Design: Retrospective cohort study.

Setting: Single hospital.

Patients or Participants: 203 patients with IUA from April 2017 to December 2020.

Interventions: As the study group, 109 patients underwent TCRA within 3-7 days after the end of menstruation (secondary amenorrhea was not altered by the menstrual cycle), the first hysteroscopic balloon dilatation was performed 10 days after the procedure, the second hysteroscopic exploration was performed 20 days after the procedure (or the second hysteroscopic exploration after the end of menstruation in case of menstruation), and so on for 2-3 cycles, and hysteroscopy was performed again 3 months after the procedure to assess the recovery of the uterine cavity; in the control group, 94 patients underwent hysteroscopy only at 3 months after the procedure to assess the recovery. All patients were routinely administered estrogen and aspirin postoperatively. Data from the two groups were analyzed and compared, including preoperative and postoperative American Fertility Society (AFS) scores, endometrial thickness in the early follicular phase, and menstrual volume, and patients were followed up for postoperative pregnancy outcomes.

Measurements and Main Results: No intraoperative or postoperative complications such as uterine perforation, infection, fever, or abdominal pain were observed in both groups. The degree of postoperative uterine adhesions, menstrual status, and endometrial thickness showed significant improvement in both groups compared to the preoperative period (P > 0.05). However, the study group showed significant improvement in AFS score, menstrual volume and endometrial thickness compared with the control group. At follow-up, more patients in the study group had a successful pregnancy (48.5% vs. 30.8%, P<0.05).

Conclusion: Early secondary hysteroscopic exploration combined with uterine balloon dilation after TCRA is safe and effective and improves the prognosis and postoperative pregnancy rate in patients with uterine adhesions.