Live Birth Outcomes in Patients With Recurrent Pregnancy Loss and Asherman Syndrome: A Retrospective Cohort Study

To assess the impact of Asherman syndrome on live birth outcomes in a recurrent pregnancy loss (RPL) cohort prior to surgical intervention and evaluate the efficacy of hysteroscopic adhesiolysis in enhancing live birth outcomes.

Retrospective cohort.

Specialized RPL clinic.

Patients with RPL seen between January 2011 and March 2022.

Participants were categorized into two groups: the Asherman syndrome group and the non-Asherman syndrome group.

A total of 296 patients were included in the study: 74 (25.0%) with Asherman syndrome and 222 (75.0%) without. At the initial RPL Clinic visit, there was no significant difference in percentage of participants with at least one abnormal RPL investigation between the two groups (35.1% vs 41.9%; p = .41). Current smoking was more common in the Asherman group (14.9% vs 5.4%; p = .02). Before treatment, patients with Asherman syndrome had lower odds of achieving a live birth with each achieved pregnancy compared to those without, after adjusting for age, smoking, and other abnormal RPL investigations (adjusted odds ratio [aOR] = 1.5, 95% confidence interval [CI]: 1.1-2.0 vs aOR-2.5, 95% CI: 1.9-3.3). Following surgical correction, patients in the Asherman syndrome group showed remarkably improved live birth odds ratio of 3.5 with each achieved pregnancy (95% CI: 1.7-7.1), as compared with the non-Asherman group's aOR of 2.7 (95% CI: 1.9-3.9), after adjusting for age, smoking status, and other abnormal RPL investigations.

In the RPL population, untreated Asherman syndrome reduced the odds of achieving a live birth associated with increased number of pregnancies, while surgical correction significantly improved live birth outcomes.