Table 1: Characteristics of included studies.

Source, yearStudy typeNumber of
patients
(mean age)
ClassificationAdhesion stageSurgical technique IUDHTFCNormal/improved
menses (%)
Conception rate
(%)
Live birth rate
(%)

Caspi and Perpinial, 1975 [30]NR80 (74 followed up)
(NR)
NRNRVaginal approach (long curved scissors)Yes Yes No NR62/74 (83.7)40/62 (64.5)

March and Israel, 1976 [31] NR10
(27.1)
NRNRHysteroscopic miniature scissorsYes Yes Yes 10/10 (100)
normal
1/1 (100)1/1 (100)

March and Israel, 1981 [37]NR38
(NR)
NRMild ()
Moderate ()
Severe ()
Hysteroscopy with miniature scissors Yes (35)YesYesNR(87.2)(87.2)

Ismajovich et al., 1985 [43]NR51
(NR)
NRMild ()
Moderate ()
Hysteroscopic scissors, uterine dilatorYes No No 46/51 (90)
normal
46/51 (90)40/46 (85)

Fedele et al., 1986 [40] Retrospective31
(NR)
NRMild ()
Moderate ()
Severe ()
Hysteroscopic scissorsYes Yes No 21/31 (67.7)
normal
13/27 (40.7)13/27 (40.7)

Valle and Sciarra, 1988 [8]Retrospective187
(NR)
AFSMild ()
Moderate ()
Severe ()
Hysteroscopy and sharp dissection with hysteroscopic scissors (hysterosalpingography guided)Yes (151)YesNo134/151 (88.2)
normal
143/187 (76.4)114/143 (79.2)

Bellingham, 1996 [42] NR17 (16 followed up)
(NR)
NRNRHysteroscopic division under US guidanceYes Yes No 11/13 (84.6)
normal
8/10 (80)8/10 (80)

Roge et al., 1997 [9] Retrospective54 (52 followed up) (NR)AFSMild () Moderate ()
Severe ()
Hysteroresectoscopy with resection electrode needle (under US guidance)Yes Yes YesNR34/52 (65.3)24/34 (70.5)

Chen et al., 1997 [18]NR7
(31.14)
MarchSevereHysteroresectoscopy with resection electrode needleYesYes No 7/7 (100)
normal
3/4 (75)2/3 (66.6)

Feng et al., 1999 [13]Retrospective cohort study365
(33.8)
SugimotoNRHysteroscopy with microscissors and biopsy forcepsYes Yes No 294/351 (83.7)
normal
156/186 (83.8)NR

Ozumba and Ezegwui, 2002 [32] NR50 (44 followed up)NRNRUterine sound and occasionally uterine dilatorsYes Yes No 34/44 (77.2)
normal
4/44 (9)NR

Orhue et al., 2003 [19] NR110
()
NRNRBlind adhesiolysis under US guidanceYes
(51)
Yes Yes
(59)
32/51 (32.7)
normal
14/51 (27.5)6/14 (42.8)

Alborzi et al., 2003 [11]Prospective30
(30.4 up) (NR)
ASRMStage I ()
Stage II ()
Stage III ()
Hysteroscopy scissors (under vision of laparoscopy)Yes Yes No 30/30 (100)
normal
19/30 (63.3)15/30 (50)

Zikopoulos et al., 2004 [16] NR46
(33.6)
AFSStage I ()
Stage II ()
Stage III ()
Resection using electrode needle (),
bipolar electrosurgery system ()
Yes Yes No 13/14 (92.85)
normal
35/46 (76.1)20/46 (43.5)

Efetie, 2006 [12] Retrospective71
()
NRNRHysteroscopy, uterine soundYesYesYes34/71 (47.9)
normal
8/71 (11.3)NR

Fumino et al., 2007 [44]NR47
(32.8)
AFSI ()
II ()
III ()
Pushing via tip of hysteroscopy () Ballooning at
hysterosalpingography (), transcervical resectoscope, and mechanical D&C (=13)
No No No NR20/47 (42.5)NR

Shokeir et al., 2008 [41]Retrospective61
(31.5)
AFSStage II ()
Stage III ()
Hysteroscopy with electrode needleYes
(40)
Yes NoNR10/40 (40)2/10 (20)

Yasmin et al., 2007 [33] Descriptive study20 (19 followed up) (26.1)NRMild ()
Moderate ()
Severe ()
Blunt and resectoscopic dissectionYes Yes Yes 18/19 (94.7)
normal
2/19 (10.5)1/2 (50)

Yu et al., 2008 [7]Retrospective85
(31.1)
ESH
ESGE
Mild ()
Moderate ()
Severe
()
Hysteroscopy using electrode needle or loopYes Yes No46/62 (74.2)
improved
39/85 (45.88)25/39 (64.1)

Pabuccu et al., 2008 [28]Prospective, randomized trial71
(group 1: )
(group 2: )
AFSStage IIISharp hysteroscopic division under US guidanceYes Yes No NRGroup 1: 17/36
(47.2)
Group 2: 11/35
(31.4)
Group 1: 10/36
(27.7)
Group 2: 7/35
(20)

Roy et al., 2010 [29]Retrospective96 (89 followed up)
(28.4)
ESH,
ESGE
I ()
III ()
IV ()
Hysteroscopic monopolar with Collin’s knifeYes Yes No 53/75 (70.67)
improved
36/89 (44.4)31/36 (86.1)

Salma et al., 2011 [34]NR60 (59 followed up)
(29.3)
AFSSevereHysteroscopy using scissors or electrode needle under direct visionYes YesYes 56/59 (94.9)
normal
NRNR

Myers and Hurst, 2012 [35]Retrospective12
(34.41)
AFSSevereHysteroscopy scissorsYesYesYes12/12 (100)
normal
6/8 (75)4/6 (66.6)

Fernandez et al., 2012 [45]Retrospective23 (22 followed up)
()
ESHRE
AFS
IV, severeHysteroscopy and bipolar electrosurgery systemNoNoNo1/24 (4.3%) (after
2 surgical
procedures)
9/22 (40.9)6/22 (27.2)

Mohamed et al., 2012 [39] Retrospective363 (130 followed up)
()
ESGEGrade I ()
Grade II ()
Grade III ()
Grade IV ()
Hysteroscopy with unipolar and bipolar electrosurgeryYes Yes Yes 3/4 (75%)
normal
40 (31.5%)36/40 (90)

Yamamoto and Takeuchi, 2013 [36]Retrospective27
()
AFSMild ()
Moderate ()
Severe ()
Hysteroscopic loop monopolar knife, Hegar’s dilators (under US guidance)Yes Yes No 27/27 (100) improved14/27 (52.9 )3/27 (11)

Lin et al., 2013 [27]Retrospective cohort study107
()
AFSMild ()
Moderate ()
Severe ()
Hysteroscopic scissorsYes (28)YesYes18/28 (64.2)
8/28 (28.5)
improved
NRNR

Şendağ et al., 2013 [38]NR24
(30.5)
ESHGrade 1 ()
Grade 2 ()
Grade 3 ()
Grade 4 ()
Hysteroscopy with sharp scissorsYes (11)YesYes24/24 (100)
normal
4/14 (28.5)3/4 (75)

HT = hormonal therapy; IUD = intrauterine device; FC = Foley catheter; NR = not reported. “Yes” = studies that used IUD; “No” = studies that didn’t used IUD.