Successful live birth following mechanical hysteroscopic adhesiolysis with MyoSure for Asherman syndrome: a case report

Abstract

Asherman syndrome is characterised by symptomatic intrauterine adhesions that may cause menstrual disturbance, pelvic pain and subfertility. We describe a 28-year-old G3P1 woman who developed dysmenorrhoea, oligomenorrhoea and difficulty conceiving after a term vaginal birth complicated by severe postpartum haemorrhage, manual removal of an adherent placenta and subsequent suction curettage for retained products of conception. Initial hysteroscopy demonstrated extensive uterine cavity obliteration, and adhesiolysis was attempted by hydrodilatation. At repeat hysteroscopy approximately 16 months postpartum, persistent adhesions obscured the left tubal ostium. Mechanical adhesiolysis was performed using the MyoSure hysteroscopic tissue removal system with concomitant laparoscopic observation. Subsequent hysteroscopic inspection demonstrated restoration of the uterine cavity, and laparoscopic tubal dye-study confirmed bilateral tubal patency. An intrauterine Foley balloon was retained for seven days, with postoperative oral antibiotics and four weeks of oestrogen-based therapy. The patient conceived four months later and delivered a live male infant at term. She subsequently underwent total laparoscopic hysterectomy for persistent severe dysmenorrhoea after completing her reproductive goals. This case documents a successful reproductive outcome following MyoSure-assisted adhesiolysis. MyoSure may provide a non-electrosurgical option for adhesiolysis in selected patients; however, comparative evidence is insufficient to establish superiority over conventional techniques or determine the optimal postoperative regimen.