Patient Reported Menstrual and Obstetrical Outcomes Following Office Based Hysteroscopic Lysis of Adhesions for Asherman's Syndrome

Abstract

Study Objective To understand the impact of hysteroscopic adhesiolysis on menstrual and obstetrical outcomes amongst Asherman's syndrome patients when stratified by disease severity using the March classification system. Design A retrospective cohort study. Setting A community teaching hospital affiliated with a large academic medical center. Patients or Participants A total of 355 Asherman's syndrome patients who underwent hysteroscopic adhesiolysis from 01/01/2015 - 03/01/2019. Interventions Hysteroscopic adhesiolysis followed by telephone survey to determine menstrual and obstetrical outcomes. Measurements and Main Results A total of 150 (42.3%) patients completed the telephone survey with a mean follow-up of 2.21 years. They were representative of the clinic population, and comprised of 40.6% with mild, 52.7% with moderate, and 6.7% with severe Asherman's syndrome. Amenorrhea was reported at initial evaluation in 23.8% of all patients, with no significant difference by March classification. However, there was a significant difference in the resolution of amenorrhea with 93.7%, 85.0%, and 50.0% of mild, moderate, and severe Asherman's syndrome patients endorsing a return of menstruation following treatment. The cumulative pregnancy rate was 81.9%. There was no significant difference in live birth rate with 50.9%, 54.6%, and 16.7% amongst the mild, moderate and severe Asherman's syndrome patients. March classification was not a predictor for ≥1 pregnancy or ≥1 live births when adjusted for confounders using multivariable logistic regression modeling. March classification was a predictor of ≥1 miscarriage in moderate disease when compared to mild cases (95% CI 0.1 - 0.8, P-value Conclusion The patient reported return of menstruation as well as the pregnancy rate following hysteroscopic adhesiolysis of Asherman's syndrome patients are both promising, however not well predicted by the March classification system.