Hysteroscopic adhesiolysis: efficacy and safety.

Objective: To evaluate the efficacy and safety of hysteroscopic adhesiolysis in patients with intrauterine adhesions (IUAs).

Setting: Minia Maternity University Hospital, Egypt.

Design: Prospective cohort study.

Patients: This study included 61 patients presented with infertility (primary or secondary) or recurrent pregnancy losses caused by IUAs.

Intervention(s): The adhesions were divided by semi-rigid scissors introduced under direct vision through hysteroscopy. Three months later, second-look hysteroscopy was performed.

Primary Outcome Parameters: Primary outcome parameters were reproductive parameters (pregnancy rate, duration of pregnancies, life births rate, time lag between the intervention and diagnosis of pregnancy).

Secondary Outcome Parameters: Secondary outcome parameters were the changes in post-operative menstrual pattern, number and duration of intervention and type of intra- and post-operative complications.

Result(s): Pregnancy rate changed from 18 to 65.5 %, while live birth rate improved from 14.7 to 36 %. The mean time until the first conception was 10.2 months (range 2-60 months) after the operation. There was significant negative correlation between the degree of IUAs and the improvement in reproductive performance. Hysteroscopic adhesiolysis significantly improved menstrual pattern in 60.7 % of patients complaining of hypomenorrhea or amenorrhea. (p = 0.0017). The average operative time was 29 ± 10.2 (10-52) min and the hospital stay was 12.5 ± 2.1 (9-24) h. Uterine perforation occurred on 3 (4.9 %), and cervical laceration occurred in one case (1.6 %).

Conclusion(s): Hysteroscopic adhesiolysis of IUAs is safe and effective in terms of reproductive outcome. The outcome is significantly affected by degree of intrauterine adhesions rather than the main complaint before the procedure.