesions (IUA). The use of estrogen as perioperative adjuvant therapy has been suggested in preventing re-adhesions. The primary objective of this article is to review existing literature for evidence on the efficacy of estrogen therapy in the management of IUA.
All eligible studies were identified using a computerized database (Pubmed, Scopus and Web of science) from its earliest publication date to July 2013. Additional relevant articles were identified from citations within these publications.
26 studies reporting the use of hormonal therapy as ancillary treatment following adhesiolysis were identified. From these studies, 19 used at least one of the following methods: IUD, Foley catheter, hyaluronic acid gel, or amnion graft in addition to hormonal therapy as ancillary treatment. There were 7 studies that used hormonal therapy as a single ancillary treatment. Two studies did not use any adjunctive therapy following adhesiolysis. Meta-analysis could not be performed due to the differences in treatment modalities in these articles. There was a wide range of reported menstrual and fertility outcomes. Better menstrual and fertility outcomes were associated with the use of estrogen combined with other methods of ancillary treatment.
At present, hormonal therapy, particularly estrogen therapy brings beneficial effects to patients with IUA regardless of stage of adhesions. However, estrogen therapy needs to be combined with other ancillary treatments to obtain the maximal outcomes, especially in patients with moderate to severe IUA.
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ABSTRACT: Intrauterine adhesions (Asherman syndrome) are rare and mainly seen after delivery or abortion in the presence of retained placental tissue. This descriptive study aimed to identify common risk factors for intrauterine adhesions. In a 10 year period 61 women were identified with intrauterine adhesions. The pathology was suspected by symptoms, ultrasonography or on hysterosalpingography, but a final diagnosis could only be given after hysteroscopy. There was no definite evidence regarding methods for prevention and treatment of the disorder. It seems, however, that a conservative approach to curettage, hysteroscopic removal of retained tissue and the use of distending media is of importance, together with gentle tissue handling when such procedures are required. This article is protected by copyright. All rights reserved.
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