Abstract
Objective:Asherman syndrome (AS) is a progressive disease involving menstrual disorders, recurrent pregnancy losses, and infertility developing as a result of partial or full blockade of the uterine cavity with adhesions. AS generally develops after trauma to the basal layer of the endometrium. In spite of a variety of methods such as adhesiolysis, inserting intrauterine devices, and administering high doses of estrogen, treatments remain insufficient. This study aimed to assess the effects of local intrauterine Ankaferd Blood Stopper (ABS) administration in inducing endometrial proliferation and building a normal endometrial layer in a rat model.Materials and Methods:AS was induced in 30 female Wistar albino rats. The rats were randomized into three groups:Group 1: AS groupGroup 2: AS + serum physiologic (SP) groupGroup 3: AS + ABS groupAS model was induced in all animals. The uterine horns were harvested after 15 days of therapy and investigated for inflammation, fibrosis, and immunohistochemical (IHC) markers.Results:Compared with the other groups, fibrosis, and inflammation were significantly reduced in group 3 (chi-square, p=19.000, 0.001 and 26.365, <0.001, respectively). The IHC assessment showed that the tumor necrosis factor-α receptor levels were not different (Kruskal-Wallis H=0.091, p=0.995), but the interleukin (IL)-1β and IL-6 expression was reduced significantly in group 3 (H, p=18.706, <0.001, and 22.114, <0.001, respectively).Conclusion:The therapeutic effects of local administration of ABS in rats with AS model were demonstrated histopathologically and immunohistochemically. Based on these results, ABS administration in addition to the current treatments for AS may increase the treatment success and reduce the need for advanced treatment.
Highlights
Asherman syndrome (AS) is defined as the complete or partial obliteration of the uterine cavity with adhesions, resulting in amenorrhea or other menstrual aberrations, recurrent pregnancy loss, and infertility[1]
The majority of animals in groups 1 and 2 had levels 3 fibrosis and inflammation, there were no cases of fibrosis or inflammation to this extent in group 3 (Table 1, Graphic 1)
The mean IL-1 and IL-6 scores were significantly lower in group 3, but there were no significant differences between the groups concerning the tumor necrosis factor (TNF)-α receptor scores (Table 2, Graphic 2)
Summary
Asherman syndrome (AS) is defined as the complete or partial obliteration of the uterine cavity with adhesions, resulting in amenorrhea or other menstrual aberrations, recurrent pregnancy loss, and infertility[1]. Detection and appropriate treatment by the removal of the adhesions could significantly improve the reproductive outcome of infertile women, promote the repair and regeneration of the destroyed endometrium, and resolve abnormal uterine bleeding complications. In this context, the actual management strategy of AS must be based on three key steps, including main treatment, re-adhesion prevention, and restoring normal endometrium[2]. Using an experimental AS model, this study aimed to assess the effects of local intrauterine ABS administration in inducing endometrial proliferation and building a normal endometrial layer. We aimed to determine whether local administration of ABS had an effect on the endometrial inflammatory response, which is associated with intrauterine adhesions (IUA)
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