A Matched Cohort Study Comparing the Outcome of Intrauterine Adhesiolysis for Asherman's Syndrome After Uterine Artery Embolization or Surgical Trauma

Abstract

Study ObjectiveTo compare the outcome of hysteroscopic adhesiolysis in women who had Asherman's syndrome after uterine artery embolization (UAE) with those who had Asherman's syndrome caused by surgical trauma. DesignA retrospective cohort study matched for age and intrauterine adhesion score (Canadian Task Force classification II-2). SettingA tertiary hysteroscopic center in a teaching hospital. PatientsNineteen women with Asherman's syndrome after UAE and 57 women with Asherman's syndrome caused by surgical trauma. InterventionsHysteroscopic adhesiolysis was followed by a second-look hysteroscopy 1 month later. The scoring system proposed by the American Fertility Society was used to evaluate intrauterine adhesion during hysteroscopy. Measurements and Main ResultsIn the UAE group, only 42.1% of women experienced improvement in menstruation defined as a subjective increase in menstrual flow after surgery, which was significantly lower than that of 86.0% observed in the non-UAE group. In the UAE group, the reduction of the American Fertility Society (AFS) score after intrauterine adhesiolysis was 30%, which was significantly lower than that of 80% in the non-UAE group. The pregnancy rate and live birth rate in the UAE group (5% and 0%, respectively) were significantly lower than the corresponding rates in the non-UAE group (33% and 25%, respectively). ConclusionThe outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome after UAE was worse than in women with Asherman's syndrome caused by surgical trauma.