Fertility and Obstetric Outcomes in Asherman Syndrome: Assessing the Impact of Hyaluronic Acid Post‐Hysteroscopic Adhesiolysis

ABSTRACT Background Installation of hyaluronic acid following hysteroscopic adhesiolysis is suggested to reduce intrauterine adhesion (IUA) reformation in women with Asherman's Syndrome (AS). We aimed to assess the impact of hyaluronic acid following hysteroscopic adhesiolysis on menstrual, surgical, fertility, obstetric and neonatal outcomes. Methods We identified 128 women treated hysteroscopically for AS over an 11‐year period and invited them to participate in a questionnaire‐based study. A total of 43 women were included; 21 treated surgically with hyaluronic acid administered immediately following adhesiolysis and 22 having surgery alone. Outcomes were assessed by reviewing medical records retrospectively and using a structured questionnaire at 3 months and 4 years post procedure. Results There were no differences in the rates of repeat adhesiolysis procedures to treat recurrent IUAs between the treatment and control groups (19% vs. 18%, p = 0.94). All women in the treatment group reported resumption of menses 6 months following the procedure, with 9% in the control group reported ongoing amenorrhoea. There was no difference in the overall pregnancy rate (77% vs. 81%, p = 0.76), maternal and neonatal outcomes between the groups. Conclusions Intrauterine application of hyaluronic acid at the time of hysteroscopic adhesiolysis for women with AS was not associated with the number of repeat surgical interventions, menstrual patterns, fertility, obstetric, or neonatal outcomes.