Association and Management of Adenomyosis Amongst Patients with Asherman's Syndrome

Study Objective To provide the first characterization of concomitant Asherman\u0027s syndrome and adenomyosis, and subsequent obstetrical outcomes. Design A retrospective cohort study from 01 January 2015 to 01 March 2019. Setting A community teaching hospital affiliated with a large academic medical center. Patients or Participants 227 Asherman\u0027s syndrome patients with available hysteroscopy and pelvic ultrasound reports. Interventions Determinants of adenomyosis and the impact of adenomyosis on fertility and obstetrical outcomes in Asherman\u0027s syndrome patients. 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\u0027s syndrome management. Adenomyosis was the most common co-occurring uterine finding, detected in 39 Asherman\u0027s patients. The overall primary symptom was infertility. Adenomyosis patients reported a different menstrual pattern than patients with Asherman\u0027s syndrome only. Adenomyosis prevalence trended higher with increasing Asherman\u0027s severity, but there were no significant independent predictors of adenomyosis. In this cohort, 77 patients attempted conception and produced 87 pregnancies, 13 of which were ongoing at study conclusion. Age (OR 0.7, 95% CI 0.5-0.9) and use of assisted reproductive technology (OR 0.1, 95% CI 0.02-0.995) were negatively associated with pregnancy. Postpartum dilation \u0026 curettage/dilation \u0026 evacuation was a risk factor for miscarriage (OR 13.6, 95% CI 1.4-129.5). Age (OR 0.9, 95% CI 0.8-0.988) and severe Asherman\u0027s disease (OR 0.1, 95% CI 0.001-0.1) were negatively associated with live birth. Adenomyosis was not an independent predictor of pregnancy rate, miscarriage rate, or live birth rate among Asherman\u0027s patients. Conclusion Adenomyosis is relatively common in Asherman\u0027s syndrome patients. Any distinct detriment to fertility from adenomyosis may be overshadowed by the lasting effects of Asherman\u0027s adhesions when these diseases occur together. Larger studies to establish management guidelines for concomitant disease are needed.