Concomitant Adenomyosis among Patients with Asherman Syndrome

Study Objective: To characterize obstetric outcomes for concomitant Asherman syndrome and adenomyosis. Design: A retrospective cohort study. Setting: A community teaching hospital affiliated with a large academic medical center. Patients: A total of 227 patients with Asherman syndrome with available hysteroscopy and pelvic ultrasound reports. Interventions: Telephone survey to assess and compare the obstetric outcomes of patients with Asherman syndrome with concomitant adenomyosis (Group A) vs patients with Asherman syndrome without concomitant adenomyosis (Group B). Measurements and Main Results: A telephone survey and confirmatory chart review were conducted to obtain information on patients’ demographics, gynecologic and obstetric history, past medical and surgical history, and Asherman syndrome management. Adenomyosis was a common sonographic finding, detected in 39 patients with Asherman syndrome (17.2%). In this cohort, 77 patients attempted pregnancy and produced 87 pregnancies. Age (odds ratio [OR] 0.67; 95% confidence intervals [CI], 0.52–0.86) was negatively associated with a pregnancy outcome. Age (OR 0.83; 95% CI, 0.73–0.95) and severe Asherman disease (OR 0.06; 95% CI, <0.01–0.99) were negatively associated with a live birth outcome. Adenomyosis was not an independent predictor of pregnancy rate, miscarriage rate, or live birth rate among patients with Asherman syndrome. Conclusion: Adenomyosis is relatively common in patients with Asherman syndrome. Adenomyosis does not seem to add any distinct detriment to fertility among patients with Asherman syndrome.