Management of intrauterine adhesions: A novel intrauterine device

Abstract

Intrauterine adhesions (IUAs) are a rare but significant cause of menstrual disturbance and infertility. Most cases are caused by uterine instrumentation. Several methods have been used to prevent IUAs in the past, which can be divided into two groups: pharmacological treatment and physical barrier. However, even with the liberal use of ancillary treatments to minimize reformation of adhesions, IUAs have a high rate of recurrence. Furthermore, medical literature of the last decades has only dedicated great attention to the restoration of normal anatomy in the uterine cavity, but not on the function of the endometrium. When the lesion of the endometrium is severe, especially intrauterine fibrosis, few basal layer is left which contains plenty stem cells to regenerate functional endometrium. Loss of endometrial stem cells directly causes the proliferation of fibrous tissue and subsequent synechiae. None of current treatments can compensate the defect of loss of stem cells. On the basis of existing researches, a novel intrauterine device (IUD) is recommended in this article. The new IUD consists of a light frame which contains two isolated drug-releasing system, one for estrogen and the other for cytokines to promote regeneration of endometrium such as growth factors, and a membrane in the middle of the frame which is also the carrier of endometrium stem cell. This device not only helps to preserve the original anatomy of the uterine cavity, but also to recover the function of endometrium. Experimental and clinical studies are now needed to testify the efficiency of the novel IUD in the prevention of IUAs. If there is a marked reduction in the IUAs and/or improvement of pregnancy success in the case group compared with the control group, our hypothesis will be confirmed.