冷刀分离宫腔粘连术后妊娠结局相关因素分析

目的:探讨冷刀分离宫腔粘连术后影响妊娠结局的相关因素。方法:回顾分析158例行冷刀分离宫腔粘连术患者的临床资料,对可能影响妊娠结局的相关因素进行单因素和多因素Logistic回归分析,包括年龄、病程、宫腔操作次数、术前月经、术后月经、是否曾电切、粘连范围、粘连类型、粘连程度、防粘连措施、再粘连与否。结果:158例患者行冷刀分离粘连后,月经改善率80.3%,总妊娠率为60.1%,活产率为55.8%。病程、术后月经、粘连范围、粘连类型、粘连程度、再粘连与妊娠结局有关(P0.05),年龄、宫腔操作次数、术前月经、曾电切、防粘连装置与妊娠结局无关(P0.05)。多因素Logistic回归分析显示,再粘连是影响妊娠结局的独立危险因素。结论:冷刀作为一种对子宫内膜和宫腔环境损伤小的手术方式,可能成为有生育要求的宫腔粘连患者的首要选择。病程、术后月经、粘连范围、粘连类型、粘连程度、再粘连是影响冷刀分离粘连术后妊娠结局的主要因素。     

重度宫腔粘连综合治疗的临床结局分析

目的探讨和分析重度宫腔粘连患者综合治疗后的临床效果,描述宫腔粘连的综合管理模式,观察患者治疗前后月经模式的改变及妊娠结局。方法回顾性分析2011年4月至2015年5月在首都医科大学附属北京天坛医院妇科进行治疗并且完成随访的有生育要求的重度宫腔粘连患者共75例,术前进行宫腔镜检查及AFS评分,并给予药物营养子宫内膜治疗2个月,再行宫腔镜下宫腔粘连分解术,术后2个月行宫腔镜二次探查,随访患者治疗前后月经模式的改变及妊娠结局。结果 75例患者平均年龄(32.05±5.06)岁,药物治疗后月经模式改善率为57.33%。宫腔镜下宫腔粘连分解术后90.67%患者粘连程度降级,月经改善率92%,妊娠率49.33%,有效妊娠率72.97%。结论术前药物营养子宫内膜可以改善患者的月经模式及AFS评分,部分患者发生粘连的降级。目前宫腔镜下粘连分解术仍是重度宫腔粘连诊治的主要手段,术后最好在一年内妊娠,未妊娠者建议考虑借助辅助生殖技术来提高术后的妊娠结局。     

防粘连膜联合宫内节育器用于宫腔粘连的效果分析

目的:探讨防粘连膜联合宫内节育器用于宫腔粘连治疗的效果及临床价值。方法:选择2012年1月至2016年12月哈尔滨医科大学附属第一医院收治的宫腔粘连患者55例,行宫腔镜下宫腔粘连切除术后,根据术后不同预防粘连方式分为观察组(25例)和对照组(30例)。观察组患者采用防粘连膜+宫内节育器,对照组患者采用宫内节育器。比较两组患者治疗后宫腔恢复情况、月经改善情况及妊娠情况。结果:观察组患者术后3个月宫腔粘连治疗的有效率为96.0%,对照组患者有效率为73.3%,两组相比差异有统计学意义(P0.05)。观察组患者月经恢复有效率为88.0%,对照组患者为60.0%,两组相比差异有统计学意义(P0.05)。观察组患者妊娠率为36.0%,对照组患者为36.7%,两组相比差异无统计学意义(P0.05)。结论:防粘连膜联合宫内节育器用于宫腔粘连行宫腔镜下宫腔粘连切除术后患者,可明显降低宫腔再粘连的发生,改善月经情况,具有一定临床价值。     

双极汽化、电切镜、冷刀治疗宫腔粘连的前瞻性随机对照研究

目的探讨双极汽化、电切镜、冷刀在治疗宫腔粘连的临床效果。方法选取2016年8月至2018年4月重庆市妇幼保健院收治的145例中重度宫腔粘连患者,按随机数字表法将其分为A组(双极汽化治疗组,49例)、B组(电切镜治疗组,48例)和C组(冷刀治疗组,48例)。所有患者在实施宫腔粘连分离术(transcervical resection of uterine adhesions,TCRA)后1~2个月再次行第二次宫腔镜检查。观察患者的月经及宫腔恢复情况,随访术后的妊娠情况。结果三组患者的一般情况差异均无统计学意义(P>0.05)。三组患者在手术时间、术中出血、第2次手术时美国生育协会(American Fertility Association,AFS)评分下降分数、术后月经恢复有效率、宫腔镜治疗次数、术后妊娠率等方面差异均无统计学意义(P>0.05)。三组患者仅在宫腔形态恢复上差异有统计学意义(P=0.037)。结论宫腔镜下双极汽化分离、电切镜分离和冷刀分离三种方法治疗宫腔粘连均有明显效果,但三种方式比较无明显差异。     

防宫腔粘连隔离器在宫腔粘连治疗中的应用及疗效分析

目的:探讨防宫腔粘连隔离器(简称隔离器)用于宫腔粘连分离术后预防再粘连的有效性及安全性,评价隔离器在宫腔粘连分离术后维持宫腔正常形态的优势。方法:选取2015年8月至2017年2月在南京医科大学第一附属医院接受治疗的中重度宫腔粘连(宫腔粘连评分≥5分)患者60例。将患者随机分为隔离器组30例(宫腔粘连分离术后宫腔放置隔离器)和宫内节育器组30例(术后宫腔放置Tcu380宫内节育器),两组患者术后均行雌孕激素序贯治疗,4周后行二次宫腔镜探查术。比较两组患者的宫腔粘连评分下降情况、月经改善情况、妊娠结局及放置后副反应,所有患者术后随访2年。结果:隔离器组患者的宫腔粘连评分术前(9.5±2.0)分,二次宫腔探查时(0.7±1.0)分,差异有统计学意义(P<0.01);节育器组术前(8.7±1.9)分,二次宫腔探查时(3.7±2.7)分,差异有统计学意义(P<0.01);隔离器组二次宫腔探查时宫腔粘连评分明显小于节育器组评分,差异有统计学意义(P<0.01)。隔离器组和节育器组二次宫腔探查时宫腔粘连评分≥5分发生率分别为0(0/30)和43%(13/30),两组比较差异有统计学意义(P<0.01);月经改善率分别为60%(18/30)和47%(14/30),两组比较差异无统计学意义(P=0.301)。随访2年,隔离器组和节育器组的妊娠率比较,差异均无统计学意义(47%vs 43%,P=0.795)。隔离组和节育器组的术后阴道出血时间比较,差异均无统计学意义[(6±3)天vs (5±2)天,P=0.078]。两组患者术后均未出现发热、泌尿生殖道感染、过敏反应、腹痛、子宫穿孔、隔离器或节育器下移或脱落、带器妊娠等副反应。结论:隔离器用于中重度宫腔粘连分离术后预防宫腔再粘连无明显副反应,在维持术后宫腔正常形态及减少术后再粘连方面有独特优势,在术后月经恢复方面及妊娠结局的改善方面与节育器组无显著差异。     

宫腔镜下宫腔粘连分离术后行体外受精-胚胎移植的妊娠结局及影响因素

目的:分析不孕症合并宫腔粘连(IUA)患者在宫腔镜下行宫腔粘连分离术(TCRA)后行体外受精-胚胎移植(IVF-ET)的妊娠结局及相关影响因素。方法:选择2016年3月至2017年8月就诊于湖北医药学院附属人民医院生殖医学中心行宫腔镜检查的不孕患者,行IVF-ET助孕治疗的临床资料及妊娠结局,根据宫腔情况分为对照组:正常宫腔形态行IVF-ET助孕患者425例;IUA组:IUA经TCRA治疗后行IVF-ET助孕患者119例。比较两组患者一般资料及妊娠结局,分析影响术后妊娠的相关因素。结果:IUA组的临床妊娠率、活产率较低,流产率较高,但差异无统计学意义(P0.05)。根据年龄、BMI、流产次数、粘连程度分组比较,临床妊娠率差异有统计学意义(P0.05);多因素Logistic回归分析显示:年龄(≥35岁)、流产次数(≥3次)、粘连程度(中、重度)及BMI(≥24 kg/m~2)是影响TCRA术后妊娠结局的独立危险因素。结论:不孕症合并IUA患者,TCRA术后行IVF-ET助孕治疗的临床妊娠率接近于正常宫腔形态患者,年龄、粘连程度、流产次数及BMI是影响术后妊娠结局的主要因素。     

重度宫腔粘连分离术后预防再粘连方法的比较

目的评估宫腔镜宫腔粘连分离术后预防宫腔再粘连方法的疗效。方法回顾性分析2004年11月至2007年5月间郑州大学第三附属医院妇科内镜诊治中心122例宫腔镜下宫腔粘连切除术患者的临床资料。术后宫腔内放置节育环(IUD)58例为IUD组,宫腔注入几丁糖并IUD64例为IUD+几丁糖组;根据病程长短将IUD组分为Ia组(病程≤1年)和Ib组(病程1年),IUD+几丁糖组分为IIa组(病程≤1年)和IIb组(病程1年)。观察术后宫腔恢复情况、月经改善及妊娠情况。结果IUD和IUD+几丁糖组术后宫腔再粘连率分别为41.4%和23.4%(P0.05),其中Ia组(19.0%)明显低于Ib组(54.1%)(P0.05);IUD组月经改善率及妊娠率分别为74.1%和29.3%,IUD+几丁糖组分别为92.2%和48.4%,IUD组明显低于IUD+几丁糖组(P0.05),其中Ia组(90.0%、47.6%)明显高于Ib组(64.9%、18.9%)(P0.05)。IIa组术后宫腔再粘连率及妊娠率分别为8.7%和78.3%,IIb组分别为31.7%和31.7%,两组比较,差异均有统计学意义(P0.05);IIa组(100%)月经改善率与IIb组(87.8%)比较,差异无统计学意义(P0.05)。结论重度宫腔粘连切除术后宫腔内放置节育环加几丁糖可有效预防再粘连,提高月经改善率及妊娠率。     

宫腔粘连术后应用三腔导管负压冲洗引流装置的临床疗效观察

目的:探讨宫腔三腔导管负压冲洗引流装置在宫腔镜下宫腔粘连分离术(TCRA)后的应用效果。方法:选择收集2017年8月至2018年8月在郑州大学第三附属医院就诊并经宫腔镜检查确诊为中、重度宫腔粘连,近期有生育要求并愿意治疗和随访的患者60例,随机数字法分为两组:A组30例,术后放置宫腔三腔导管负压冲洗引流装置治疗;B组30例术后放置二腔球囊导管治疗。观察时间为术后6个月。比较两组患者术后再粘连率、内膜恢复情况、月经评分及妊娠率。结果:在二次宫腔镜探查时A组有效率为93.3%,B组为83.4%,差异均有统计学意义(P<0.05);再粘连率分别为6.7%及16.7%。术后6个月A组内膜厚度及术后经量评分中位数值均高于B组,差异有统计学意义(P<0.05);术后6个月两组妊娠率差异无统计学意义(P>0.05);两组阴道总引流液量差异有统计学意义(P<0.05),而宫腔感染率、脱管率差异无统计学意义(P>0.05)。结论:宫腔镜下宫腔粘连分离术后应用宫腔三腔导管负压冲洗引流装置相比普通二腔球囊,可降低患者再粘连率,增加患者子宫内膜厚度,改善月经情况。     

宫腔冲洗引流在重度宫腔粘连患者宫腔镜下宫腔粘连分离术后的应用效果研究

目的:评价宫腔冲洗引流在重度宫腔粘连患者宫腔镜下宫腔粘连分离术(TCRA)后的临床应用效果。方法:选择2019年1～12月在郑州大学第三附属医院就诊的重度宫腔粘连患者86例作为研究对象,根据术后预防再粘连的方法不同分为3组:A组30例,术后放置二腔球囊导管引流,B组30例,术后放置三腔球囊导管+0.9%氯化钠液冲洗引流,C组26例,术后放置三腔球囊导管+抗生素冲洗引流。比较3组患者宫腔引流量、子宫内膜厚度、月经评分、宫腔形态、满意度、妊娠结局及不良反应发生情况。结果:术后6个月3组患者子宫内膜厚度、月经评分、宫腔形态均较术前改善,差异均有统计学意义(P<0.05);B、C两组术后总引流液量、子宫内膜厚度、月经评分、宫腔形态改善率均高于A组,差异有统计学意义(P<0.05),B、C两组间比较,差异无统计学意义(P>0.05);3组不良反应、妊娠情况、满意情况比较差异无统计学意义(P>0.05)。结论:TCRA后放置三腔球囊导管行冲洗引流相比放置二腔球囊导管被动引流更能有效预防重度宫腔粘连术后再粘连的发生,增加患者子宫内膜厚度,有效改善月经情况,采用0.9%氯化钠液或抗生素冲洗宫腔对比术后治疗效果无明显差别。     

冷器械联合周期性球囊扩张治疗宫腔粘连在体外受精助孕中的临床效果分析

目的:探讨冷器械联合周期性球囊扩张术治疗宫腔粘连(IUA)在体外受精-胚胎移植(IVF-ET)中的临床效果。方法:对175例经宫腔镜检查确诊为IUA的患者行冷刀分离粘连,术后继续每间隔1周进行球囊扩张术并联合雌、孕激素人工周期治疗。治疗后行冻融胚胎移植。比较IUA轻度组(95例)、中度组(65例)及重度组(15例)患者的一般情况及临床结局。结果:(1)3组患者治疗后子宫内膜厚度均比治疗前增厚(P<0.01),3组治疗前后子宫内膜厚度的差值比较,差异有统计学意义(P<0.05),重度IUA组子宫内膜的差值最大。(2)治疗后,共有163例(93.14%)患者恢复正常宫腔形态,12例患者行再次IUA分离术,其中轻度IUA组(97.89%)和中度IUA组(93.89%)宫腔形态恢复正常的比例显著高于重度IUA组(60.00%);轻度IUA组月经恢复正常的比例(84.21%)高于中度IUA组(66.15%)和重度IUA组(33.33%)。(3)人工替代周期准备内膜并行冻融胚胎移植后整体临床妊娠率为54.29%(95/175),继续妊娠率为40.00%(70/175)。3组间移植胚胎数目、胚胎类型、胚胎种植率、临床妊娠率、继续妊娠率、早期流产率及异位妊娠率差异均无统计学意义(P>0.05)。结论:宫腔镜下冷刀联合周期性球囊扩张术有利于子宫内膜的改善,对于IVF助孕合并宫腔粘连的女性有一定的临床效果,尤其是轻度粘连者可能效果更佳。     

子宫动脉栓塞后宫腔粘连生殖预后分析——附26例报告

目的：探讨子宫动脉栓塞（uterine artery embolization,UAE）后宫腔粘连患者的生殖预后。方法：2008年5月—2014年3月首都医科大学附属复兴医院宫腔镜中心行宫腔镜下宫腔粘连分离术治疗UAE后患者26例,分析宫腔粘连分离术后美国生育学会（American Fertility Society,AFS）评分、月经恢复情况以及生殖预后。结果：仅38.5%（10/26）的患者术后月经较术前有改善;88.5%（23/26）的患者术后AFS评分较术前降低;26例患者中有2例自然妊娠,妊娠率7.7%,其中1例最终以妊娠早期胚胎停育而终止妊娠,另1例目前妊娠早期先兆流产,无1例活产。结论：UAE术后宫腔粘连的患者宫腔粘连分离术后生殖预后差,其原因可能与UAE后子宫血管灌注不良影响术后内膜再生有关。     

Asherman��s syndrome after removal of placenta remnants: a serious clinical problem

Intrauterine adhesions (IUA) or Asherman’s syndrome is thought to develop after trauma to the uterine cavity by destruction of the basal layer of the endometrium. IUA can result in menstrual disorders, infertility, and complication during pregnancy and delivery. IUA formation is multifactorial, with pregnancy being an important etiologic factor. Performing a postpartum exploration/evacuation or curettage can lead to adhesion formation. We present three patients who presented with a menstrual disorder after postpartum surgical intervention on suspicion of placental remnants. Hysteroscopic evaluation revealed severe intrauterine adhesions with complete obliteration of the uterine cavity. Repeated and extensive hysteroscopic adhesiolysis is performed to acquire a cavity with a normal appearance. Besides the puerperal uterus, the time of surgical performance is crucial in the risk for adhesion formation. Performing a late surgical intervention, as from 24–48 h after delivery, leads to an increased risk for adhesion formation. Prevention of IUA can be established by an accurate indication for late postpartum surgical interventions. When performing a late surgical intervention, hysteroscopic surgery is preferable. Firstly, hysteroscopy allows the possibility for identification of placental remnants, and secondly, the possibility for selective removal, thus avoiding unnecessary trauma to the endometrium compared to blindly curettage. Caution is advised when performing a late puerperal surgical intervention. An accurate indication is essential, and when needed, hysteroscopic surgery is preferable, minimizing trauma to the endometrium.     

Hysteroscopic Adhesiolysis

EDITORIAL COMMENT: These cases suggest that hysteroscopic adhesiolysis resulted in restoration of menstruation (Cases 1 and 3) and a normal shaped uterine cavity (Cases 1–3) albeit at the price of uterine perforations (Case 3). Pregnancies after treatment of intrauterine adhesions have a high risk of complications including placenta accreta (Case 3). Elsewhere the author has reported a high incidence of abnormal cornual ostia in patients with infertility but also in women having elective sterilization and presumably normal fertility (Aust NZ J Obstet Gynaecol 1989; 29: 4:425–427). It seems that hysteroscopy offers greater precision than other methods in assessment of the intrauterine anatomy but we require much more information to interpret the significance of intrauterine adhesions seen at hysteroscopy in infertile patients .     

A Matched Cohort Study Comparing the Outcome of Intrauterine Adhesiolysis for Asherman's Syndrome After Uterine Artery Embolization or Surgical Trauma

Study ObjectiveTo compare the outcome of hysteroscopic adhesiolysis in women who had Asherman's syndrome after uterine artery embolization (UAE) with those who had Asherman's syndrome caused by surgical trauma.DesignA retrospective cohort study matched for age and intrauterine adhesion score (Canadian Task Force classification II-2).SettingA tertiary hysteroscopic center in a teaching hospital.PatientsNineteen women with Asherman's syndrome after UAE and 57 women with Asherman's syndrome caused by surgical trauma.InterventionsHysteroscopic adhesiolysis was followed by a second-look hysteroscopy 1 month later. The scoring system proposed by the American Fertility Society was used to evaluate intrauterine adhesion during hysteroscopy.Measurements and Main ResultsIn the UAE group, only 42.1% of women experienced improvement in menstruation defined as a subjective increase in menstrual flow after surgery, which was significantly lower than that of 86.0% observed in the non-UAE group. In the UAE group, the reduction of the American Fertility Society (AFS) score after intrauterine adhesiolysis was 30%, which was significantly lower than that of 80% in the non-UAE group. The pregnancy rate and live birth rate in the UAE group (5% and 0%, respectively) were significantly lower than the corresponding rates in the non-UAE group (33% and 25%, respectively).ConclusionThe outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome after UAE was worse than in women with Asherman's syndrome caused by surgical trauma.     

Amnion graft following hysteroscopic lysis of intrauterine adhesions

AIM: To evaluate the safety and efficacy of amnion grafting after hysteroscopic lysis of intrauterine adhesions. METHODS: In a pilot study involving 25 patients with moderate or severe intrauterine adhesions, hysteroscopic adhesiolysis was followed by intrauterine application of a fresh amnion graft over an inflated balloon of a Foley's catheter for 2 weeks. Follow-up hysteroscopy was performed after 4 months. Outcome measures included recurrence of adhesions, achievement of normal menstrual flow, and improvement in the uterine length. RESULTS: Moderate (group A) and severe (group B) adhesions were found in 12 and 13 subjects, respectively. Uterine perforation occurred in two patients in group B, one treated conservatively and the other via laparoscopy. No clinical evidence of infection was observed, and spontaneous expulsion of the balloon occurred within days in three patients, with easy removal after 2 weeks in the rest of the subjects. Significant improvement in uterine length was found in both groups. Despite improvement, failure to achieve normal menstrual flow was found in 16.7% in group A versus 23.1% in group B. Follow-up hysteroscopy revealed adhesion reformation in 48%, all belonging to group B, all with minimal adhesions. Moderate adhesions were found in only two subjects with previous tuberculous endometritis. CONCLUSION: Hysteroscopic lysis of intrauterine adhesions with amnion grafting seems to be a promising procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration. Randomized comparative studies are needed to validate its benefits, including reproductive outcome.     

A comparison of intrauterine balloon,intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study

Objective

To compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman's syndrome.

Study design

Retrospective cohort study of 107 women with Asherman's syndrome who were treated with hysteroscopic division of intrauterine adhesions. After hysteroscopic adhesiolysis, 20 patients had intrauterine balloon inserted, 28 patients had intrauterine contraceptive device (IUD) fitted, 18 patients had hyaluronic acid gel instilled into the uterine cavity, and 41 control subjects did not have any of the three additional treatment measures. A second-look hysteroscopy was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society classification system.

Results

Both the intrauterine balloon group and the IUD group achieved significantly (P < 0.001) greater reduction in the adhesion score than that of the hyaluronic acid gel group and control group. The efficacy of the balloon was greater than that of the IUD (P < 0.001). There was no significant difference in results between the hyaluronic acid gel group and the control groups.

Conclusion

The insertion of an intrauterine balloon or intrauterine device is more effective than the use of hyaluronic acid gel in the prevention of intra-uterine adhesion reformation.     

Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility

Objective: To assess the safety and efficacy of hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility.

Design: Retrospective case report series.

Setting: The obstetrics and gynecology clinic of a medical school.

Patient(s): Forty women with recurrent pregnancy loss or infertility resulting from intrauterine adhesions.

Intervention(s): Hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility.

Main Outcome Measure(s): Postoperative adhesion formation, intraoperative complication, conceivement after surgery, pregnancy rate, and pregnancies resulted in term or viable preterm infants.

Result(s): Most patients with minimal or moderate adhesions were free of adhesions when compared with postoperative control subjects. However, adhesion re-formation was noted in 60% of the patients who initially had severe adhesions. Normal menstrual flow was restored in 81% of the patients. All the patients who had recurrent pregnancy loss conceived after treatment, and 71% of the pregnancies resulted in a term or viable preterm infant. Of the 16 infertile patients treated, 10 (63%) conceived and 6 (37%) were delivered of viable infants.

Conclusion(s): Hysteroscopic adhesiolysis is a safe and effective procedure for restoring the normal menstrual pattern and fertility. The initial severity of the adhesions appears to correlate best with the reproductive outcome.     

Factors That Impact Fertility after Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: A Retrospective Cohort Study

Study ObjectiveTo identify factors that affect reproductive outcomes after hysteroscopic adhesiolysis in patients with severe intrauterine adhesions (IUAs, scored between 9 and 12 according to the American Fertility Society classification) and amenorrhea.DesignA retrospective cohort study.SettingA university-affiliated hospital.PatientsOne hundred fifty-one patients with severe IUAs and amenorrhea.InterventionPatients were diagnosed via hysteroscopy and underwent at least 1 hysteroscopic adhesiolysis between May 2012 and January 2016.Measurements and Main ResultsOf 151 patients, 12 were lost to follow-up, and 139 were included in the study with a follow-up period ranging from 2 to 6 years. Of the 139 evaluable patients, 107 (77%) recovered with a normal uterine cavity (free of IUAs), 28 (20.1%) had improved uterine cavity (fewer IUAs), and 4 (2.9%) showed no improvement. Moreover, 79 patients (56.8%) recovered with normal menstruation, 54 (38.9%) showed increased frequency of menstruation, and 6 (4.3%) had persistent amenorrhea. Seventy-seven (55.4%) became pregnant, of whom 13 had a spontaneous miscarriage, 11 birthed prematurely (at 31–36 gestational weeks), 44 experienced term delivery, and 9 were still pregnant at the end of the study. Age >32 years (p = .002, odds ratio [OR] = 3.442), >2 surgeries (p = .027, OR = 2.969), cervical canal adhesions (p = .047, OR = 2.112), and disease course >6 months (p = .037, OR = 2.335) were risk factors for infertility in patients with severe IUAs and amenorrhea.ConclusionYounger age, earlier treatment within the disease course, fewer cervical canal adhesions, and fewer surgical procedures improve the reproductive outcome in patients with severe IUAs and amenorrhea.     

Durations of intrauterine balloon therapy and adhesion reformation after hysteroscopic adhesiolysis: a randomized controlled trial

Research questionDoes placing an intrauterine balloon for different durations (7, 14 or 28 days) affect the recurrence of intrauterine adhesions after hysteroscopic adhesiolysis?DesignProspective randomized control trial involving 138 patients recruited over a 12-month period and followed up post-operatively for 15 months. The primary outcome measure was the rate of adhesion reformation at third-look hysteroscopy.ResultsAt third-look hysteroscopy, 8 weeks after the initial hysteroscopy, the adhesion recurrence rate in women who had an intrauterine balloon for 28 days (20%) was significantly (P < 0.01) lower than that of women who had the balloon for 14 days (55%) or 7 days (36.8%).ConclusionsPlacing an intrauterine balloon for 28 days instead of 7 or 14 days after hysteroscopic adhesiolysis resulted in a greater reduction in the recurrence rate of adhesions. However, the study was underpowered to address whether the ongoing pregnancy rate could be improved by keeping the balloon in the uterine cavity for a longer period of time.