Concomitant hysteroscopy and hysterography in Asherman's syndrome

Intrauterine adhesions (IUA) (Asherman's syndrome) are a relatively frequent sequel of curettage and may cause fertility problems. Diagnosis is by hysterography, and hitherto treatment was by blind division or curettage. Lately hysteroscopic division has been introduced. A few weeks later re-hysterography is done to evaluate the results. A one-stage method is presented, in which hysteroscopic division of adhesions and immediate hysterography are done on the operating table. If some adhesions are still seen, repeat hysteroscopy and adhesionolysis re done, until the uterine cavity is restored to normal. A Lippes IUD is inserted for 2 months, with cyclic hormonal treatment, and the patient allowed subsequently to become pregnant. Fifty-six patients were treated in this manner and in 53 a regular cavity was obtained. Obstetric performance was improved from 31.9% to 64.9%, so that anatomical and functional results compare very favorably with previous reports that used other methods. This one-stage method offers a short and efficient treatment of IUA.