title: Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome.
abstract: OBJECTIVE
  To evaluate the outcome of hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome.
  
  
  METHODS
  This was a retrospective clinical analysis of 89 patients who underwent hysteroscopic adhesiolysis by monopolar electrode knife. A second-look office hysteroscopy was performed in all cases after 2 months. On second-look hysteroscopy, 12 patients showed reformation of adhesions and needed a repeat procedure.
  
  
  RESULTS
  The mean age of the patient was 28.4 years. In the majority (64%) of patients, the possible cause of Asherman's syndrome was previous curettage on gravid uterus. The overall conception rate was 40.4% after hysteroscopic adhesiolysis. The mean conception time after surgery was 12.8 months. There was no conception in patients who needed repeat adhesiolysis. The conception rate was higher (58%) in mild Asherman's syndrome compared to 30% conception rate in moderate and 33.3% conception rate in severe cases. There was no significant association between conception rate and preoperative menstrual pattern. There was significant higher likelihood of conception rate (44.3%) in those who continued to have improved menstrual pattern compared to only 10% likelihood of conception in those who continued to have amenorrhea after adhesiolysis. The live birth rate was 86.1% and miscarriage rate was 11.1%. Cumulative pregnancy rate showed that 97.2% patients conceived within 24 months. There was increased incidence (43.8%) of cesarean section. Four (12.5%) patients had postpartum hemorrhage for adherent placenta.
  
  
  CONCLUSIONS
  Hysteroscopic adhesiolysis for Asherman's syndrome is a safe and effective method of choice for restoring menstrual function and fertility.
authors.affiliation: Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Room No. 3085, Teaching Block, 3rd Floor, New Delhi, India. drkkroy2003@yahoo.co.in
authors.forename: K K
authors.initials: KK
authors.lastname: Roy
authors.forename: Jinee
authors.initials: J
authors.lastname: Baruah
authors.forename: Jai Bhagwan
authors.initials: JB
authors.lastname: Sharma
authors.forename: Sunesh
authors.initials: S
authors.lastname: Kumar
authors.forename: Garima
authors.initials: G
authors.lastname: Kachawa
authors.forename: Neeta
authors.initials: N
authors.lastname: Singh
mesh_terms: D000328:Adult; D005260:Female; D005306:Fertilization / Q000502:physiology; D006175:Gynatresia / Q000601:surgery*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods* / Q000592:standards; D007231:Infant, Newborn; D007247:Infertility, Female / Q000601:surgery*; D008597:Menstrual Cycle / Q000502:physiology*; D011247:Pregnancy; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000601:surgery*