An Innovative New Treatment for Asherman Syndrome with an Intrauterine Amniograft: A Case Series

Objective: To determine if placing a cryopreserved amniotic membrane product (AmnioGraft) at the time of hysteroscopic treatment for Asherman syndrome will promote regeneration of the endometrium.Methods: This case-series evaluated the use of an allogenic AmnioGraft technology on women with the diagnosis of severe Asherman syndrome, a thin endometrial stripe, and a desire for future fertility. An AmnioGraft is a novel treatment modality to reduce infl ammation and adhesion formation after hysteroscopic adhesiolysis. The AmnioGraft is designed to prevent scaring, reduce infl ammation, and promote wound healing, which would be benefi cial in the treatment of Asherman syndrome. After obtaining consent, women underwent operative hysteroscopy, lysis of intrauterine synechiae under ultrasound guidance, and curettage. A 3.5x3.5cm AmnioGraft was wrapped around a Cook intrauterine balloon stent and inserted into the uterus for two weeks.Results: Ten women received the AmnioGraft between the years 2011-2015. Six of the ten women had amenorrhea prior to the surgery (ranging from 1.5-12 months of amenorrhea), and all of the women achieved menses post-operatively. The average change in the pre to post-operative endometrial thickness was an increase of 3.3mm. Four of the ten women achieved pregnancy.Conclusion: The AmnioGraft may provide an alternative treatment option for patients with Asherman syndrome who desire future menses and pregnancy. Larger randomized studies need to be performed to confirm this result.