title: Comprehensive treatment for infertile women with severe Asherman syndrome.
abstract: OBJECTIVE
  Many preoperative, intraoperative, and postoperative methods have been described that improve the outcomes of women with severe Asherman syndrome, and it is likely that an integrated application of all of these methods may provide better reproductive outcomes; however, there is as yet no report on this type of integrated approach.
  
  
  METHODS
  The cases of four infertile women with severe Asherman syndrome were analyzed retrospectively. The comprehensive therapeutic plan for the four women included (1) preoperative office hysteroscopy to confirm the diagnosis and evaluate the severity of disease; (2) the use of ultrasound-guided intraoperative abdominal procedures during the surgical procedure, including hysteroscopic adhesiolysis to ensure the entire the hysteroscopic dissection, and placement of a Hyalobarrier(®) gel and an intrauterine balloon catheter at the end of the surgery; (3) postoperative oral estrogen supplementation to enhance endometrial proliferation, removal of the balloon catheter, and a second-look office hysteroscopy; and (4) in vitro fertilization and embryo transfer (IVF & ET) for three of the four patients.
  
  
  RESULTS
  After treatment, the endometrium was significantly thicker than at baseline (median endometrial thickness, 7.5 mm versus 3.0 mm, p < 0.05). All the women (100%, 4/4) conceived successfully (three undergoing IVF & ET, and one had a spontaneous pregnancy), but only two patients had a term pregnancy with cesarean section (one placenta previa and the other placental abruption), contributing to 50% of successful term pregnancies. One patient had the complication of abortion after amniocentesis. The last one woman underwent an abortion because of thyroid problems.
  
  
  CONCLUSIONS
  Comprehensive management offers promising reproductive outcomes for infertile women with severe Asherman syndrome.
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung County, Taiwan.
authors.forename: Kuan-Hao
authors.initials: KH
authors.lastname: Tsui
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Su-Ao and Yuanshan Branch, Yilan, Taiwan.
authors.forename: Li-Te
authors.initials: LT
authors.lastname: Lin
authors.affiliation: Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
authors.forename: Jiin-Tsuey
authors.initials: JT
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology, Cardinal Tien Hospital-Hsintien, New Taipei City, Taiwan; Department of Obstetrics and Gynecology, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Sen-Wen
authors.initials: SW
authors.lastname: Teng
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: phwang@vghtpe.gov.tw.
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
mesh_terms: D000328:Adult; D002404:Catheterization; D004624:Embryo Transfer; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D005307:Fertilization in Vitro; D006175:Gynatresia / Q000150:complications / Q000628:therapy*; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D004967:Estrogens
keywords: Asherman syndrome; hysteroscopy; infertility; intrauterine adhesions; uterine synechiae