In Vitro Fertilization in Women with Asherman's Syndrome - Comparison of Maternal and Neonatal Morbidity

Abstract

Study Objective We seek to examine effects of in vitro fertilization (IVF) on the maternal and neonatal morbidities of patients previously treated for Asherman's syndrome. Design A retrospective cohort study using fertility and obstetrical data from our institution's electronic medical records. Setting A community teaching hospital affiliated with a large academic medical center. Patients or Participants 43 singleton births identified from 40 women previously treated at our institution for Asherman's syndrome. Interventions Data analysis comparing the maternal and neonatal outcomes in singleton births from Asherman's syndrome patients who had been treated with hysteroscopic adhesiolysis, then either conceived spontaneously versus IVF. Measurements and Main Results Of the 43 singleton births, 27/43 (62.8%) were conceived spontaneously and 16/43 (37.2%) were conceived through IVF. No statistical differences were found in antepartum conditions within clinical pregnancies in patients who conceived spontaneously versus through IVF. There was no difference in the rate of preterm birth in Asherman's pregnancies (11.6%) regardless of conception method. We documented 4/43 (9.3%) cases of IUGR in our study, with no difference in between spontaneous versus IVF conception groups. The rate of morbidly adherent placenta (MAP) in Asherman's syndrome patients was 14.0%, with no differences in the rate of MAP found in the two conception groups. Postpartum hemorrhage in Asherman's patients was documented at 32.6% (14/43). Newborn anatomic malformations of any cause were documented in 18.6% (8/43) of all singleton births. Conclusion Our series indicates a higher prevalence of IUGR, MAP, post-partum hemorrhage, and newborn anatomical malformations in Asherman's syndrome pregnancies compared to incidences reported in pregnancies within the general population. However, we found no significant differences in the maternal and neonatal outcomes of Asherman's syndrome patients who conceived either spontaneously or through IVF after being treated with hysteroscopic adhesiolysis.