Laser surgical treatment of intrauterine synechiae in patients with a complicated obstetric and gynecological history: a STROBE-based analysis

Background: Uterine factor accounts for up to 15% of female infertility cases, and the prevalence of intrauterine synechiae and Asherman syndrome is increasing due to the growing number of intrauterine procedures. Despite the availability of effective treatments, the risk of Asherman syndrome recurrence remains high, reaching 30%–66% after various surgical interventions. One of the current challenges in medicine is the development of more effective methods aimed at suppressing fibrosis, stimulating regeneration, and restoring functional endometrium.

Aim: To evaluate the effectiveness of a comprehensive approach to the surgical treatment of patients with intrauterine synechiae and Asherman syndrome in the context of a compromised obstetric and gynecological history.

Methods: A retrospective cohort study was conducted at the V.F. Snegirev Clinic of Obstetrics and Gynecology, Sechenov University. Medical records of 32 patients with uterine infertility due to intrauterine synechiae or Asherman syndrome treated between 2014 and 2021 were analyzed. The diagnosis was based on the results of pelvic ultrasound and office hysteroscopy. The study included patients with complicated obstetric and gynecological history, including pregnancy loss, multiple intrauterine interventions, complicated deliveries, and postpartum complications. Destruction of intrauterine synechiae was performed using laser energy, followed by intrauterine administration of an anti-adhesion gel. Follow-up office hysteroscopy was performed at 3 and 6 months postoperatively to assess treatment outcomes.

Results: Long-term surgical outcomes were obtained in 294 (90.0%) patients. At 3- and 6-month follow-ups, isolated intrauterine adhesions were identified in 20 (6.7%) patients, 18 of which underwent repeat hysteroscopy with laser adhesiolysis and intrauterine gel administration, while two required a three-stage hysteroscopic laser adhesiolysis. No recurrence of synechiae was observed among patients who received intrauterine anti-adhesion gel. Of 178 patients with menstrual disorders, restoration of regular cycles was reported in 136 (76.0%), whereas 42 (24.0%) reported light but regular menstruation. Within one year, 300 patients planned pregnancy; follow-up data were obtained for 239, and 155 (65.0%) reported conception, with 132 resulting in childbirth. A total of 46 patients continued treatment at assisted reproductive technology clinics.

Conclusion: Laser adhesiolysis followed by intrauterine anti-adhesion gel administration demonstrated high effectiveness (by reducing recurrence rates, restoring menstrual function, and increasing the likelihood of pregnancy). These findings highlight the importance of a comprehensive approach to timely diagnosis, treatment, and prevention of synechiae to improve the reproductive health of patients.