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Huang R, Huang X, Li S, Zhao Y, Lv X, Li Y, Saravelos S, Cheng Q, Xia E, Li TC. Value of 2D ultrasonography in the diagnosis and evaluation of intrauterine adhesions - a prospective study. Reprod Biomed Online 2023; 49:103771. [PMID: 38761561 DOI: 10.1016/j.rbmo.2023.103771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 05/20/2024]
Abstract
RESEARCH QUESTION What is the value of 2D ultrasonography in the diagnosis and assessment of intrauterine adhesions (IUA)? DESIGN This was a prospective study conducted at a hysteroscopy centre. RESULTS Of a total of 600 subjects recruited, 41 dropped out and 559 were finally enrolled and analysed. The observed 2D ultrasonography features, in decreasing order of frequency, were 'irregular endometrium' (37.9%), 'broken endometrial echo' (23.4%), 'thin endometrium' (13.7%), 'loss of endometrial echo' (13.1%,), 'hyperechoic focus' (12.5%) and 'fluid in the cavity' (8.8%). The sensitivity of individual ultrasound features ranged from 8.8% to 37.9%, whereas the specificity of individual ultrasound features ranged from 78.9% to 100%. When all the six ultrasound features were considered together, the sensitivity and specificity were 71.7% and 66.2% respectively. The sensitivity, specificity and accuracy of ultrasound diagnosis in the mid-proliferative phase, peri-ovulatory phase and mid-luteal phase did not appear to be significantly different statistically, although the results in the mid-proliferative phase appeared to be consistently higher than those in the mid-luteal phase. In women confirmed to have IUA, the likelihood of the adhesions being severe in nature in the presence of zero, one, two or three or more ultrasound features was 8.7%, 23.0%, 40.2% and 80.5%, respectively (P < 0.001). CONCLUSIONS The findings in this study support the notions that ultrasonography examination in women suspected to have IUA cannot replace hysteroscopy in the diagnosis of the condition. However, it does provide useful clinical information regarding severity and could help in the planning of hysteroscopy to optimize management.
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Affiliation(s)
- Rui Huang
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Xiaowu Huang
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China..
| | - Sijing Li
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yuting Zhao
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Xiaodan Lv
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - YingTao Li
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | | | - Qi Cheng
- Gosun Medical Imaging Diagnostic Center, Guangzhou, China
| | - Enlan Xia
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Tin-Chiu Li
- Hysteroscopy Center, Fuxing Hospital, Capital Medical University, Beijing, China.; Union Hospital Reproductive Medicine Centre, Hong Kong, China
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Khan Z. Etiology, Risk Factors, and Management of Asherman Syndrome. Obstet Gynecol 2023; 142:543-554. [PMID: 37490750 DOI: 10.1097/aog.0000000000005309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
Asherman syndrome is characterized by a triad of symptoms including pain, menstrual abnormalities, and infertility and is a result of intrauterine scar tissue after instrumentation of a gravid uterus. Saline sonohysterogram is typically the most sensitive diagnostic tool; however, hysteroscopy is the criterion standard for diagnosis. Treatment includes hysteroscopic-guided lysis of adhesion, with restoration of the anatomy of the uterine cavity. Several modalities are used in an attempt to reduce the reformation of scar tissue after surgery; however, there is no consensus on the ideal method. Stem cells and platelet-rich plasma are being explored as means of regenerative therapy for the endometrium, but data remain limited. At present, most individuals can have restoration of menstrual function; however, lower pregnancy rates and obstetric complications are not uncommon. These complications are worse for patients with a higher grade of disease. Efforts are needed in standardizing classification, reducing uterine instrumentation of the gravid uterus, and referring patients to health care professionals with clinical expertise in this area.
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Affiliation(s)
- Zaraq Khan
- Division of Reproductive Endocrinology & Infertility and the Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota
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3
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Conservative surgical treatment of post-partum hemorrhage: Should we reconsider compression penetrating sutures? J Gynecol Obstet Hum Reprod 2022; 51:102495. [DOI: 10.1016/j.jogoh.2022.102495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
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Devine K, Dolitsky S, Ludwin I, Ludwin A. Modern assessment of the uterine cavity and fallopian tubes in the era of high-efficacy assisted reproductive technology. Fertil Steril 2022; 118:19-28. [PMID: 35725118 DOI: 10.1016/j.fertnstert.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
The high efficacy of modern assisted reproductive technology (ART) and increase in the number of noninfertile patients who are using ART for family building in the United States call into question the relevance of the standard, one-size-fits-all infertility evaluation. Here, we explore whether all patients presenting for ART need uterine cavity and tubal assessment and what tests are most appropriate, efficient, and cost-effective in current times.
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Affiliation(s)
- Kate Devine
- Division of Reproductive Endocrinology and Infertility, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland; Shady Grove Fertility, Washington, D.C..
| | - Shelley Dolitsky
- Division of Reproductive Endocrinology and Infertility, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland
| | - Inga Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
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5
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Jiang X, Chen X, Li J, Wang W, Li J. Clinical application of three-dimensional transvaginal ultrasonography in the diagnosis of intrauterine adhesions. J Int Med Res 2021; 49:3000605211024520. [PMID: 34842482 PMCID: PMC8649470 DOI: 10.1177/03000605211024520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The present study aimed to evaluate the diagnostic accuracy of
three-dimensional transvaginal ultrasonography (3D-TVS) for intrauterine
adhesions (IUA). Methods We performed a retrospective cohort study. A total of 500 women aged 19 to 46
years with uterine lesions who received treatment from the Department of
Obstetrics and Gynecology were enrolled. Endometrial 3D imaging was
conducted to obtain the display plane and 3D-TVS parameters. Patients also
underwent hysteroscopy for a definitive diagnosis. Results For diagnosing IUA, the sensitivity, specificity, positive predictive value
(PPV), negative predictive value (NPV), and overall accuracy of 3D-TVS were
98.8%, 90.8%, 91.4%, 98.7%, and 94.8%, respectively. For diagnosing a
submucosal myoma, the sensitivity, specificity, PPV, NPV, and overall
accuracy of 3D-TVS were 88.2%, 97.9%, 88.2%, 97.9%, and 96.4%, respectively.
For diagnosing endometrial polyps, the sensitivity, specificity, PPV, NPV,
and overall accuracy of 3D-TVS were 94.7%, 96.8%, 92.9%, 97.7%, and 96.2%,
respectively. Conclusions Before hysteroscopy, 3D-TVS, as a method of screening, has great value for
comparing differences before and after treatment, and for evaluating
therapeutic effects.
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Affiliation(s)
- Xinkui Jiang
- Department of Ultrasound, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Xiaofeng Chen
- Department of Echocardiography, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jiangtao Li
- Department of Ultrasound, Shenzhen Nanshan Maternal and Child Healthcare Hospital, Shenzhen, China
| | - Weiqi Wang
- Department of Ultrasound, Maternal and Child Health Care Hospital of Xinjiang, Urumqi, China
| | - Jing Li
- Department of Endocrinology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Fertility evaluation of infertile women: a committee opinion. Fertil Steril 2021; 116:1255-1265. [PMID: 34607703 DOI: 10.1016/j.fertnstert.2021.08.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022]
Abstract
Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all the relevant factors with an initial emphasis on the least invasive methods for detecting the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of in fertile women, and it replaces the document of the same name, last published in 2015 (Fertil Steril 2015;103:e44-50). This guidance is intended for any provider evaluating women for infertility.
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Vitale SG, Laganà AS, Török P, Lasmar RB, Carugno J, Palumbo M, Tesarik J. Virtual sonographic hysteroscopy in assisted reproduction: A retrospective cost-effectiveness analysis. Int J Gynaecol Obstet 2021; 156:112-118. [PMID: 33615469 DOI: 10.1002/ijgo.13651] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To analyze the cost-effectiveness of virtual sonographic hysteroscopy (VSH) performed before in vitro fertilization (IVF) (Scenario 1), frozen embryo transfer (Scenario 2), and oocyte donation (Scenario 3) attempts. METHODS A retrospective analysis of data extracted from patients' files was conducted. Before undergoing the assigned treatment, VSH was offered to all patients. Cost-effectiveness was calculated on the basis of cost per live birth. The total cost was compared with a control group of patients who declined to have hysteroscopy before their treatment. RESULTS A total of 292 women were involved. Virtual sonographic hysteroscopy was performed in 192 women. Conventional operative hysteroscopy was subsequently required in 34 of them (17.7%). Subsequent assisted reproduction attempts resulted in live birth in 111 women-34/69 (49.3%), 35/69 (50.7%), and 42/54 (77.8%) in Scenarios 1, 2, and 3, respectively. This compared favorably with 100 women who declined VSH, with live birth achieved in 15/39 (38.5%), 14/37 (37.8%), and 15/24 (62.5%) in Scenarios 1, 2, and 3, respectively. The overall cost-effectiveness of VSH compared favorably with straightforward treatment performed without this test. CONCLUSION The overall cost-effectiveness of treatment attempts carried out after previous VSH compared favorably with straightforward treatment performed without this test.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Ricardo Bassil Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Minimally Invasive Gynecology Unit, University of Miami Miller School of Medicine, Miami, USA
| | - Marco Palumbo
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Doroftei B, Dabuleanu AM, Ilie OD, Maftei R, Anton E, Simionescu G, Matei T, Armeanu T. Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome-Where Are We after One Hundred and Twenty-Six Years? Diagnostics (Basel) 2020; 10:diagnostics10090706. [PMID: 32957624 PMCID: PMC7554703 DOI: 10.3390/diagnostics10090706] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023] Open
Abstract
Asherman syndrome is a multifaceted condition describing the partial or complete removal of the uterine cavity and/or cervical canal. It is a highly debatable topic because of its pronounced influence on both reproductive outcomes and gynaecologic symptoms. The latest reports demonstrated that trauma to the endometrium is the main cause of intrauterine adhesion formation. Left untreated, such adhesions gradually lead to a range of repercussions ranging from mild to severe. Considering the lack of non-invasive approaches, the advent of hysteroscopy has revolutionized the entire field, being otherwise considered the most efficient tool offering new directions and amplifying the chances of treating the Asherman syndrome.
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Affiliation(s)
- Bogdan Doroftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ana-Maria Dabuleanu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Research, Faculty of Biology, Alexandru Ioan Cuza University, Carol I Avenue, No. 20A, 700505 Iasi, Romania
- Correspondence:
| | - Radu Maftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Emil Anton
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Gabriela Simionescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Theodor Matei
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Theodora Armeanu
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
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Intrauterine infusion of platelet-rich plasma for severe Asherman syndrome: a cutting-edge approach. Updates Surg 2020; 73:2355-2362. [DOI: 10.1007/s13304-020-00828-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/31/2020] [Indexed: 12/16/2022]
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10
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Wall DJ, Reinhold C, Akin EA, Ascher SM, Brook OR, Dassel M, Henrichsen TL, Learman LA, Maturen KE, Patlas MN, Robbins JB, Sadowski EA, Saphier C, Uyeda JW, Glanc P. ACR Appropriateness Criteria® Female Infertility. J Am Coll Radiol 2020; 17:S113-S124. [PMID: 32370955 DOI: 10.1016/j.jacr.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/12/2022]
Abstract
The most common known causes of female infertility are male factor (26%), ovulatory failure (21%), and tubal damage (14%), while in 28% a couple's infertility remains unexplained. Female-specific causes of infertility include deterioration of oocyte quality with increasing maternal age; ovulatory disorders, most notably polycystic ovarian syndrome; history of salpingitis such as that caused by chlamydia infection; endometriosis; and uterine cavity abnormalities interfering with implantation causing inability to become pregnant or causing recurrent pregnancy loss. These potential causes of female infertility are discussed in this document and the appropriate imaging recommendations for each variant are provided. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | | | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Di Guardo F, Della Corte L, Vilos GA, Carugno J, Török P, Giampaolino P, Manchanda R, Vitale SG. Evaluation and treatment of infertile women with Asherman syndrome: an updated review focusing on the role of hysteroscopy. Reprod Biomed Online 2020; 41:55-61. [PMID: 32444259 DOI: 10.1016/j.rbmo.2020.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022]
Abstract
Asherman syndrome is a rare acquired clinical condition resulting in the obliteration of the uterine cavity causedby the presence of partial or complete fibrous intrauterine adhesions involving at least two-thirds of the uterine cavity potentially obstructing the internal cervical orifice. Common reported symptoms of the disease are alterations of the menstrual pattern with decreased menstrual bleeding leading up to amenorrhoea and infertility. Hysteroscopy is currently considered the gold standard diagnostic and therapeutic approach for patients with intrauterine adhesions. An integrated approach, including preoperative, intraoperative and postoperative therapeutic measures, however, are warranted owing to the complexity of the syndrome. This review aims to summarize the most recent evidence on the recommended preoperative, intraoperative and postoperative procedures to restore the uterine cavity and a functional endometrium, as well as on the concomitant use of adjuvant therapies to achieve optimal fertility outcomes.
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Affiliation(s)
- Federica Di Guardo
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - George Angelos Vilos
- The Fertility Clinic, London Health Sciences Centre, Department of Obstetrics and Gynecology, Western University, 800 Commissioners Road, London, Ontario N6A 4G5, Canada
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Science Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynaecology, University of Debrecen, 4032 Debrecen, Nagyerdei krt. 94, Hungary
| | - Pierluigi Giampaolino
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Rahul Manchanda
- Department of Gynae Endoscopy, Manchanda's Endoscopic Centre, Pushawati Singhania Research Institute, Press Enclave Marg, Sheikh Sarai II, Near Saket Court, New Delhi - 110017, India
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania 95123, Italy.
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12
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Asherman syndrome and insufficient endometrial thickness: A hypothesis of integrated approach to restore the endometrium. Med Hypotheses 2019; 134:109521. [PMID: 31887722 DOI: 10.1016/j.mehy.2019.109521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/03/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022]
Abstract
Asherman syndrome consists in an acquired condition characterized by the development of fibrous intrauterine adhesions involving until two-thirds of the uterine cavity. Common signs of the syndrome are represented by alterations of regular menses, hypomenorrhea and amenorrhea. Moreover, women affected by Asherman syndrome, often struggle with fertility problems such as difficulty in spontaneous conceiving as well as complications including recurrent pregnancy loss and invasive placentation. The abnormality of the endometrial line consisting in insufficient thickness and/or endometrial trauma damaging the decidua basalis, are characteristic elements of the disease. Several studies have been conducted during the last ten years to find a solution restoring the regular endometrial line solving the fertility issue in Asherman women. Hormonal therapy as well as the use of stem cells seem to represent valid options to regenerate the endometrium opening a new scenario in the fertility treatment of these women. In this context, the presented study proposes an integrated approach to reach an adequate endometrial reconstitution and consequentially optimal fertility outcomes.
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13
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Kamath MS, Bosteels J, D'Hooghe TM, Seshadri S, Weyers S, Mol BWJ, Broekmans FJ, Sunkara SK. Screening hysteroscopy in subfertile women and women undergoing assisted reproduction. Cochrane Database Syst Rev 2019; 4:CD012856. [PMID: 30991443 PMCID: PMC6472583 DOI: 10.1002/14651858.cd012856.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Screening hysteroscopy in infertile women with unexplained infertility, or prior to intrauterine insemination (IUI) or in vitro fertilisation (IVF) may reveal intrauterine pathology that may not be detected by routine transvaginal ultrasound. Hysteroscopy, whether purely diagnostic or operative may improve reproductive outcomes. OBJECTIVES To assess the effectiveness and safety of screening hysteroscopy in subfertile women undergoing evaluation for infertility, and subfertile women undergoing IUI or IVF. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL CRSO, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (September 2018). We searched reference lists of relevant articles and handsearched relevant conference proceedings. SELECTION CRITERIA Randomised controlled trials comparing screening hysteroscopy versus no intervention in subfertile women wishing to conceive spontaneously, or before undergoing IUI or IVF. DATA COLLECTION AND ANALYSIS We independently screened studies, extracted data, and assessed the risk of bias. The primary outcomes were live birth rate and complications following hysteroscopy. We analysed data using risk ratio (RR) and a fixed-effect model. We assessed the quality of the evidence by using GRADE criteria. MAIN RESULTS We retrieved 11 studies. We included one trial that evaluated screening hysteroscopy versus no hysteroscopy, in women with unexplained subfertility, who were trying to conceive spontaneously. We are uncertain whether ongoing pregnancy rate improves following a screening hysteroscopy in women with at least two years of unexplained subfertility (RR 4.30, 95% CI 2.29 to 8.07; 1 RCT; participants = 200; very low-quality evidence). For a typical clinic with a 10% ongoing pregnancy rate without hysteroscopy, performing a screening hysteroscopy would be expected to result in ongoing pregnancy rates between 23% and 81%. The included study reported no adverse events in either treatment arm. We are uncertain whether clinical pregnancy rate is improved (RR 3.80, 95% CI 2.31 to 6.24; 1 RCT; participants = 200; very low-quality evidence), or miscarriage rate increases (RR 2.80, 95% CI 1.05 to 7.48; 1 RCT; participants = 200; very low-quality evidence), following screening hysteroscopy in women with at least two years of unexplained subfertility.We included ten trials that included 1836 women who had a screening hysteroscopy and 1914 women who had no hysteroscopy prior to IVF. Main limitations in the quality of evidence were inadequate reporting of study methods and higher statistical heterogeneity. Eight of the ten trials had unclear risk of bias for allocation concealment.Performing a screening hysteroscopy before IVF may increase live birth rate (RR 1.26, 95% CI 1.11 to 1.43; 6 RCTs; participants = 2745; I² = 69 %; low-quality evidence). For a typical clinic with a 22% live birth rate, performing a screening hysteroscopy would be expected to result in live birth rates between 25% and 32%. However, sensitivity analysis done by pooling results from trials at low risk of bias showed no increase in live birth rate following a screening hysteroscopy (RR 0.99, 95% CI 0.82 to 1.18; 2 RCTs; participants = 1452; I² = 0%).Only four trials reported complications following hysteroscopy; of these, three trials recorded no events in either group. We are uncertain whether a screening hysteroscopy is associated with higher adverse events (Peto odds ratio 7.47, 95% CI 0.15 to 376.42; 4 RCTs; participants = 1872; I² = not applicable; very low-quality evidence).Performing a screening hysteroscopy before IVF may increase clinical pregnancy rate (RR 1.32, 95% CI 1.20 to 1.45; 10 RCTs; participants = 3750; I² = 49%; low-quality evidence). For a typical clinic with a 28% clinical pregnancy rate, performing a screening hysteroscopy would be expected to result in clinical pregnancy rates between 33% and 40%.There may be little or no difference in miscarriage rate following screening hysteroscopy (RR 1.01, 95% CI 0.67 to 1.50; 3 RCTs; participants = 1669; I² = 0%; low-quality evidence).We found no trials that compared a screening hysteroscopy versus no hysteroscopy before IUI. AUTHORS' CONCLUSIONS At present, there is no high-quality evidence to support the routine use of hysteroscopy as a screening tool in the general population of subfertile women with a normal ultrasound or hysterosalpingogram in the basic fertility work-up for improving reproductive success rates.In women undergoing IVF, low-quality evidence, including all of the studies reporting these outcomes, suggests that performing a screening hysteroscopy before IVF may increase live birth and clinical pregnancy rates. However, pooled results from the only two trials with a low risk of bias did not show a benefit of screening hysteroscopy before IVF.Since the studies showing an effect are those with unclear allocation concealment, we are uncertain whether a routine screening hysteroscopy increases live birth and clinical pregnancy, be it for all women, or those with two or more failed IVF attempts. There is insufficient data to draw conclusions about the safety of screening hysteroscopy.
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Affiliation(s)
- Mohan S Kamath
- Christian Medical CollegeDepartment of Reproductive MedicineIda Scudder RoadVelloreTamil NaduIndia632004
| | - Jan Bosteels
- Cochrane BelgiumAcademic Centre for General PracticeKapucijnenvoer 33blok J bus 7001LeuvenBelgium3000
| | - Thomas M D'Hooghe
- University Hospital GasthuisbergLeuven University Fertility CentreHerestraat 49LeuvenBelgium3000
| | - Srividya Seshadri
- The Centre for Reproductive & Genetic Health256 Gray’s Inn RoadLondonUKWC1X 8LD
| | - Steven Weyers
- University Hospital GhentObstetrics and GynaecologyDe Pintelaan 185GhentBelgium
| | - Ben Willem J Mol
- Monash UniversityDepartment of Obstetrics and Gynaecology246 Clayton RoadClaytonVictoriaAustralia3168
| | - Frank J Broekmans
- University Medical CenterDepartment of Reproductive Medicine and GynecologyHeidelberglaan 100UtrechtNetherlands3584 CX
| | - Sesh Kamal Sunkara
- King's College LondonDivision of Women's Health, Faculty of Life Sciences & MedicineStrandLondonUKWC2R 2LS
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Abstract
Intrauterine adhesions with symptoms like hypomenorrhea or infertility are known under the term Asherman's syndrome. Although the syndrome has been widely investigated, evidence of both prevention of the syndrome and the ideal treatment are missing. Understanding the pathogenesis of intrauterine adherences is necessary for the prevention of the formation of intrauterine scarring. Intrauterine adhesions can develop from lesion of the basal layer of the endometrium caused by curettage of the newly pregnant uterus. The syndrome may also occur after hysteroscopic surgery, uterine artery embolization or uterine tuberculosis. For initial diagnosis the less invasive contrast sonohysterography or hysterosalpingography is useful. The final diagnosis is based on hysteroscopy. Magnetic resonance imaging is required in cases with totally obliterated uterine cavity. Intrauterine adherences are classified in accordance with different classification systems based on the hysteroscopic diagnosis of severity and localization of adherences. Classification is necessary for the planning of surgery, information on prognosis and scientific purposes. Surgery is performed in symptomatic patients with either infertility or with painful periods. Intrauterine adherences are divided with a hysteroscope using scissors or a power instrument working from the central part of the uterus to the periphery. Peroperative ultrasonography is useful in an outpatient setting for the prevention of complications. Hysteroscopy with fluoroscopy is a solution in difficult cases. Use of intrauterine devices like balloon catheters or intrauterine contraceptive devices seems to be the preferred methods for the prevention of re-occurrence of adhesions after treatment. Both primary prevention after hysteroscopic surgery or curettage and secondary prevention of new adhesions after adhesiolysis have been investigated. The aim of this review was to summarize the literature on diagnosis, classification, treatment and prevention, based on a literature search with a wide range of search terms.
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Affiliation(s)
- Eva Dreisler
- Department of Gynecology, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
| | - Jens Joergen Kjer
- Department of Gynecology, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
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Khan Z, Goldberg JM. Hysteroscopic Management of Asherman's Syndrome. J Minim Invasive Gynecol 2018; 25:218-228. [DOI: 10.1016/j.jmig.2017.09.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 01/30/2023]
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16
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AAGL Practice Report: Practice Guidelines on Intrauterine Adhesions Developed in Collaboration With the European Society of Gynaecological Endoscopy (ESGE). J Minim Invasive Gynecol 2017; 24:695-705. [PMID: 28473177 DOI: 10.1016/j.jmig.2016.11.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 11/15/2022]
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17
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AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE). ACTA ACUST UNITED AC 2017; 14:6. [PMID: 28603474 PMCID: PMC5440524 DOI: 10.1186/s10397-017-1007-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/23/2017] [Indexed: 11/22/2022]
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18
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Saravelos SH, Jayaprakasan K, Ojha K, Li TC. Assessment of the uterus with three-dimensional ultrasound in women undergoing ART. Hum Reprod Update 2017; 23:188-210. [PMID: 28007752 DOI: 10.1093/humupd/dmw040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A detailed assessment of the uterus forms a pivotal part of the ART treatment process. The emergence of three-dimensional ultrasound (3D US) has provided clinicians with a highly powerful tool in this respect. Assessments with 3D US range from the reconstruction of anatomical planes elusive to conventional US, to the objective measurement of anatomical volumes and vascularization parameters. However, despite the ever increasing number of publications emerging in the literature, the question of which aspects of 3D US are of most clinical value remains a topic of debate. OBJECTIVE AND RATIONALE The objective of this review is to dissect which aspects of the 3D US assessment of the uterus are supported by a strong level of evidence to date, and should therefore be incorporated into current routine clinical practice. SEARCH METHODS We conducted a systematic search of the PubMed database up to May 2016, using a combination of text words and Medical Subject Headings (MeSH) pertaining to the 3D US assessment of the uterus. All articles published in the English language were screened to ascertain relevance to women of reproductive age; further citations were retrieved through manual reference list searching. OUTCOMES A multitude of predominantly observational studies were identified, which concerned a vast variety of 3D US uterine assessments. All articles unequivocally praised the non-invasive, cost-effective, highly acceptable and objective nature of 3D US. Studies regarding the value of assessing the endometrial volume and vascularization prior to embryo transfer appeared conflicting and inconsistent. Studies regarding the imaging of uterine pathology and identification of intratubal and intrauterine devices consistently reported high rates of diagnostic accuracy. A recent RCT did not show an improvement in clinical outcomes when comparing 3D versus 2D US during embryo transfer. However, preliminary studies suggested that 3D US is superior in determining the site of implantation, particularly in ambiguous cases such as interstitial and angular pregnancies. Finally, pilot studies have suggested that the further integration of 3D and possibly 4D US with surgical interventions of the uterus may be a promising prospect. WIDER IMPLICATIONS 3D US may prove to be an invaluable tool in the assessment of the uterus within the context of ART. Currently, the aim should be to highlight the aspects of 3D US that are most evidence-based and valuable for patients, and to incorporate these into routine clinical practice.
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Affiliation(s)
- Sotirios H Saravelos
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
| | - Kannamannadiar Jayaprakasan
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
| | - Kamal Ojha
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
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19
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Accuracy of three dimensional ultrasound and treatment outcomes of intrauterine adhesion in infertile women. Taiwan J Obstet Gynecol 2016; 54:737-41. [PMID: 26700995 DOI: 10.1016/j.tjog.2015.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the accuracy and usefulness of three-dimensional transvaginal ultrasound (3D-TVUS) in diagnosing intrauterine adhesion (IUA) and to evaluate treatment outcomes associated with fertility. MATERIALS AND METHODS IUA patients (110) underwent hysteroscopy to definitively diagnose and treat adhesiolysis. Morphologic characteristics of endometrium suggesting IUA, such as marginal irregularity, thinning, defects, obliteration, fibrosis, and calcification, were identified and recorded by 3D-TVUS. The sensitivity of 3D-TVUS findings and the attainment of postoperative fertility were evaluated prospectively. The clinical records were followed up for 2 years for obstetrical outcomes and analyzed. RESULTS On comparing the findings of 3D-TVUS with those of hysteroscopy in 110 patients, 45 (88.23%) patients were confirmed as IUA by hysteroscopy among 51 (46.36%) patients, with one finding in 3D-TVUS; 42 (97.67%) patients were confirmed among 43 (39.09%) patients with two findings; and 16 (100%) patients were confirmed among 16 (14.55%) patients with over three findings. A pregnancy rate of eight out of 47 (17.02%) was achieved in patients who desired fertility. CONCLUSION 3D-TVUS assessment of the uterus provides an accurate depiction of adhesion and extent of cavity damage in patients with suspected IUA.
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Abstract
Asherman's syndrome has significant reproductive implications for patients. In most case series, the rate of fertility and full term birth directly correlates to extent of disease. However, there does not seem to be a connection between number of prior curettages, nor aetiology of adhesions in predicting outcome. Without a universally accepted classification system, comparison of research data and results for imaging modalities is difficult.
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Affiliation(s)
- I-Ferne Tan
- Department of Obstetrics and Gynaecology Australian National University Medical School Acton ACT Australia
| | - Meiri Robertson
- Fetal Medicine Unit Women and Children's Health Services The Canberra Hospital Garran ACT Australia
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21
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Hai N, Ding X. Intrauterine adhesion after transvaginal ultrasound-guided radiofrequency myolysis. J Obstet Gynaecol Res 2015; 41:1851-4. [PMID: 26311404 DOI: 10.1111/jog.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/16/2015] [Accepted: 06/06/2015] [Indexed: 11/28/2022]
Abstract
Transvaginal ultrasound-guided radiofrequency myolysis offers an alternative to surgery for symptomatic uterine myomas, with encouraging efficacy and safety, suggesting low complication rates. This case study describes the first reported intrauterine adhesion after transvaginal ultrasound-guided radiofrequency myolysis. Women who desire further pregnancy should be warned about the particular risk of intrauterine adhesion of radiofrequency myolysis.
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Affiliation(s)
- Ning Hai
- Department of Gynecology, The PLA Second Artillery Force General Hospital, Beijing, China
| | - Xiaoping Ding
- Department of Gynecology, The PLA Second Artillery Force General Hospital, Beijing, China
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22
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Amin TN, Saridogan E, Jurkovic D. Ultrasound and intrauterine adhesions: a novel structured approach to diagnosis and management. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:131-139. [PMID: 26094824 DOI: 10.1002/uog.14927] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 06/04/2023]
Affiliation(s)
- T N Amin
- Institute for Women's Health, University College London, London, UK
| | - E Saridogan
- Institute for Women's Health, University College London, London, UK
| | - D Jurkovic
- Institute for Women's Health, University College London, London, UK
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23
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Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril 2015; 103:e44-50. [PMID: 25936238 DOI: 10.1016/j.fertnstert.2015.03.019] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
Abstract
Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all relevant factors with initial emphasis on the least invasive methods for detection of the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of the infertile female, and it replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:302–7).
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24
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Warembourg S, Huberlant S, Garric X, Leprince S, de Tayrac R, Letouzey V. Prévention et traitement des synéchies endo-utérines : revue de la littérature. ACTA ACUST UNITED AC 2015; 44:366-79. [DOI: 10.1016/j.jgyn.2014.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 12/25/2022]
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25
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26
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Seshadri S, Khalil M, Osman A, Clough A, Jayaprakasan K, Khalaf Y. The evolving role of saline infusion sonography (SIS) in infertility. Eur J Obstet Gynecol Reprod Biol 2014; 185:66-73. [PMID: 25528732 DOI: 10.1016/j.ejogrb.2014.11.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/19/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
Saline infusion sonography (SIS) has become a valuable diagnostic modality in gynaecology over the last three decades. SIS is now commonly employed for detailed evaluation of the uterine cavity as part of pre-treatment assessment in infertile women. The objective of this paper is review the scientific literature on SIS in infertility. Medline, Ovid and Cochrane databases were searched for relevant articles. The indications, technical aspects and the potential advantages of SIS are discussed. The efficacy and sensitivity of SIS are compared to hysteroscopy in the evaluation of uterine polyps, fibroids, intrauterine adhesions and uterine anomalies. Increasing evidence suggests the use of SIS prior to an in-vitro fertilization (IVF) cycle as it has increased sensitivity in the detection of intrauterine pathology. SIS is cost-effective and results in better patient satisfaction scores than hysteroscopy.
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Affiliation(s)
- S Seshadri
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom.
| | - M Khalil
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom
| | - A Osman
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom
| | - A Clough
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom
| | - K Jayaprakasan
- Royal Derby Hospital, Derby & NURTURE, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Y Khalaf
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom
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Seshadri S, El-Toukhy T, Douiri A, Jayaprakasan K, Khalaf Y. Diagnostic accuracy of saline infusion sonography in the evaluation of uterine cavity abnormalities prior to assisted reproductive techniques: a systematic review and meta-analyses. Hum Reprod Update 2014; 21:262-74. [DOI: 10.1093/humupd/dmu057] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Vendittelli F, Savary D, Storme B, Rieu V, Chabrot P, Charpy C, Lémery D, Jacquetin B. Ovarian thrombosis and uterine synechiae after arterial embolization for a late postpartum haemorrhage. Case Rep Womens Health 2014; 5:1-4. [PMID: 29594009 PMCID: PMC5863026 DOI: 10.1016/j.crwh.2014.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 12/01/2022] Open
Abstract
Background We report two unusual separate complications after uterine artery embolization for a late postpartum haemorrhage. This report appeared important to us in view of the apparent absence of any other publications on this topic. Case presentation We report the case of a 25-year-old woman, gravida 3, para 1, admitted for uterine bleeding 7 days after a spontaneous delivery at term, in our university hospital. A suction curettage and then, after persistent bleeding, uterine artery embolization were necessary. Immediately after the embolization, a bilateral ovarian thrombosis occurred, subsequently followed by amenorrhea, due to uterine synechiae, and depression. Hysteroscopic surgery was performed to remove the adhesions. A complete work-up for thrombophilia showed a heterozygous mutation of the factor V gene R506Q. The pathology examination found subinvolution of the placental bed. One month after treatment of the synechiae (and insertion of a copper IUD for contraception), the woman's menstrual cycle returned to normal. Her clinical examination 19 months later was normal. Conclusions This case teaches us that one rare complication can hide another! It is important to consider the diagnosis of subinvolution of the placental bed in cases of late PPH and to know the complications associated with vascular artery embolization in order to provide the most rapid and least invasive treatment. Arterial embolization is associated with ovarian thrombosis. Do not forget the subinvolution of the placental bed in late postpartum haemorrhage. Suction curettage can lead to uterine synechiae.
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Affiliation(s)
- Françoise Vendittelli
- Department of Obstetrics and Gynaecology, Academic Medical Centre, France.,PEPRADE, EA 4681, Auvergne University, France
| | - Denis Savary
- Department of Obstetrics and Gynaecology, Academic Medical Centre, France
| | - Brigitte Storme
- Department of Anaesthesiology, Academic Medical Centre, France
| | - Virginie Rieu
- Department of Internal Medicine, Academic Medical Centre, France
| | - Pascal Chabrot
- Department of Radiology, Academic Medical Centre, France
| | - Cécile Charpy
- Department of Histology, Academic Medical Centre, France
| | - Didier Lémery
- Department of Obstetrics and Gynaecology, Academic Medical Centre, France.,PEPRADE, EA 4681, Auvergne University, France
| | - Bernard Jacquetin
- Department of Obstetrics and Gynaecology, Academic Medical Centre, France
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Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol 2013; 11:118. [PMID: 24373209 PMCID: PMC3880005 DOI: 10.1186/1477-7827-11-118] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 12/19/2013] [Indexed: 12/13/2022] Open
Abstract
Asherman syndrome is a debatable topic in gynaecological field and there is no clear consensus about management and treatment. It is characterized by variable scarring inside the uterine cavity and it is also cause of menstrual disturbances, infertility and placental abnormalities. The advent of hysteroscopy has revolutionized its diagnosis and management and is therefore considered the most valuable tool in diagnosis and management. The aim of this review is to explore the most recent evidence related to this condition with regards to aetiology, diagnosis management and follow up strategies.
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Affiliation(s)
- Alessandro Conforti
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Via Sergio Pansini n. 6, Naples 80100, Italy
| | - Carlo Alviggi
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Via Sergio Pansini n. 6, Naples 80100, Italy
| | - Antonio Mollo
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Via Sergio Pansini n. 6, Naples 80100, Italy
| | - Giuseppe De Placido
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Via Sergio Pansini n. 6, Naples 80100, Italy
| | - Adam Magos
- University Department of Obstetrics and Gynaecology, Royal Free Hospital, London NW3 2QG, UK
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Ahmadi F, Javam M. Role of 3D sonohysterography in the investigation of uterine synechiae/asherman's syndrome: pictorial assay. J Med Imaging Radiat Oncol 2013; 58:199-202. [PMID: 24314038 DOI: 10.1111/1754-9485.12137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
Abstract
Several imaging methods have been applied for evaluation of suspected uterine synechiae; however, sonohysterography is yet recognised as a valid and accurate modality. Performing three-dimensional (3D) imaging along with sonohysterography enables evaluation of the uterus in the coronal plane to detect and grade the adhesions that characterise this condition. Thus, 3D sonohysterography is a minimally invasive and cost-effective tool for investigating suspected synechiae and is particularly useful when the transvaginal sonography findings are normal.
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Affiliation(s)
- Firoozeh Ahmadi
- Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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31
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Yang T, Pandya A, Marcal L, Bude RO, Platt JF, Bedi DG, Elsayes KM. Sonohysterography: Principles, technique and role in diagnosis of endometrial pathology. World J Radiol 2013; 5:81-7. [PMID: 23671744 PMCID: PMC3650208 DOI: 10.4329/wjr.v5.i3.81] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/21/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Sonohysterography (SHG), which provides enhanced endometrial visualization during standard transvaginal ultrasonography, is a relatively safe procedure for the evaluation of endometrial pathology. It can be used to evaluate patients with abnormal vaginal bleeding or infertility. This modality offers real time imaging of the endometrium without exposure to ionizing radiation. SHG is typically used in patients for whom standard transvaginal ultrasonography does not show the endometrium well, show a potential abnormality for which further imaging is required, or in patients without endometrial pathology defined on routine transvaginal imaging but in whom there is a strong clinical suspicion of an abnormality. This article will discuss the utility of the sonohysterogram in evaluation of various endometrial pathologies. Imaging examples of these pathological entities will be illustrated as well.
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Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril 2012; 98:302-7. [PMID: 22698637 DOI: 10.1016/j.fertnstert.2012.05.032] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022]
Abstract
Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all relevant factors with initial emphasis on the least invasive methods for detection of the most common causes of infertility. The purpose of this Committee Opinion is to provide a critical review of the current methods and procedures for the evaluation of the infertile female, and it replaces the 2006 ASRM Practice Committee document titled "Optimal evaluation of the infertile female."
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Changes in endometrial receptivity in women with Asherman's syndrome undergoing hysteroscopic adhesiolysis. Arch Gynecol Obstet 2012; 286:525-30. [PMID: 22535194 DOI: 10.1007/s00404-012-2336-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 04/13/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether there is any improvement in the endometrial receptivity in infertile women with Asherman's syndrome undergoing hysteroscopic adhesiolysis. MATERIALS AND METHODS This was a prospective observational clinical analysis of 40 infertile patients who underwent hysteroscopic adhesiolysis for Asherman's syndrome in a tertiary level hospital. Endometrial thickness and blood flow impedance of the uterine spiral artery by transvaginal color pulsed Doppler ultrasound was measured post-menstrual on day 2/3 and post-menstrual on day 21 pre- and post-hysteroscopic adhesiolysis or at a randomly chosen time in patients with amenorrhea. RESULTS The age of the patients was 18-36 years (mean 29.2 years). The mean duration of infertility was 6.9 years. There were 27 (67.5 %) women with primary infertility and 13 (32.5 %) had secondary infertility. 22 (55 %) women had had genital tuberculosis in the past. A significant improvement in the endometrial thickness was observed on day 2 (p < 0.0001) and day 21 (p < 0.0001) 3 months post-adhesiolysis. The spiral artery RI was statistically significant (p < 0.04) on day 2 pre-adhesiolysis compared to post-adhesiolysis. CONCLUSIONS A significant improvement in the endometrial thickness was observed post-adhesiolysis. A high blood flow impedance of spiral artery perhaps impairs growth of the endometrium making it unsuitable for successful implantation.
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HRAZDIROVA LUCIE, SVABIK KAMIL, ZIZKA ZDENEK, GERMANOVA ANNA, KUZEL DAVID. Should hysteroscopy be provided for patients who have undergone instrumental intrauterine intervention after delivery? Acta Obstet Gynecol Scand 2012; 91:514-7. [DOI: 10.1111/j.1600-0412.2011.01338.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- LUCIE HRAZDIROVA
- Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - KAMIL SVABIK
- Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - ZDENEK ZIZKA
- Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - ANNA GERMANOVA
- Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - DAVID KUZEL
- Department of Obstetrics and Gynecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Comprehensive management of severe Asherman syndrome and amenorrhea. Fertil Steril 2011; 97:160-4. [PMID: 22100167 DOI: 10.1016/j.fertnstert.2011.10.036] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/27/2011] [Accepted: 10/31/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe a comprehensive approach to women with severe Asherman syndrome and amenorrhea, including preoperative, operative, and postoperative care and subsequent resumption menses, and pregnancy. DESIGN Retrospective case series. SETTING Tertiary care teaching hospital. PATIENT(S) Twelve women with severe Asherman syndrome and amenorrhea. INTERVENTION(S) Preoperative administration of prolonged preoperative and postoperative oral E(2) 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.
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Deans R, Abbott J. Review of intrauterine adhesions. J Minim Invasive Gynecol 2010; 17:555-69. [PMID: 20656564 DOI: 10.1016/j.jmig.2010.04.016] [Citation(s) in RCA: 263] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 04/26/2010] [Accepted: 04/30/2010] [Indexed: 02/07/2023]
Abstract
This article has been produced to review the literature on symptomatic and asymptomatic intrauterine adhesions. Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Current Contents, and EMBASE were searched using the Medical Subject Headings (MeSH), including all subheadings, and the keywords "Asherman syndrome," "Hysteroscopic lysis of adhesions," "Hysteroscopic synechiolysis," "Hysteroscopy and adhesion," "Intrauterine adhesions," "Intrauterine septum and synechiae," and "Obstetric outcomes after intrauterine surgery." The vast majority of evidence in the literature consists of uncontrolled case series, with only intrauterine adhesion barriers being assessed in a randomized controlled format. This article reviews epidemiology, pathologic features, classification systems, and treatments. Seven classification systems are described, with no universal acceptance of any one system and no validation of any of them. Hysteroscopy is the mainstay of both diagnosis and treatment, with medical treatments having no role in management. There is a wide range of treatment techniques with no controlled comparative studies, and assessments are descriptive and report fertility and menstrual outcomes, with more severe adhesions having the worst clinical outcomes. One of the most important features of treatment is prevention of recurrence, with the best available evidence demonstrating that newly developed adhesion barriers such as hyaluronic acid show promise for preventing new adhesions.
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Affiliation(s)
- Rebecca Deans
- Department of Gynaecology, Royal Hospital for Women, and School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
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AAGL Practice Report: Practice Guidelines for Management of Intrauterine Synechiae. J Minim Invasive Gynecol 2010; 17:1-7. [DOI: 10.1016/j.jmig.2009.10.009] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 10/27/2009] [Accepted: 10/27/2009] [Indexed: 11/29/2022]
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Ahonkallio SJ, Liakka AK, Martikainen HK, Santala MJ. Feasibility of endometrial assessment after thermal ablation. Eur J Obstet Gynecol Reprod Biol 2009; 147:69-71. [DOI: 10.1016/j.ejogrb.2009.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 04/01/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
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Elsayes KM, Pandya A, Platt JF, Bude RO. Technique and diagnostic utility of saline infusion sonohysterography. Int J Gynaecol Obstet 2009; 105:5-9. [DOI: 10.1016/j.ijgo.2008.11.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 11/07/2008] [Accepted: 11/17/2008] [Indexed: 11/29/2022]
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Intrauterine adhesions (IUA): has there been progress in understanding and treatment over the last 20 years? ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0421-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Asherman syndrome--one century later. Fertil Steril 2008; 89:759-79. [PMID: 18406834 DOI: 10.1016/j.fertnstert.2008.02.096] [Citation(s) in RCA: 435] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 02/07/2008] [Accepted: 02/07/2008] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To provide an update on the current knowledge of Asherman syndrome. DESIGN Literature review. SETTING The worldwide reports of this disease. PATIENT(S) Patients with Asherman syndrome who presented with amenorrhea or hypomenorrhea, infertility, or recurrent pregnancy loss. INTERVENTION(S) Hysteroscopy and hysteroscopic surgery have been the gold standard of diagnosis and treatment respectively for this condition. MAIN OUTCOME MEASURE(S) The etiology, pathology, symptomatology, diagnosis, treatment, and reproductive outcomes were analyzed. RESULT(S) This syndrome occurs mainly as a result of trauma to the gravid uterine cavity, which leads to the formation of intrauterine and/or intracervical adhesions. Despite the advances in hysteroscopic surgery, the treatment of moderate to severe Asherman syndrome still presents a challenge. Furthermore, pregnancy after treatment remains high risk with complications including spontaneous abortion, preterm delivery, intrauterine growth restriction, placenta accrete or praevia, or even uterine rupture. CONCLUSION(S) The management of moderate to severe disease still poses a challenge, and the prognosis of severe disease remains poor. Close antenatal surveillance and monitoring are necessary for women who conceive after treatment.
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Kodaman PH, Arici A. Intra-uterine adhesions and fertility outcome: how to optimize success? Curr Opin Obstet Gynecol 2007; 19:207-14. [PMID: 17495635 DOI: 10.1097/gco.0b013e32814a6473] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the etiology, diagnosis, and clinical manifestations of intra-uterine adhesions and to address treatment with a specific focus on fertility outcome. RECENT FINDINGS Intra-uterine adhesions can cause recurrent pregnancy loss and infertility. The gravid or recently postpartum uterus is particularly susceptible to adhesion formation following instrumentation. While sonohysterography and hysterosalpingography are useful as screening tests of intra-uterine adhesions, hysteroscopy remains the mainstay of diagnosis and treatment. Hysteroscopic lysis of adhesions with scissors, electrosurgery, or laser can restore the size and shape of the endometrial cavity. Significantly obliterated cavities may require multiple procedures to achieve a satisfactory anatomical result. Postoperative mechanical distention of the endometrial cavity and hormonal treatment to facilitate endometrial regrowth appear to decrease the high rate of adhesion reformation. Newer antiadhesive barriers may also prevent the recurrence of intra-uterine adhesions. Endometrial development can remain stunted due to a scant amount of residual functioning endometrium and fibrosis. Potential pregnancy complications, especially placenta accreta, after the treatment of intra-uterine adhesions should be anticipated and discussed with the patient. SUMMARY Diagnosis and treatment of intra-uterine adhesions are integral to the optimization of fertility outcomes. Favorable results in terms of pregnancy and live birth rates can be expected after hysteroscopic adhesiolysis.
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Affiliation(s)
- Pinar H Kodaman
- Yale University School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Section of Reproductive Endocrinology and Infertility, New Haven, Connecticut 06520, USA.
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Abstract
If the Müllerian ducts fail to fuse, or, if the wall which is the result of fusion is not adequately resorbed, the result is a spectrum of uterine abnormalities called Müllerian fusion and absorption defects. The impact of these abnormalities on fertility is a subject for debate, but at least a subset seems to have a negative impact on reproductive performance manifesting in recurrent abortion and/or premature labor. Previous surgical interventions required laparotomy, but, with careful application of imaging techniques, a group of patients can be identified with a uterine septum amenable to removal under hysteroscopic direction with little morbidity. Intrauterine adhesions or synechiae are usually secondary to curettage in the context of missed abortion or pregnancy-related hemorrhage. These lesions cover a spectrum that ranges from minor and insignificant to severe cohesive adhesions that affect menstrual function and fertility. Surgical repair of the endometrial cavity affected with such adhesions presents a challenge to the hysteroscopic surgeon. Appropriate management is controversial but may include second loop hysteroscopy and the use of postoperative adjuvants such as systemic estrogens and intrauterine devices or systems designed to impede the development of adhesions.
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Affiliation(s)
- Luigi Fedele
- Clinica Ostetrica e Ginecologica II, Università di Milano, Milano, Italy.
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Guimarães Filho HA, Mattar R, Pires CR, Araujo Júnior E, Moron AF, Nardozza LMM. Prevalence of uterine defects in habitual abortion patients attended on at a University Health Service in Brazil. Arch Gynecol Obstet 2006; 274:345-8. [PMID: 16947058 DOI: 10.1007/s00404-006-0202-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 06/22/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Assessment of the prevalence and types of uterine defects in patients with recurrent pregnancy loss (RPL) through hysteroscopy (HTC). PATIENTS AND METHODS Sixty non pregnant patients with history of three or more consecutive spontaneous abortions were evaluated through HTC. The findings were separated into three groups: synechias, polypoids lesions (endometrial polyps and submucous myomas), and alterations of the cavity shape (mullerian anomalies). The findings were gathered and tabulated according to the presence of each defect. RESULTS Uterine anomalies were observed in 23 (38.3%) patients, with 16 (26.7%) synechias, 3 (5.0%) polypoids lesions and 8 (13.3%) shape alterations. CONCLUSIONS The results obtained here suggest that the uterine factor has high prevalence in patients with a RPL history, and for this reason it should be systematically assessed in patients with a RPL history.
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Affiliation(s)
- Hélio Antonio Guimarães Filho
- Obstetrics Department, São Paulo's Federal University, Unifesp/EPM, Reinaldo Tavares de Melo street, 142/901, Manaíra, João Pessoa, CEP 58038-300, PB, Brazil.
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Ando H, Toda S, Harada M, Yoshida S, Kondo I, Masahashi T, Mizutani S. Which infertile women should be indicated for sonohysterography? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:566-571. [PMID: 15459940 DOI: 10.1002/uog.1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the indications for transvaginal saline contrast sonohysterography (TV-SCSH) in endometrial screening by transvaginal sonography in infertile women. METHODS The study involved 850 consecutive infertile women presenting to an outpatient clinic. Using transvaginal ultrasound endometrial images were evaluated in the proliferative phase. Abnormal images were classified as follows: rugged (R), hyperechoic (H), waved (W), or thick (T). Clinical symptoms such as hypermenorrhea, dysmenorrhea and abnormal uterine bleeding were also recorded. Abnormal endometrial images were further evaluated on TV-SCSH. Age-matched women with normal endometrial images underwent TV-SCSH as controls. RESULTS The endometrial pattern was abnormal in 111 patients (13.1%). Lesions that had been identified by TV-SCSH including endometrial polyps (44 cases), submucosal myomata (29 cases), and intramural myomata with mucosal extension (24 cases) were largely associated with the R and/or the H pattern, the W or the T pattern, and the W pattern, respectively. Sensitivity and specificity of the abnormal endometrial image for any lesion were 100% and 91.5%, respectively. Sixty-four patients (59.3%) were asymptomatic despite an abnormal endometrial image. CONCLUSIONS TV-SCSH should be performed on selected patients following assessment of endometrial images on transvaginal sonography in order to diagnose intra- and pericavitary lesions in infertile women.
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Affiliation(s)
- H Ando
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan.
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Nass Duce M, Oz U, Ozer C, Yildiz A, Apaydin FD, Cil F. Diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps. Aust N Z J Obstet Gynaecol 2003; 43:448-52. [PMID: 14712949 DOI: 10.1046/j.0004-8666.2003.00129.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate the diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps. METHODS Thirty-two women whose preliminary transvaginal ultrasound suggested endometrial abnormality underwent sonohysterography. The findings were then compared with histopathological results. RESULTS The sonohysterographic diagnosis was fibroid in seven patients, endometrial polyp in 23 patients and simple hyperplasia in two patients. Histopathological findings confirmed our diagnosis in all except three patients with endometrial polyps, who had normal secretory endometrium. Sonohysterography was found to have a sensitivity of 100%, a positive predictive value of 90% and diagnostic accuracy of 90.6%. CONCLUSION Sonohysterography is a useful, minimally invasive and accurate technique to evaluate the pathologies involving endometrium and uterine cavity.
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Affiliation(s)
- Meltem Nass Duce
- Department of Radiology, Faculty of Medicine, Mersin University, Mersin, Turkey.
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