MedWorm: Asherman's Syndrome

Impact of pulmonary tuberculosis on menstrual pattern and fertility

The Clinical Respiratory Journal — Tue, 02 Mar 2010 00:00:00 +0100

Conclusions: TB had marked reversible effect on the menstrual cycle but minimal association with genital TB and infertility. Pretreatment counseling of pulmonary TB women should include information on these reversible changes. Persistence of menstrual abnormalities or presence of infertility after completion of treatment should stimulate investigation for the possibility of genital tract involvement. Please cite this paper as: Hassan WA and Darwish AM. Impact of pulmonary tuberculosis on menstrual pattern and fertility. The Clinical Respiratory Journal 2010; DOI:10.1111/j.1752-699X.2009.00166.x. (Source: The Clinical Respiratory Journal)

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AAGL Practice Report: Practice Guidelines for Management of Intrauterine Synechiae

The Journal of Minimally Invasive Gynecology — Fri, 01 Jan 2010 00:00:00 +0100

Intrauterine adhesions (IUAs) have been recognized as a cause of secondary amenorrhea since the end of the 19th century , and in the mid-20th century, Asherman further described the eponymous condition occurring after pregnancy . The terms “Asherman syndrome” and IUAs are often used interchangeably, although the syndrome requires the constellation of signs and symptoms (in this case, pain, menstrual disturbance, and subfertility in any combination) and the presence of IUAs . The presence of IUAs in the absence of symptoms may be best referred to as asymptomatic IUAs or synechiae. (Source: The Journal of Minimally Invasive Gynecology)

Hysteroscopic Appearance of Endometrial Cavity after Microwave Endometrial Ablation

The Journal of Minimally Invasive Gynecology — Fri, 01 Jan 2010 00:00:00 +0100

Conclusion: The hysteroscopic appearance of the uterine cavity after microwave endometrial ablation varies considerably. In this study, the menstrual outcome was correlated with postablation uterine cavity appearance. (Source: The Journal of Minimally Invasive Gynecology)

Use of intrauterine devices in women with uterine anatomic abnormalities

International Journal of Gynaecology and Obstetrics — Fri, 25 Dec 2009 00:00:00 +0100

Conclusion: Evidence concerning the safety and effectiveness of IUD use among women with uterine abnormalities is very limited. (Source: International Journal of Gynaecology and Obstetrics)

The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review

Human Reproduction Update — Fri, 11 Dec 2009 15:56:30 +0100

CONCLUSIONS Scarce evidence on the effectiveness of hysteroscopic surgery in subfertile women with polyps, fibroids, septate uterus or intrauterine adhesions indicates a potential benefit. More randomized controlled trials are needed before widespread use of hysteroscopic surgery in the general subfertile population can be justified. (Source: Human Reproduction Update)

Feasibility of endometrial assessment after thermal ablation

European Journal of Obstetrics, Gynecology, and Reproductive Biology — Tue, 07 Jul 2009 23:00:00 +0100

Conclusion: Endometrial assessment is compromised after previous endometrial thermal ablation. Both endometrial sampling and sonohysterography fail quite often, causing problems in diagnosis of abnormal bleeding. Intrauterine adhesions may also decrease the reliability of the endometrial sampling. (Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology)

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Hysteroscopic Management of Residual Trophoblastic Tissue and Reproductive Outcome: A Pilot Study

The Journal of Minimally Invasive Gynecology — Tue, 30 Jun 2009 23:00:00 +0100

We report on the feasibility, efficiency, and reproductive outcomes of hysteroscopic resection of late residual trophoblastic tissue in 50 patients in an observational study over 6 years. Complete evacuation of the uterus was achieved in all patients by hysteroscopy. The median operative time was 21 (15-30) min. Only one surgical complication was registered: a uterine perforation in a patient with previous metroplasty. Hysteroscopic resection of persistent trophoblastic tissue seems to be a safe and efficient procedure that could be proposed as an alternative to conventional non-selective blind curettage. We would also recommend systematic second-look hysteroscopy to asess the exact prevalence of post-procedure intrauterine adhesions. (Source: The Journal of Minimally Invasive Gynecology)

Traumatic uterine synechiae

Irish Journal of Medical Science — Wed, 10 Dec 2008 07:21:43 +0100

Summary SIX cases of traumatic uterine synechiae are reported. The condition is discussed and possible resasons for its apparent rarity in Britain are given. Content Type Journal ArticleDOI 10.1007/BF03004783Authors Rokhsareh Karimi, University of Isfahan Department of Obstetrics and Gynaecology IranKenneth Chapman, University of Isfahan Department of Obstetrics and Gynaecology Iran Journal Irish Journal of Medical ScienceOnline ISSN 1863-4362Print ISSN 0021-1265 Journal Volume Volume 143 Journal Issue Volume 143, Number 1 / December, 1974 (Source: Irish Journal of Medical Science)

Efficiency and pregnancy outcome of serial intrauterine device–guided hysteroscopic adhesiolysis of intrauterine synechiae

Fertility and Sterility — Sat, 01 Nov 2008 04:00:00 +0100

Conclusion(s): The method described especially for early intervention may prevent complications during the treatment of severe intrauterine adhesions and may present a secure and effective alternative for constructive clinical outcomes. (Source: Fertility and Sterility)

Balloon fluoroscopy as treatment for intrauterine adhesions: a novel approach

Fertility and Sterility — Sat, 01 Nov 2008 04:00:00 +0100

Conclusion(s): Hysteroplasty, using standard interventional radiographic techniques, may provide an alternative treatment modality for patients with intrauterine adhesions and lower uterine defects from prior cesarean deliveries in select cases. While treating intrauterine adhesions improves pregnancy outcome, the effect of lower uterine segment-filling defects from cesarean deliveries on pregnancy outcome in assisted reproductive technology cycles warrants further investigation. (Source: Fertility and Sterility)

Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility

Fertility and Sterility — Mon, 20 Oct 2008 00:00:00 +0100

Objective: To determine the rate of uterine synechiae after bipolar hysteroscopic myomectomy in patients suffering from infertility.Design: Retrospective case series study.Setting: University obstetrics gynecologic and assisted reproduction center.Patient(s): A group of 53 patients with primary (n = 30) and secondary (n = 23) infertility.Intervention(s): Patients underwent bipolar hysteroscopic resection of myomas between 2001 and 2006, and an outpatient hysteroscopy was performed 2 months after the fibroid resection.Main Outcome Measure(s): The formation of uterine synechiae and pregnancy rates were collected from the patients' clinical notes.Result(s): The submucosal myomas were intracavitary class 0 (n = 12), intramural class 1 (n = 19), and intramural class 2 (n = 22). The mean age of ...

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Fluoroscopically guided balloon hysteroplasty can lyse lower uterine lesions

MedWire News - Ob/Gyn — Mon, 29 Sep 2008 00:00:00 +0100

Researchers have reported success with a novel fluoroscopically guided approach to treating severe intrauterine adhesions and cervical stenosis using balloon hysteroplasty. (Source: MedWire News - Ob/Gyn)

Thin unresponsive endometrium—a possible complication of surgical curettage compromising ART outcome

Journal of Assisted Reproduction and Genetics — Wed, 17 Sep 2008 06:49:58 +0100

Conclusions Thin unresponsive endometrium was associated with curettage, not necessarily with intrauterine adhesions. Even if adequate thickening eventually occurred, the reproductive outcome was still very poor. Therefore other alternatives should be sought for these patients. Content Type Journal ArticleCategory SHORT COMMUNICATIONDOI 10.1007/s10815-008-9245-yAuthors Yoel Shufaro, Hadassah University Hospital, Ein Kerem IVF Unit, The Department of Obstetrics and Gynecology P.O. Box 12000 Jerusalem 91120 IsraelAlex Simon, Hadassah University Hospital, Ein Kerem IVF Unit, The Department of Obstetrics and Gynecology P.O. Box 12000 Jerusalem 91120 IsraelNeri Laufer, Hadassah University Hospital, Ein Kerem IVF Unit, The Department of Obstetrics and Gynecology P.O. Box 12...

Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study

European Radiology — Wed, 03 Sep 2008 10:57:22 +0100

Abstract To evaluate long-term effects of arterial embolization (AE) for postpartum hemorrhage (PPH) on menses recovery and subsequent pregnancies. One hundred thirteen consecutive patients, recruited from 1999 to 2006, who had undergone AE for severe PPH were evaluated in a retrospective monocentric study. As embolization agents, pledgets of absorbable gelatine sponge (Curaspon®) were used in 106 cases, Curaspon powder in 3 cases, and inert microparticles in 4 cases. In 111/113 cases (98.1%), AE was successful in controlling PPH. In two cases (1.7%), the AE was unsuccessful and required a total abdominal postembolization hysterectomy. Concerning fertility, 6 patients were lost to follow-up and 107 were available. The average time to follow-up was 46.4±21.8 months. ...

Intrauterine Adhesions

Seminars in Reproductive Medicine — Fri, 29 Aug 2008 12:43:31 +0100

Semin Reprod Med 2008; 26: 349-355DOI: 10.1055/s-0028-1082393ABSTRACTJoseph Asherman first described intrauterine adhesions in 1948. It is commonly referred to as Asherman's syndrome and intrauterine synechiae. It is characterized by a spectrum ranging from amenorrhea to menstrual disturbance to normal menses. It is frequently associated with infertility. The true incidence is unknown. Most cases occur within close temporal proximity to a pregnancy, usually within 4 months and usually while the woman is in a hypoestrogenized state. Most cases are associated with trauma to the endometrium from surgical procedures, primarily curettage. Increasingly, cases are associated with myomectomy both abdominal and hysteroscopic, removal of septae, and any other intrauterine surgery. Pathology shows fi...

Intrauterine adhesions (IUA): has there been progress in understanding and treatment over the last 20 years?

Gynecological Surgery — Wed, 27 Aug 2008 15:50:21 +0100

Abstract We review the current evidence about the treatment modalities of intrauterine adhesions (IUA) or Asherman’s Syndrome (AS). Systematic approach, audit and well-structured research is mandatory in order to establish the best treatment for the individual needs of patients. The clinical practice changed significantly over the last 20 years with technological advances in hysteroscopy and imaging techniques. Hysteroscopic treatment seems effective and safe. IUA or AS is a rather uncommon finding in general gynaecological practice. The referral to a tertiary centre will help to centralise the most difficult cases and create the opportunity to study more in detail the efficacy of each treatment modality and to compare the different treatment techniques. Content T...

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Pelvic pain following microwave endometrial ablation—is hysteroscopic adhesiolysis worthwhile?

Gynecological Surgery — Wed, 25 Jun 2008 07:56:23 +0100

In conclusion, some patients were still symptomatic following hysteroscopy and needed further intervention in the form of major gynaecological surgery. However, 45% of patients improved following only the minor day case procedure, without needing to resort to a hysterectomy with its inherent risks and costs. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10397-008-0413-yAuthors J. A. Allen, Castle Hill Hospital Castle Road Cottingham North Humberside HU16 5JQ UKK. Phillips, Castle Hill Hospital Castle Road Cottingham North Humberside HU16 5JQ UK Journal Gynecological SurgeryOnline ISSN 1613-2084Print ISSN 1613-2076 (Source: Gynecological Surgery)

Hysteroscopy in the evaluation of habitual abortions.

The European Journal of Contraception and Reproductive Health Care — Sun, 01 Jun 2008 04:00:00 +0100

CONCLUSIONS: SUAs were detected in nearly half of the patients with HA. After appropriate treatment when applicable, 78% of patients with SUAs achieved a successful ongoing pregnancy. Hysteroscopy has much to offer in the diagnosis and treatment of SUAs. PMID: 18465483 [PubMed - indexed for MEDLINE] (Source: The European Journal of Contraception and Reproductive Health Care)

[Prevention of intrauterine adhesions after hysteroscopic surgery.]

Gynecologie, Obstetrique & Fertilite — Tue, 26 Feb 2008 05:00:00 +0100

Authors: Revaux A, Ducarme G, Luton D Intrauterine adhesions are the most frequent complications after hysteroscopic surgery in women of reproductive age. The prevalence of intrauterine adhesions after hysteroscopic surgery is correlated to intrauterine pathology (myoma, polyp, or adhesions). Few clinical trials have demonstrated the efficiency of barrier agents developed in order to prevent adhesions after operative hysteroscopy. Adhesion barriers are mechanic agent (intrauterine device), fluid agents (Seprafilm((R)), Hyalobarrier((R))) and postoperative systemic treatment (estroprogestative treatment). In this article, we evaluate the efficiency of these barrier agents for adhesion prevention in hysteroscopic surgery, undertaking a review of clinical trials published. The most freque...

Endometrial thickness measured by ultrasound scan in women with uterine outlet obstruction due to intrauterine or upper cervical adhesions

Human Reproduction — Wed, 16 Jan 2008 05:00:00 +0100

CONCLUSIONS Non-invasive ultrasound measurements have demonstrated very thin endometrium and absence of haematometra in most women with uterine outlet occlusion by adhesions. This unusual phenomenon of failure of cyclical endometrial growth and breakdown in the sole presence of cervical occlusion by adhesions merits further study. (Source: Human Reproduction)

The uterus and fertility.

Fertility and Sterility — Thu, 20 Dec 2007 05:00:00 +0100

CONCLUSION(S): Congenital anomalies and acquired diseases of the uterus may negatively impact on the complex processes of embryo implantation. Hysteroscopic surgery to correct uterine septa, intrauterine synechiae, and myomas that distort the uterine cavity may benefit women with infertility or recurrent pregnancy loss. The effect of endometrial polyps on fertility is uncertain, but their removal, once identified, is justifiable. Complex congenital anomalies such as unicornuate uterus and uterus didelphys may negatively affect fertility and pregnancy outcome, and surgical treatment may benefit select patients. PMID: 18155200 [PubMed - as supplied by publisher] (Source: Fertility and Sterility)

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The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications

Archives of Gynecology and Obstetrics — Tue, 16 Oct 2007 15:36:43 +0100

Conclusion The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting from the original surgery. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00404-007-0475-5Authors Tarek A. Shokeir, Mansoura University Hospital Department of Obstetrics and Gynecology, Fertility Care Unit, Mansoura Faculty of Medicine Mansoura EgyptMuhammad Fawzy, Mansoura University Hospital Department of Obstetrics and Gynecology, Fertility Care Unit, Mansoura Faculty of Medicine Mansoura EgyptMuhammad Tatongy, Mansoura University Hospital Department of Obstetrics and Gynecology, Ferti...

Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination.

Contraception — Sun, 30 Sep 2007 00:40:51 +0100

CONCLUSION: Intrauterine adhesions are a cause of failed surgical abortion. Ultrasound-guided hysteroscopy may be required for diagnosis. PMID: 17900447 [PubMed - in process] (Source: Contraception)

Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome.

Fertility and Sterility — Sat, 04 Aug 2007 04:00:00 +0100

CONCLUSION(S): The outcome of hysteroscopic adhesiolysis for Asherman's syndrome is significantly affected by recurrence of intrauterine adhesions. Further research in Asherman's syndrome should be directed toward reduction of adhesion reformation with a view to improving outcome. PMID: 17681324 [PubMed - as supplied by publisher] (Source: Fertility and Sterility)

Genital tuberculosis: an important cause of Asherman’s syndrome in India

Archives of Gynecology and Obstetrics — Wed, 25 Jul 2007 06:49:41 +0100

Conclusion Genital tuberculosis appears to be an important and common cause of Asherman's syndrome in India, causing oligomenorrhoea or amenorrhoea with infertility. Content TypeJournal Article JournalArchives of Gynecology and ObstetricsOnline ISSN 1432-0711Print ISSN 0932-0067 (Source: Archives of Gynecology and Obstetrics)

Genital tuberculosis in Indian infertility patients.

International Journal of Gynaecology and Obstetrics — Tue, 01 May 2007 04:00:00 +0100

CONCLUSION: Genital tuberculosis is common in India and a combination of clinical and laparoscopic diagnoses, along with endometrial histopathologic studies, acid-fast bacillus culture, and polymerase chain reaction assays provides the best available method for the diagnosis of genital tuberculosis in infertile women. PMID: 17362955 [PubMed - in process] (Source: International Journal of Gynaecology and Obstetrics)

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Amnion graft following hysteroscopic lysis of intrauterine adhesions

Journal of Obstetrics and Gynaecology Research — Tue, 14 Nov 2006 09:39:43 +0100

Journal of Obstetrics and Gynaecology Research Volume 32, Issue 6, Page 559-566, Dec 2006. (Source: Journal of Obstetrics and Gynaecology Research)

Prevalence of uterine synechiae among infertile females in a Nigerian teaching hospital

Journal of Obstetrics — Wed, 31 May 2006 06:00:00 +0100

(Source: Journal of Obstetrics)