IVF pregnancy in a case of Asherman’s syndrome

Asherman’s syndrome (AS), an increasingly diagnosed cause of infertility owing to improvement in diagnostic modalities, poses a challenge in achieving pregnancy. Intrauterine adhesions due to breach in the basalis layer of the endometrium interfere with implantation or obstruct tubal ostia. AS occurs subsequent to curettage performed for pregnancy related conditions more commonly than gynaecological conditions. Patients may present with infertility with or without menstrual complaints. Here we present a case of 29-year-old woman, P0L0A1 who presented to our clinic with secondary infertility for one year. The patient had undergone hystero-laparoscopic myomectomy with uterine artery ligation in view of multiple fibroids. A relook hysteroscopy on follow-up revealed a normal uterine cavity with synechiae formation at right cornua for which synechiolysis was done. Upon failure to conceive for the next six months, another hysteroscopy was performed which showed that the cavity was small with pale endometrium and right ostia could not be visualized. Subsequently a hysteroscopic reconstruction of the uterine cavity was done with bilateral lateral wall and fundal metroplasty followed by estrogen and progesterone therapy to avoid post-operative adhesion formation. The couple underwent an IVF cycle in the following month. Controlled ovarian stimulation was done and ovum pick up was performed on day 12 with intra-uterine PRP instillation. A fresh transfer was performed on day 5 after pick up. Luteal phase support was given with vaginal and subcutaneous progesterone support. A UPT 14 days later was positive and the patient is under follow-up for her antenatal care at present.