Arch Gynecol Obstet (2010) 281:355–361 DOI 10.1007/s00404-009-1117-x 123 ORIGINAL ARTICLE Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome K. K. Roy · Jinee Baruah · Jai Bhagwan Sharma · Sunesh Kumar · Garima Kachawa · Neeta Singh Received: 27 March 2009 / Accepted: 29 April 2009 / Published online: 20 May 2009  Springer-Verlag 2009 Abstract Objectives To evaluate the outcome of hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome. Materials and methods This was a retrospective clinical analysis of 89 patients who underwent hysteroscopic adhes- iolysis by monopolar electrode knife. A second-look oYce hysteroscopy was performed in all cases after 2 months. On second-look hysteroscopy, 12 patients showed reformation of adhesions and needed a repeat procedure. Results The mean age of the patient was 28.4 years. In the majority (64%) of patients, the possible cause of Asher- man’s syndrome was previous curettage on gravid uterus. The overall conception rate was 40.4% after hysteroscopic adhesiolysis. The mean conception time after surgery was 12.8 months. There was no conception in patients who needed repeat adhesiolysis. The conception rate was higher (58%) in mild Asherman’s syndrome compared to 30% conception rate in moderate and 33.3% conception rate in severe cases. There was no signiWcant association between conception rate and preoperative menstrual pattern. There was signiWcant higher likelihood of conception rate (44.3%) in those who continued to have improved men- strual pattern compared to only 10% likelihood of concep- tion in those who continued to have amenorrhea after adhesiolysis. The live birth rate was 86.1% and miscarriage rate was 11.1%. Cumulative pregnancy rate showed that 97.2% patients conceived within 24 months. There was increased incidence (43.8%) of cesarean section. Four (12.5%) patients had postpartum hemorrhage for adherent placenta. Conclusion Hysteroscopic adhesiolysis for Asherman’s syndrome is a safe and eVective method of choice for restoring menstrual function and fertility. Keywords Infertility · Asherman’s syndrome · Hysteroscopic adhesiolysis · Reproductive outcome Introduction Intrauterine adhesions (IUA) were Wrst described and reported by Joseph Asherman in 1948 [1]. Asherman’s syndrome applies to partial or complete obliteration of the uterine cavity by adhesions secondary to trauma to a gravid or non-gravid uterine cavity [2]. A majority of patients of Asherman’s syndrome present with infertility, with associ- ated menstrual problems [3]. The treatment of Asherman’s syndrome improved dramatically with the emergence of hysteroscopy [4]. Nowadays, hysteroscopy is the method of choice to diagnose, treat and follow up patients with Asherman’s syndrome [5]. There have been a number of studies that reported on the reproductive outcome after treatment of Asherman’s syndrome [5–9], but very few analyzed systematically the reproductive outcome of infer- tility patients. This retrospective clinical study analyzed 89 patients with infertility due to Asherman’s syndrome, to evaluate the fertility outcome, associated menstrual factors aVecting conception, rate of conception (according to severity of adhesions) and pregnancy outcome. K. K. Roy (&) · J. Baruah · J. B. Sharma · S. Kumar · G. Kachawa · N. Singh Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Room No. 3085, Teaching Block, 3rd Floor, New Delhi, India e-mail: drkkroy2003@yahoo.co.in