Top

Archives of Gynecology and Obstetrics

Published in:

01-08-2012 | Reproductive Medicine

Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis

Authors: Neena Malhotra, Anupama Bahadur, Mani Kalaivani, Suneeta Mittal

Published in: Archives of Gynecology and Obstetrics | Issue 2/2012

Abstract

Objective

To determine whether there is any improvement in the endometrial receptivity in infertile women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis.

Materials and methods

This was a prospective observational clinical analysis of 40 infertile patients who underwent hysteroscopic adhesiolysis for Asherman’s syndrome in a tertiary level hospital. Endometrial thickness and blood flow impedance of the uterine spiral artery by transvaginal color pulsed Doppler ultrasound was measured post-menstrual on day 2/3 and post-menstrual on day 21 pre- and post-hysteroscopic adhesiolysis or at a randomly chosen time in patients with amenorrhea.

Results

The age of the patients was 18–36 years (mean 29.2 years). The mean duration of infertility was 6.9 years. There were 27 (67.5 %) women with primary infertility and 13 (32.5 %) had secondary infertility. 22 (55 %) women had had genital tuberculosis in the past. A significant improvement in the endometrial thickness was observed on day 2 (p < 0.0001) and day 21 (p < 0.0001) 3 months post-adhesiolysis. The spiral artery RI was statistically significant (p < 0.04) on day 2 pre-adhesiolysis compared to post-adhesiolysis.

Conclusions

A significant improvement in the endometrial thickness was observed post-adhesiolysis. A high blood flow impedance of spiral artery perhaps impairs growth of the endometrium making it unsuitable for successful implantation.

Fritsch H (1894) Ein Fall von volligem Schwund der Gebormutterhohle nach Auskratzung. Zentralbl Gynaekol 18:1337–1342

Asherman JG (1948) Amenorrhoea Traumatica (Atretica). J Obstet Gynaecol Br Emp 55:23–30PubMedCrossRef

Schenker JG, Margalioth EJ (1982) Intrauterine adhesions: an updated appraisal. Fertil Steril 37:593–610PubMed

Diamond MP (2000) Incidence of postsurgical adhesions. In: diZirega G (ed) Peritoneal surgery. Springer, New York, pp 217–220CrossRef

Polishuk W, Kohane S (1966) Intrauterine adhesions: diagnosis and therapy. Obstet Gynecol Digest 8:41

Confino E, Friberg J, Giglia R, Gleicher N (1985) Sonographic imaging of intrauterine adhesions. Obstet Gynecol 66:596–598PubMed

Schlaff WD, Hurst BS (1995) Preoperative sonographic measurement of endometrial pattern predicts outcome of surgical repair in patients with severe Asherman’s syndrome. Fertil Steril 63:410–413PubMed

Salle B, Gaucherand P, de Saint Hilaire P, Rudigos RC (1999) Transvaginal sonohysterographic evaluation of intrauterine adhesions. J Clin Ultrasound 27:131–134PubMedCrossRef

Bahadur A, Malhotra N, Mittal S, Singh N, Sumana G (2010) Second-look Hysteroscopy after antitubercular treatment in infertile women with genital tuberculosis undergoing artificial reproductive therapy. Int J Gynaecol Obstet 108(2):128–131PubMedCrossRef

10.

Westendorp ICD, Ankum WM, Mol B, Vonk J (1998) Prevalence of Asherman’s syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum Reprod 13:3347–3350PubMedCrossRef

11.

Rochet Y, Dargent D, Bremond A (1979) The obetetrical outcome of women with surgically treated uterine synaechiae. J Gynecol Obstet Biol Reprod 8:723–726

12.

Parent B, Barbot J, Dubuisson J (1988) Uterine synaechiae. Encycl Med Chir Gynecol 140A(suppl):10–12

13.

Sharma JB, Roy KK, Pushparaj M, Gupta N, Jain SK, Malhotra N et al (2008) Genital tuberculosis: an important cause of Asherman’s syndrome in India. Arch Gynecol Obstet 277(1):37–41PubMedCrossRef

14.

Wamsteker K, De Block S (1998) Diagnostic hysteroscopy: technique and documentation. In: Sutton C, Diamond M (eds) Endoscopic surgery for gynaecologists. Saunders, London, pp 511–524

15.

Pabuccu R, Atay V, Orhon E, Urman B, Ergiin A (1997) Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation. Fertil Steril 68:1141–1143PubMedCrossRef

16.

Yu D, Li TC, Xia E, Huang X, Liu Y, Peng X (2008) Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman’s syndrome. Fertil Steril 89(3):715–722PubMedCrossRef

17.

Friedler S, Schenker JG, Herman A, Lewin A (1996) The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Hum Reprod Update 2:323–335PubMedCrossRef

18.

Orhue AAE, Aniken ME, Igbefoh JO (2003) A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet 82:49–56PubMedCrossRef

19.

Roy KK, Baruah Jinee, Sharma Jai Bhagwan, Kumar Sunesh, Kachawa Garima, Singh Neeta (2010) Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome. Arch Gynecol Obstet 281:355–361PubMedCrossRef

20.

Smith SK (2000) Angiogenesis and implantation. Hum Reprod 15:59–66PubMedCrossRef

21.

Smith SK (1998) Angiogenesis, vascular endothelial growth factor and the endometrium. Hum Reprod Update 4:509–519PubMedCrossRef

22.

Kashida S, Sugino N, Takiguchi S, Karube A, Takayama H, Yamagata Y et al (2001) Regulation and role of vascular endothelial growth factor in the corpus luteum during mid-pregnancy in rats. Biol Reprod 64:317–323PubMedCrossRef

23.

Sharkey AM, Day K, McPherson A, Malik S, Licence D, Smith SK et al (2000) Vascular endothelial growth factor expression in human endometrium is regulated by hypoxia. J Clin Endocrinol Metab 85:402–409PubMedCrossRef

24.

Shifren JL, Tseng JF, Zaloudek CJ, Ryan IP, Meng YG, Ferrara N et al (1996) Ovarian steroid regulation of vascular endothelial growth factor in the human endometrium: implications for angiogenesis during the menstrual cycle and in the pathogenesis of endometriosis. J Clin Endocrinol Metab 81:3112–3118PubMedCrossRef

25.

Sugino N, Kashida S, Karube-Harada A, Takiguchi S, Kato H (2002) Expression of vascular endothelial growth factor (VEGF) and its receptors in human endometrium throughout the menstrual cycle and in early pregnancy. Reproduction 123:379–387PubMedCrossRef

26.

Torry DS, Holt VJ, Keenan JA, Harris G, Caudle MR, Torry RJ (1996) Vascular endothelial growth factor expression in cycling human endometrium. Fertil Steril 66:72–80PubMed

27.

Miwa I, Tamura H, Takasaki A, Yamagata Y, Shimamura K, Sugino N (2009) Pathophysiologic features of “thin” endometrium. Fertil Steril 91(4):998–1004PubMedCrossRef

28.

Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N (2010) Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertil Steril 93(6):1851–1858PubMedCrossRef

Title: Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis
Authors: Neena Malhotra
Anupama Bahadur
Mani Kalaivani
Suneeta Mittal
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 2/2012
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-012-2336-0

At a glance: The STEP trials

Springer Medicine

Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis

Abstract

Objective

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2012

Does obesity complicate perioperative course in patients undergoing abdominal hysterectomy?

TVT-Secur for the treatment of female stress urinary incontinence: a 24-month follow-up retrospective study

Transvaginal 3D HD-flow in diagnosis of uterine arteriovenous malformation

Effect of AT1R knockdown on ishikawa cell proliferation induced by estrogen

Work-related repetitive strain injuries amongst practitioners of obstetric and gynaecological ultrasound worldwide

3D-Endometrial volume and outcome of cryopreserved embryo replacement cycles