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Mrs Srivastava ,33yrs married for 6 years with secondary infertility but no living issues came to our clinic..She had a previous pregnancy with blighted ovum for which she underwent dilatation and evacuation outside 1yr back . After this procedure she did not get regular periods (amenorrhoea)and was not conceiving as well for which she was worried . She was given medicines for period and also advised HSG (Hysterosalpingography).The report showed distorted uterine cavity with intrauterine adhesions( Asherman syndrome) .She also complained of very little flow with medicines.
She had a normal BMI .Her vitals were stable and per abdomen examination was soft and non tender.On P/S examination –a normal cervix with no vaginal discharge .Her first USG showed a normal uterus with B/L PCO and around 10-12 antral follicle count .Her AMH level was 3.32 ng/ml and husband’s semen analysis was normal.
Management—She was counselled regarding Asherman syndrome-iatrogenic type ,the prognosis was explained and was advised adhesiolysis to take care of it . The following treatment plan was given —Self IVF with freezing of all the embryos followed by Hysteroscopic adhesiolysis in the next cycle and subsequent frozen embryo transfer .She agreed with the plan and proceeded for self IVF in the next cycle .
We did an antagonist cycle for her with an agonist trigger and retrieved 22 oocytes which resulted in 8 blastocysts .In the next cycle she was given OCP for 21days, with one leuprolide depot 3.75 given on day 21 . She underwent a hysteroscopic evaluation in the next cycle. Her uterus showed adhesions in the lower uterine segment with entry being difficult .An adhesiolysis of the adhesions was done and a recheck hysteroscopy was done .
Once satisfied with the cavity ,endometrium was sent for TBPCR testing which came out negative. Post hysteroscopic adhesiolysis her endometrium was prepared with oral medicines in the same cycle ,an endometrium of 7.3 mm ,triple line was achieved . We planned blastocyst transfer for her and 2 good blastocysts were transferred and injectibles were used for luteal phase support along with the vaginal medicines .Her hcg 10 days after transfer was 553Miu/ml. The patient has an ongoing single pregnancy of 8 weeks.
To summarise—The patient had severe intrauterine adhesions after dilatation and evacuation which was managed with adhesiolysis . Iatrogenic Asherman syndrome usually has a good prognosis as compared to the tubercular variety .Once a good uterine cavity was created and a requisite endometrium prepared ,pregnancy could be achieved for the patient.
