title: Fluoroscopically guided synechiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes.
abstract: OBJECTIVE
  To describe a 5-year experience of fluoroscopically guided hysteroscopic synechiolysis for Asherman's syndrome.
  
  
  METHODS
  Retrospective, uncontrolled cohort study.
  
  
  METHODS
  Department of Endo-Gynaecology, University of New South Wales, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia.
  
  
  METHODS
  Thirty consecutive patients with confirmed Asherman's syndrome (March 1999-March 2004).
  
  
  METHODS
  Women had hysteroscopy performed under general anesthetic, with the use of a spinal needle in parallel to the hysteroscope to perform synechiolysis. The progress of the procedure was determined by injecting radiographic contrast medium, and visualized with the use of an image intensifier. Individual procedures were terminated when the endometrial cavity was reconstructed, or at 60 minutes. Cyclic high-dose estrogen therapy was used to stimulate endometrial proliferation. Repeat procedures were performed monthly until the endometrial cavity was reestablished.
  
  
  METHODS
  Menstrual and fertility outcomes were obtained from patient records and by postal questionnaire.
  
  
  RESULTS
  Thirty patients were treated for Asherman's syndrome (13% AFS Grade I, 43% AFS Grade II, and 43% AFS Grade III). Prior to treatment, 60% of patients were amenorrheic. The median number of procedures per patient was 1.5 (range, 1-6), and the mean length of the procedure was 42 minutes (range, 10-70 minutes). After treatment, 96% had regular menses. Seventeen patients attempted to conceive after surgery, and 9 (53%) were successful.
  
  
  CONCLUSIONS
  Hysteroscopic synechiolysis under image-intensifier control appears to be an effective treatment for Asherman's syndrome.
authors.affiliation: Department of Endo-Gynaecology, University of New South Wales, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia. angus.thomson@worcsacute.wmids.nhs.uk <angus.thomson@worcsacute.wmids.nhs.uk>
authors.forename: Angus J M
authors.initials: AJ
authors.lastname: Thomson
authors.forename: Jason A
authors.initials: JA
authors.lastname: Abbott
authors.forename: Ashley
authors.initials: A
authors.lastname: Kingston
authors.forename: Meegan
authors.initials: M
authors.lastname: Lenart
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Vancaillie
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006175:Gynatresia / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007247:Infertility, Female / Q000175:diagnosis / Q000601:surgery*; D008599:Menstruation Disturbances / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome