Question: 37 year old with fertility impairment associated with recurrent endometrial synechiae- advice on latest treatment.
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Answer: The NICE guideline on fertility treatment (1) published in 2004, recommends that “Women with amenorrhoea who are found to have intrauterine adhesions should be offered hysteroscopic adhesiolysis because this is likely to restore menstruation and improve the chance of pregnancy.”
(Evidence level IV)
A recent systematic review (2) found that randomized controlled studies on hysteroscopic treatment of intrauterine adhesions are lacking.
Retrospective studies of hysteroscopic adhesiolysis in women with Asherman's syndrome found that the conception rate in women who had reformation of intrauterine adhesions was significantly lower than that of women who had a normal cavity (11.8 % compared with 59.1% (3), or no conception in 12 patients who showed reformation of adhesions and needed a repeat procedure (4)).
A comparison of the use of an intrauterine contraceptive device or the Foley catheter balloon, for the adjunctive treatment of intrauterine adhesion (IUA) in patients presenting with infertility(5) reported that the need for repeated treatment was significantly less in the Foley catheter group.
(Evidence level III)
A recent review article has also been published on this topic (6)
References:
- Fertility: assessment and treatment for people with fertility problems. NICE, London. 2004
- Bosteels J. Weyers S. Puttemans P. Panayotidis C. Van Herendael B. Gomel V. Mol BW. Mathieu C. D'Hooghe T.The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. [Review] [128 refs] Human Reproduction Update. 16(1):1-11, 2010 Jan-Feb. Abstract available here, or free full text on registration
- Yu D. Li TC. Xia E. Huang X. Liu Y. Peng X. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome. Fertility & Sterility. 89(3):715-22, 2008 Mar. Abstract
- Roy KK. Baruah J. Sharma JB. Kumar S. Kachawa G. Singh N. Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome. Archives of Gynecology & Obstetrics. 281(2):355-61, 2010 Feb. Abstract
- Orhue AA. Aziken ME. Igbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis. International Journal of Gynaecology & Obstetrics. 82(1):49-56, 2003 Jul. Abstract
- Thomson AJ. Abbott JA. Deans R. Kingston A. Vancaillie TG. The management of intrauterine synechiae. [Review] [36 refs] Current Opinion in Obstetrics & Gynecology. 21(4):335-41, 2009 Aug. Abstract. Free full text for Fellows, Members and Trainees
Search date: June 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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