Reproductive Outcomes after Hysteroscopic Adhesiolysis in Nine Women with Uterine Artery Embolization-related Intrauterine Adhesions

Abstract

The objective is to describe reproductive outcomes following hysteroscopic adhesiolysis for intrauterine adhesions (IUAs) secondary to uterine artery embolization (UAE) and to discuss perioperative management and subsequent pregnancy complications. This retrospective study included nine women treated between 2006 and 2023 at a single tertiary center. UAE was performed for fibroids ( n = 3), postpartum hemorrhage ( n = 4), cervical pregnancy ( n = 1), and retained placental polyp ( n = 1). Adhesiolysis was conducted under transabdominal ultrasonographic guidance using scissor forceps. Postoperative management consisted of intrauterine device placement, estrogen therapy, and scheduled early second- and third-look hysteroscopies at 2 and 8 weeks postoperatively. Five women had moderate, and four had severe adhesions according to the American Fertility Society (1988) classification. The mean interval between UAE and adhesiolysis was 51 months (range, 11–166). Surgery was performed once in eight patients and twice in one, with no cases of uterine perforation. All four women whose UAE indication was postpartum hemorrhage achieved pregnancy, three via assisted reproductive technology. There were three live births, all preterm cesarean deliveries, and two required hysterectomy for placenta accreta. One patient developed postoperative pulmonary embolism but recovered completely following treatment. Although limited by its small sample size and retrospective design, this study suggests that ultrasound-guided hysteroscopic adhesiolysis using scissor forceps, combined with early postoperative surveillance, can restore fertility even after UAE-related IUA. Vigilant prenatal monitoring is essential due to the high risk of placenta accreta spectrum.