Association and Management of Adenomyosis Amongst Patients with Asherman's Syndrome

Abstract

Study Objective To provide the first characterization of concomitant Asherman's syndrome and adenomyosis, and subsequent obstetrical outcomes. Design A retrospective cohort study from 01 January 2015 to 01 March 2019. Setting A community teaching hospital affiliated with a large academic medical center. Patients or Participants 227 Asherman's syndrome patients with available hysteroscopy and pelvic ultrasound reports. Interventions Determinants of adenomyosis and the impact of adenomyosis on fertility and obstetrical outcomes in Asherman's syndrome patients. Measurements and Main Results A telephone survey and confirmatory chart review were conducted to obtain information on patients’ demographics, gynecologic and obstetric history, past medical and surgical history, and Asherman's syndrome management. Adenomyosis was the most common co-occurring uterine finding, detected in 39 Asherman's patients. The overall primary symptom was infertility. Adenomyosis patients reported a different menstrual pattern than patients with Asherman's syndrome only. Adenomyosis prevalence trended higher with increasing Asherman's severity, but there were no significant independent predictors of adenomyosis. In this cohort, 77 patients attempted conception and produced 87 pregnancies, 13 of which were ongoing at study conclusion. Age (OR 0.7, 95% CI 0.5-0.9) and use of assisted reproductive technology (OR 0.1, 95% CI 0.02-0.995) were negatively associated with pregnancy. Postpartum dilation & curettage/dilation & evacuation was a risk factor for miscarriage (OR 13.6, 95% CI 1.4-129.5). Age (OR 0.9, 95% CI 0.8-0.988) and severe Asherman's disease (OR 0.1, 95% CI 0.001-0.1) were negatively associated with live birth. Adenomyosis was not an independent predictor of pregnancy rate, miscarriage rate, or live birth rate among Asherman's patients. Conclusion Adenomyosis is relatively common in Asherman's syndrome patients. Any distinct detriment to fertility from adenomyosis may be overshadowed by the lasting effects of Asherman's adhesions when these diseases occur together. Larger studies to establish management guidelines for concomitant disease are needed.