Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome

One hundred eighty-seven patients were evaluated and treated by hysteroscopy over a 10-year period. To assess therapeutic prognosis, these patients were classified according to the extent of uterine cavity occlusion seen on hysterosalpingography and the type of intrauterine adhesions observed at hysteroscopy. Forty-three patients had mild or filmy intrauterine adhesions, 97 had moderate or fibromuscular adhesions, and 47 patients were classified as having severe connective tissue adhesions. After hysteroscopic treatment, normal menstruation was restored in 88.2% of patients who had menstrual abnormalities including amenorrhea, hypomenorrhea, and dysmenorrhea. Among the 187 patients, 143 women achieved pregnancy; of those, 114 (79.7%) achieved a term pregnancy, 26 (18.2%) had a spontaneous abortion, and 3 (2.1%) had ectopic pregnancies. The reproductive outcome correlated with the type of adhesions and extent of uterine cavity occlusion, ranging from a term pregnancy rate of 81.3% in patients with mild disease to 31.9% in patients with severe disease.