Surgical treatment of Asherman syndrome and reproductive outcome.

INTRODUCTION: Asherman syndrome may be challenging to treat. This study presented the results after hysteroscopic treatment of Asherman syndrome in our clinic focusing on the reproductive outcome. METHODS: A total of 43 women were operated in the course of a five-year period. The women were post-operatively treated with hyaluronic acid gel, intrauterine device (IUD) and hormonal supplementation. A second-look minihysteroscopy and removal of the IUD were conducted seven weeks later. Data concerning the results after one or more operations were obtained from a phone interview and from the medical records. RESULTS: The pregnancy rate among the 38 women who wished to conceive was 82%, and the live birth rate was 63%. Among the 31 women who became pregnant, 42% achieved spontaneous pregnancy, whereas 58% became pregnant after fertility treatments. An increased risk of obstetric complications was recorded, especially related to abnormal placentation and impaired placenta function. CONCLUSIONS: Hysteroscopic treatment of Asherman syndrome seems to be a safe procedure, but a risk possibly exists of obstetrical complications in the subsequent pregnancies. Pregnancies following hysteroscopic adhesiolysis should be considered high-risk pregnancies. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Reproductive surgery for female infertility].

Although assisted reproductive technology has reduced the need for surgery for women with infertility, there is evidence to support, that targeted reproductive surgery can improve fertility and pregnancy outcomes. In the last decades, increased access to minimal invasive surgery has brought a new era to reproductive surgery. An integration of reproductive surgery in the fertility treatment is therefore recommended. The patient should be offered detailed information regarding the pros and cons before the surgical treatment, as the evidence in the field is sparse, which is discussed in this review.

Urinary incontinence during pregnancy and 1 year after delivery in primiparous women compared with a control group of nulliparous women.

AIMS: To investigate the impact of the first pregnancy and delivery on the prevalence and types of urinary incontinence during pregnancy and 1 year after delivery. METHODS: The study was a prospective cohort study with a control group. Primiparous women, who delivered in our department from June 2003 to July 2005, participated. The women filled out a questionnaire 2-3 days after the delivery and a new questionnaire after 1 year. The questionnaires comprised basic characteristics and symptoms of urinary incontinence. An attempted age-matched control group of nulliparous women was included, and filled out similar questionnaires. Prevalences and types of urinary incontinence, and a combined severity- and bother-score (ICIQ-SF score) among the incontinent women, were calculated and compared. RESULTS: The two groups differed significantly in age and most basic characteristics. During pregnancy, the prevalence of any type of urinary incontinence in the primiparous group was 32.1%, compared to 13.8% in the control group. Adjusted OR = 3.3 (95%CI = 2.4-4.4). One year after delivery, the prevalence in the primiparous group was 29.3%, compared to 16.6% in the control group. Adjusted OR = 2.5 (95%CI = 1.8-3.5). ICIQ-SF mean scores among the incontinent women varied insignificantly between 5.8 and 6.2. CONCLUSIONS: The prevalence of urinary incontinence during pregnancy was 3.3 times higher compared with a control group of nulliparous women. After 1 year, the difference was reduced, but still 2.5 times higher in the primiparous group. The symptoms and impact on quality of life seemed to be mild to moderate in both groups.

Outcome of repeated hysteroscopic resection of the endometrium.

STUDY OBJECTIVE: To evaluate the efficacy and safety of repeated endometrial resection. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospital. PATIENTS: Women with a failed primary endometrial resection. INTERVENTION: Repeated endometrial resection, roller-ball coagulation, or both. MEASUREMENTS AND MAIN RESULTS: In all, 65 women had a repeated endometrial resection during the period from January 1995 through December 2002. Data were collected from standardized data sheets, hospital records, and the National Patient Registry of the National Board of Health. The primary outcome measurement was subsequent hysterectomy, and secondary, perioperative complications. The median follow-up time was 56 months (range 40-110 months). In all, 28 (43%) women required a hysterectomy eventually. Six (9%) women had operative complications. CONCLUSION: Repeat endometrial resection is a relatively safe, minimally invasive operation and approximately 60% of women operated on will avoid hysterectomy. The operation should be performed by an experienced hysteroscopic surgeon.