Live Birth Outcomes in Patients With Recurrent Pregnancy Loss and Asherman Syndrome: A Retrospective Cohort Study.

STUDY

OBJECTIVE

To assess the impact of Asherman syndrome on live birth outcomes in a recurrent pregnancy loss (RPL) cohort prior to surgical intervention and evaluate the efficacy of hysteroscopic adhesiolysis in enhancing live birth outcomes.

DESIGN

Retrospective cohort.

SETTING

Specialized RPL clinic.

PATIENTS: Patients with RPL seen between January 2011 and March 2022.

INTERVENTION: Participants were categorized into two groups: the Asherman syndrome group and the non-Asherman syndrome group.

MEASUREMENTS AND MAIN

RESULTS

A total of 296 patients were included in the study: 74 (25.0%) with Asherman syndrome and 222 (75.0%) without. At the initial RPL Clinic visit, there was no significant difference in percentage of participants with at least one abnormal RPL investigation between the two groups (35.1% vs 41.9%; p = .41). Current smoking was more common in the Asherman group (14.9% vs 5.4%; p = .02). Before treatment, patients with Asherman syndrome had lower odds of achieving a live birth with each achieved pregnancy compared to those without, after adjusting for age, smoking, and other abnormal RPL investigations (adjusted odds ratio [aOR] = 1.5, 95% confidence interval [CI]: 1.1-2.0 vs aOR-2.5, 95% CI: 1.9-3.3). Following surgical correction, patients in the Asherman syndrome group showed remarkably improved live birth odds ratio of 3.5 with each achieved pregnancy (95% CI: 1.7-7.1), as compared with the non-Asherman group's aOR of 2.7 (95% CI: 1.9-3.9), after adjusting for age, smoking status, and other abnormal RPL investigations.

CONCLUSION

In the RPL population, untreated Asherman syndrome reduced the odds of achieving a live birth associated with increased number of pregnancies, while surgical correction significantly improved live birth outcomes.