title: Fertility after treatment of Asherman's syndrome stage 3 and 4.
abstract: OBJECTIVE
  To evaluate the efficacy of hysteroscopic adhesiolysis and subsequent fertility in patients with adhesions stage 3 and 4.
  
  
  METHODS
  A retrospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  A tertiary referral center for hysteroscopic surgery.
  
  
  METHODS
  Seventy-one patients with intrauterine permanent adhesions.
  
  
  METHODS
  Hysteroscopic surgery with monopolar energy (n=31) or bipolar energy (n=40). Uterine cavity with at least one free ostial area was restored after one (n=31), two (n=20), three (n=15), or four or more (n=5) surgical procedures
  
  
  RESULTS
  Sixty-four patients were followed. Evaluation of the uterine cavity after surgery has been performed by hysteroscopy for all the patients. All patients had resumption of menses, except for two patients with a history of uterine artery embolization. Pregnancy index rate after the procedure was 28 (43.8%) of 64, and the live birth rate was 21 (32.8%) of 64. In patients 35 years of age or younger, 20 of 30 (66.6%) conceived compared with 8 of 34 (23.5%) in patients older than 35 years (p=.01). Three patients had either hysterectomy (n=2) or hypogastric arteries ligation for placenta accreta with uneventful postoperative course.
  
  
  CONCLUSIONS
  Hysteroscopic adhesiolysis can be performed for severe adhesions stage 3 and 4 with safety and efficacy. Age is the main predictive factors of success: the pregnancies were at risk of abnormal placentation.
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Clamart cedex, France. herve.fernandez@abc.aphp.fr
authors.forename: Hervé
authors.initials: H
authors.lastname: Fernandez
authors.forename: Fadheela
authors.initials: F
authors.lastname: Al-Najjar
authors.forename: Aurélia
authors.initials: A
authors.lastname: Chauveaud-Lambling
authors.forename: René
authors.initials: R
authors.lastname: Frydman
authors.forename: Amélie
authors.initials: A
authors.lastname: Gervaise
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006175:Gynatresia / Q000150:complications / Q000601:surgery*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome