Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes

Abstract

To study severity of intrauterine adhesions after uterine arterial embolization and to evaluate fertility, pregnancy and obstetrical outcomes after hysteroscopic treatment. Retrospective Cohort SETTING: French University Hospital PATIENTS: Thirty-three patients under the age of 40 years who were treated by uterine artery embolization with non-absorbable microparticles between 2010 and 2020 for symptomatic fibroids or adenomyosis or postpartum hemorrhage. All patients had a diagnosis of intrauterine adhesions after embolization. All patients desired future fertility. Intrauterine adhesions was treat with operative hysteroscopy. Severity of intrauterine adhesions, number of operative hysteroscopies performed to obtain a normal cavity shape, pregnancy rate, obstetrical outcomes. On our 33 patients, 81.8% had severe intrauterine adhesions (state IV et V according to the European Society of Gynecological Endoscopy or state III according to the American fertility society classification). To restore fertility potential, an average of 3.4 operative hysteroscopies had to be performed [IC 95% (2.56 - 4.16)]. We reported a very low rate of pregnancy (8/33, 24%). Obstetrical outcomes reported are 50% of premature birth and 62,5% of delivery hemorrhage partly due to 37,5% of placenta accreta. We reported also 2 neonatal deaths. Intrauterine adhesions after uterine embolization are severe, more difficult to treat than others synechiae, probably related to endometrial necrosis. Pregnancy and obstetrical outcomes have shown a low pregnancy rate, an increased risk of preterm delivery, a high risk of placental disorders and very severe post-partum hemorrhage. Those results have to alert gynecologists and radiologists to the use of UAE in women who desired future fertility.