Comprehensive management of severe Asherman syndrome and amenorrhea.

OBJECTIVE: To describe a comprehensive approach to women with severe Asherman syndrome and amenorrhea, including preoperative, operative, and postoperative care and subsequent resumption menses, and pregnancy. DESIGN: Retrospective case series. SETTING: Tertiary care teaching hospital. PATIENT(S): Twelve women with severe Asherman syndrome and amenorrhea. INTERVENTION(S): Preoperative administration of prolonged preoperative and postoperative oral E(2) to enhance endometrial proliferation, intraoperative abdominal ultrasound-directed hysteroscopic lysis of uterine synechia to ensure that the dissection is performed in the proper tissue plane, placement of a triangular uterine balloon catheter during surgery, and postoperative removal with placement of a copper intrauterine device (IUD) to maintain separation of the cavity and mechanically lyse newly formed adhesions during removal. MAIN OUTCOME MEASURE(S): Resumption of menses, pregnancy, and delivery. RESULT(S): All women resumed menses, although 5 of 12 had a preoperative maximal endometrial thickness of 4 mm or less, with follow-up ranging from 6 months to 10 years. Six of nine women less than age 39 years (67%) became pregnant, and four of six achieved a term or near-term delivery. CONCLUSION(S): Comprehensive management provides the best possible outcomes in poor-prognosis women with severe Asherman syndrome.