Page 26 - WJOLS - Laparoscopic Journal

WJOLS

10.5005/jp-journals-10007-1113
REVIEW ARTICLE Reproductive Outcome following Hysteroscopic Adhesiolysis in Patients with Asherman’s Syndrome
Reproductive Outcome following Hysteroscopic

Adhesiolysis in Patients with Asherman’s

Syndrome

Fadare Oluwaseun O
Department of Obstetrics and Gynecology, Diff Hospital, 6 Udi Hills Street, Aso Drive, Abuja, Nigeria

ABSTRACT

Asherman’s syndrome is a clinical condition characterized by a spectrum of disorders ranging from amenorrhea to hypomenorrhea to
normal menses. It is frequently associated with infertility or recurrent pregnancy loss. Hysteroscopic adhesiolysis with adjuvant
measures is considered the gold standard of treatment. A number of studies have reported on the reproductive outcomes after
treatment of Asherman’s syndrome with varied results as these are difficult to assess because there is no universally agreed system
of classification. Such outcome measures include resumption of normal menses, conception rate and pregnancy outcome. We review
the current best evidence about treatment modalities as well as subsequent reproductive outcome for Asherman’s syndrome.
Conclusion: Large prospective controlled studies are needed to determine the best diagnostic and treatment modalities for intrauterine
adhesions.
Keywords: Asherman’s syndrome (AS), Intrauterine adhesions (IUA), Uterine synechiae (US), Intrauterine synechiae (IUS),
Hysteroscopic adhesiolysis, Amenorrhea, Infertility, Reproductive outcome.

INTRODUCTION METHODOLOGY
Asherman’s syndrome was first described by Heinrich Materials
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Fritsch in 1894 but it was Joseph Asherman who first The study was carried out through a literature search using
pointed out the frequency of the pathologic condition and the information technology installations of the World
described the symptoms of amenorrhea, infertility and Laparoscopy Hospital, Gurgaon, NCR Delhi. Standard
dysmenorrhea following complicated delivery or abortion stationary was also provided by the resource centre of the
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(Asherman, 1948). The syndrome is also commonly hospital.
referred to as intrauterine adhesion (IUA), although, Time: The study was carried out during a period of one

attempts have often been made by some authors to week between 17 December 2010 and 24 December 2010.
differentiate Asherman’s syndrome (where amenorrhea
from complete obliteration of the uterine cavity is a cardinal Data Collection
symptom) from intrauterine adhesions (where there is All the publications used in the current study were accessed
varied menstrual flow patterns, ranging from eumenorrhea from the electronic (virtual) library using the following
through hypomenorrhea to amenorrhea, occurring as a search engines: Google, Cochrane library, SpringerLink,
3,4
result of partial obstruction of uterine cavity), this HighWire press, PubMed and other linked references.
differentiation has not gained widespread popularity. Other Publications used were searched for using the following
common names given to this condition include intrauterine key words: Asherman’s syndrome, intrauterine adhesions,
synechiae, uterine atresia, amenorrhea traumatica and uterine synechiae, hysteroscopic adhesiolysis, amenorrhea,
endometrial sclerosis. infertility, reproductive outcome.
PREVALENCE
OBJECTIVES
The true incidence of Asherman’s syndrome is unknown
1. To assess the various types of hysteroscopic adhesio- as the clinical spectrum ranges from amenorrhea to
lysis and adjuvant treatment measures used in menstrual disturbance to infertility. It is, however, known
management of patients with Asherman’s syndrome. to be a relatively uncommon condition. The American
2. To assess the reproductive outcome (resumption of Society for Reproductive Medicine (ASRM) Practice
menses, conception rate, time interval to conceive as Committee educational bulletin published in 2006 estimates
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well as pregnancy outcome) in patients with Asherman’s a frequency of 7% of secondary amenorrhea, while it was
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syndrome following hysteroscopic adhesiolysis. found in 6.3% of subfertile population in Nigeria. Schenker
World Journal of Laparoscopic Surgery, January-April 2011;4(1):31-39 31