Should We Consider Alternative Therapies to Operative Hysteroscopy for the Treatment of Asherman Syndrome?

The document from March 1, 2020, debates the use of alternative therapies versus operative hysteroscopy for treating Asherman syndrome (AS). Xavier Santamaria, M.D., Ph.D., supports considering alternatives, especially for refractory AS, and cites a pilot study of 18 patients where CD133+ bone marrow-derived stem cells showed promise. Keith Isaacson, M.D., counters that repeated hysteroscopies are effective, with adjuvant treatments like hyaluronic acid reducing adhesion recurrence. The document also includes data from a telephone survey of 127 patients, indicating a 81.9% pregnancy rate and a 51.2% live birth rate after treatment for AS. It mentions advancements in hysteroscopic technology and the potential of cryopreserved amniotic membrane, based on a case series of 35 patients, as an anti-adhesion barrier. Additionally, it discusses the intrauterine infusion of platelet-rich plasma (PRP) for endometrial regeneration, with a pilot study converted to a case-control study due to recruitment challenges. The document concludes that while alternative therapies show potential, operative hysteroscopy remains the primary treatment, and high-quality studies are needed to define the role of post-surgery barrier methods.