Patient-reported menstrual and obstetric outcomes following hysteroscopic adhesiolysis for Asherman syndrome

Objective: Review the menstrual and obstetric outcomes among Asherman syndrome patients when stratified by disease severity. Design: Retrospective cohort study. Setting: A community teaching hospital affiliated with a large academic medical center. Patients: A total of 355 Asherman syndrome patients stratified by March classification who underwent hysteroscopic adhesiolysis. Interventions: Telephone survey, analyzed with multivariable analysis. Main Outcome Measures: Return of menstruation. Pregnancy, miscarriage, and live birth rate. Results: A total of 355 patients underwent hysteroscopic adhesiolysis. Of these, 150 (42.3%) patients completed the telephone survey with a mean follow-up of 2.21 years. Additionally, 40.7% had mild, 52.7% had moderate, and 6.6% had severe disease. Furthermore, 25.3% of patients reported amenorrhea at presentation, with mild disease patients having the highest rate of returning menstruation (93.8%) following treatment. The cumulative pregnancy rate was 81.9%, and the cumulative live birth rate was 51.2%, with no statistical differences identified by the classification group. Conclusion: Asherman syndrome disease severity predicted returning menstruation but not pregnancy or live birth rate.