Comprehensive management of severe Asherman syndrome and amenorrhea

ObjectiveTo describe a comprehensive approach to women with severe Asherman syndrome and amenorrhea, including preoperative, operative, and postoperative care and subsequent resumption menses, and pregnancy.DesignRetrospective case series.SettingTertiary care teaching hospital.Patient(s)Twelve women with severe Asherman syndrome and amenorrhea.Intervention(s)Preoperative administration of prolonged preoperative and postoperative oral E2 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.