Complex therapy of severe asherman syndrome

Barsegyan G.

Purpose: many pre-operative, intraoperative and postoperative treatments for women with severe Ascherman syndrome are described as methods that improve results, and there is a high probability that the use of all these methods can restore the reproductive function of women; however, the success of this type of integrated approach has not yet been proven. Materials and methods: the study included 13 women with severe Ascherman syndrome. All operations were performed without complications. Plan comprehensive treatment for these thirteen cases included: (1) preoperative hysterosalpingography and office hysteroscopy to confirm the diagnosis and assess the severity of the disease; (2) preoperative hormonal therapy; (3) intraoperative ultrasound monitoring; (4) hysteroscopic syphilitic;(5) postoperative dynamic office hysteroscopy; (6) oral estrogen therapy; (7) physical therapy; (8) routine control office hysteroscopy in three cycles; and (9) in vitro fertilization and embryo transfer (IVF and PE). Results: after the therapy, the endometrium was much thicker than at the beginning of therapy (the average thickness of the endometrium was 8.5 mm versus 3.0 mm). Twelve women were successfully fertilized seven women underwent IVF AND PE, (two of them had an undeveloped pregnancy at the terms of five and seven weeks, five patients had a full - term pregnancy and childbirth), five women became pregnant on their own, (one of them had an undeveloped pregnancy at the term of nine weeks, four patients had a full-term pregnancy). Conclusion: Complex therapy of patients with severe Ascherman syndrome contributes to the preservation and restoration of reproductive function.

Keywords:intrauterine synechiae, hysteroscopic adhesiolysis, infertility.