Patient Reported Menstrual and Obstetrical Outcomes Following Hysteroscopic Lysis of Adhesions for Asherman Syndrome at an American Hysteroscopic Office Practice

Abstract

Purpose: Asherman syndrome encompasses intrauterine scarring that results in menstrual and obstetrical irregularities. There has been a scarcity of publications regarding Asherman syndrome within the United States of America. Methods: All patients meeting inclusion criteria were contacted via trained research assistants and invited to complete a telephone survey. Univariate and multivariate analysis was done on the three severity classifications of Asherman syndrome. Results: The mean distance traveled per patient was 571.3 ± 849.1 miles (Median 205.0 miles). Among all of the Asherman syndrome patients treated in the clinic, 42.5% of had mild disease, 48.7% had moderate disease and only 8.7% had severe disease. Of the 355 clinic patients, 150 (42.3%) were successfully contacted and completed the telephone survey. Patients who completed the telephone survey were overall representative of the clinic population. On follow up of patients who presented with amenorrhea (absent flow, 38 patients), there was a significant difference in the rate of resolution of amenorrhea based on March classification with 93.7%, 85.0%, and 50.0% of mild, moderate, and severe Asherman syndrome. A total of 104 of the 127 patients reported ≥1 pregnancy following hysteroscopic treatment at our institution, for a 81.9% cumulative pregnancy rate amongst all Asherman syndrome patients completing the telephone survey. Amongst the total of 149 reported pregnancies, 46.3% (69 pregnancies) were categorized as “Preterm & Full Term Births”, 38.9% (58 pregnancies) were categorized as “SAB/TAB/Ectopic”, and 14.8% (22 pregnancies) were categorized as “Active Pregnancies”. In multivariable analysis, March classification severity was not a predictor for ≥1 pregnancy or ≥1 live births when adjusted for potential confounders. March classification was a predictor of ≥1 miscarriage, specifically moderate Asherman syndrome patients demonstrating a lower rate of miscarriages when compared to mild Asherman syndrome patients (95% CI 0.1 - 0.8, P-value < 0.05). Conclusions: We are the first group to investigate the impact of the March classification system on both pregnancy rate and live birth rate, and additionally perform a multivariate analysis to investigate for confounding variables.