LAUSR

Study Objective Does post adhesiolysis oral administration of estrogen and progesterone prevent or reduce the recurrence of adhesions and increase the life birth rate. Design Randomized controlled trial. Setting Asherman Expertise Center an academic affiliated hospital. Patients or Participants Women with M. Asherman, undergoing successful hysteroscopic adhesiolysis in the operation theater. The follow-up length was two years. Interventions Consented patients underwent hysteroscopic adhesiolysis and were randomly allocated in two groups. In the intervention group women were given hormonal support with estrogen and progesterone post operative adhesiolysis and in the control group women received no tablets. Measurements and Main Results A total of 120 patients were included with a dropout of 5 cases. 115 patients were analyzed. At the second look hysteroscopy, the uterine cavity was completely restored in 73.2% cases in the intervention group and in 71.1% of the cases in the control group. The presence of adhesions during the second look hysteroscopy was not significant different between the two groups (p=0.834). The endometrial thickness was measured at the three months visit, with a mean thickness of 5,37 mm (minimum 3.0 mm - maximum 10.0 mm). The administration of exogenous hormones had no significant effect on the endometrial thickness (p=0.179). A total of 79/115 (68.7%) women became pregnant during the trial. The time until a successful pregnancy was not different between the two groups (p=0.383). In the intervention group 66.7% had a successful pregnancy, opposite to 70.9% in the control group (p= 0.483). The obstetrical outcome in both groups were similar. There was a remarkable high rate of post partum problems seen in both groups. Conclusion Administration of hormones did not improve the risk of recurrence of adhesions by second look hysteroscopy, menses or endometrial thickness. The take home baby rate was not influenced by the administration of hormones. There was a remarkable high rate of post partum problems seen in both groups.