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Fertil Steril. 2012 Jan;97(1):160-4. doi: 10.1016/j.fertnstert.2011.10.036. Epub 2011 Nov 17.

Comprehensive management of severe Asherman syndrome and amenorrhea.

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1
Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina 28204, USA.

Abstract

OBJECTIVE:

To describe a comprehensive approach to women with severe Asherman syndrome and amenorrhea, including preoperative, operative, and postoperative care and subsequent resumption menses, and pregnancy.

DESIGN:

Retrospective case series.

SETTING:

Tertiary care teaching hospital.

PATIENT(S):

Twelve women with severe Asherman syndrome and amenorrhea.

INTERVENTION(S):

Preoperative administration of prolonged preoperative and postoperative oral E(2) to enhance endometrial proliferation, intraoperative abdominal ultrasound-directed hysteroscopic lysis of uterine synechia to ensure that the dissection is performed in the proper tissue plane, placement of a triangular uterine balloon catheter during surgery, and postoperative removal with placement of a copper intrauterine device (IUD) to maintain separation of the cavity and mechanically lyse newly formed adhesions during removal.

MAIN OUTCOME MEASURE(S):

Resumption of menses, pregnancy, and delivery.

RESULT(S):

All women resumed menses, although 5 of 12 had a preoperative maximal endometrial thickness of 4 mm or less, with follow-up ranging from 6 months to 10 years. Six of nine women less than age 39 years (67%) became pregnant, and four of six achieved a term or near-term delivery.

CONCLUSION(S):

Comprehensive management provides the best possible outcomes in poor-prognosis women with severe Asherman syndrome.

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