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Han, Kim, Im, and Park: Factors affecting reproductive outcome of hysteroscopic adhesiolysis for intrauterine adhesion: Live-birth rate after surgery
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(10): 707-712.

Published online: 9 October 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.10.707

Factors affecting reproductive outcome of hysteroscopic adhesiolysis for intrauterine adhesion: Live-birth rate after surgery

Woo-Suk Han, MD, Min-Kyoung Kim, MD, Seung-Yeon Im, MD, Won I Park, MD

Department of Obstetrics and Gynecology, Eulji University School of Medicine, Seoul, Korea.

Corresponding author: Won I Park, MD. Department of Obstetrics and Gynecology, Eulji General Hospital, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 139-872, Korea. Tel: +82-2-970-8245, Fax: +82-2-972-0068, pwi3110@eulji.ac.kr

Received 30 May 2012       Revised 5 August 2012       Accepted 20 August 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The purpose of this study is to assess the impact of various factors of hysteroscopic lysis of intrauterine adhesion on live-birth rate after surgery.

Methods

Medical records of 54 patients suffering from infertility or recurrent spontaneous abortion were retrospectively analyzed. The independent variables were degree of intrauterine adhesion, surgical technique, use of intrauterine Foley catheter, insertion of intrauterine device, and dose of postoperative estradiol. Multivariate analysis as well as univariate analysis was performed.

Results

Among the 54 patients, 17 patients gave live-birth. The degree of intrauterine adhesion was found to be a sole factor affecting the live-birth rate by univariate and multivariate analysis. The mechanical dissection with scissors had been resulted a higher live-birth rate against resectoscopic electrosurgery, but the difference was not statistically significant.

Conclusion

The degree of intrauterine adhesion is the most important factor affecting the live-birth. The uses of intrauterine Foley catheter, insertion of intrauterine device and dose of postoperative estradiol have little impact.

Keywords: Asherman's syndrome, Adhesiolysis, Hysteroscopy, Reproductive outcome

Figures and Tables

Fig. 1
Flowchart of patient selection.
kjog-55-707-g001
Table 1
Univariate analysis of factors affecting live-birth rate
kjog-55-707-i001
Table 2
Multivariate analysis of factors affecting live-birth rate
kjog-55-707-i002

References

1. Fritsch H. Ein Fall von volligem Schwund der Gebormutterhohle nach Auskratzung. Zentralbl Gynaekol. 1894. 18:1337–1342.
2. Asherman JG. Amenorrhoea traumatica (atretica). J Obstet Gynaecol Br Emp. 1948. 55:23–30.
3. March CM. Intrauterine adhesions. Obstet Gynecol Clin North Am. 1995. 22:491–505.
4. Westendorp IC, Ankum WM, Mol BW, Vonk J. Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum Reprod. 1998. 13:3347–3350.
5. March CM, Israel R. Gestational outcome following hystero-scopic lysis of adhesions. Fertil Steril. 1981. 36:455–459.
6. Fernandez H, Al-Najjar F, Chauveaud-Lambling A, Frydman R, Gervaise A. Fertility after treatment of Asherman's syndrome stage 3 and 4. J Minim Invasive Gynecol. 2006. 13:398–402.
7. Pabuccu R, Onalan G, Kaya C, Selam B, Ceyhan T, Ornek T, et al. Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopic adhesiolysis of intrauterine synechiae. Fertil Steril. 2008. 90:1973–1977.
8. Duffy S, Reid PC, Sharp F. In-vivo studies of uterine electrosurgery. Br J Obstet Gynaecol. 1992. 99:579–582.
9. Propst AM, Hill JA 3rd. Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med. 2000. 18:341–350.
10. Yu D, Li TC, Xia E, Huang X, Liu Y, Peng X. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome. Fertil Steril. 2008. 89:715–722.
11. March CM, Israel R, March AD. Hysteroscopic management of intrauterine adhesions. Am J Obstet Gynecol. 1978. 130:653–657.
12. Eum HJ, Choi EY, Cha JM, Chung JY, Park EJ, Kim SH, et al. Clinical analysis of hysteroscopic treatment of intrauterine adhesion. Korean J Obstet Gynecol. 2001. 44:1285–1290.
13. Kim BW, Shin SH, Jung S, Hong SW, Kim DH, Kee KS, et al. Clinical outcome of intrauterine adhesion after resectoscopy. Korean J Obstet Gynecol. 1999. 42:2242–2247.
14. Thomson AJ, Abbott JA, Kingston A, Lenart M, Vancaillie TG. Fluoroscopically guided synechiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes. Fertil Steril. 2007. 87:405–410.
15. Capella-Allouc S, Morsad F, Rongières-Bertrand C, Taylor S, Fernandez H. Hysteroscopic treatment of severe Asherman's syndrome and subsequent fertility. Hum Reprod. 1999. 14:1230–1233.
16. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988. 49:944–955.
17. Thomson AJ, Abbott JA, Deans R, Kingston A, Vancaillie TG. The management of intrauterine synechiae. Curr Opin Obstet Gynecol. 2009. 21:335–341.
18. Roy KK, Baruah J, Sharma JB, Kumar S, Kachawa G, Singh N. Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome. Arch Gynecol Obstet. 2010. 281:355–361.
19. Robinson JK, Colimon LM, Isaacson KB. Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman's syndrome). Fertil Steril. 2008. 90:409–414.
20. Orhue AA, Aziken ME, Igbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet. 2003. 82:49–56.
21. March CM. Asherman's syndrome. Semin Reprod Med. 2011. 29:83–94.
22. Bosteels J, Weyers S, Puttemans P, Panayotidis C, Van Herendael B, Gomel V, et al. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update. 2010. 16:1–11.
23. Zikopoulos KA, Kolibianakis EM, Platteau P, de Munck L, Tournaye H, Devroey P, et al. Live delivery rates in subfertile women with Asherman's syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system. Reprod Biomed Online. 2004. 8:720–725.
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