Hysteroscopic Adhesiolysis In Patients Research Articles

4DryField vs. hyalobarrier gel for preventing the recurrence of intrauterine adhesions – a pilot study

Introduction This was a single-center pilot study that sought to describe an innovative use of 4DryField® PH (premix) for preventing the recurrence of intrauterine adhesions (IUAs) after hysteroscopic adhesiolysis in patients with Asherman’s syndrome (AS). Material and methods Twenty-three patients with AS were enrolled and 20 were randomized (1:1 ratio) to intrauterine application of 4DryField® PH (n = 10) or Hyalobarrier® gel (n = 10) in a single-blind manner. We evaluated IUAs (American Fertility Society [AFS] score) during initial hysteroscopy and second-look hysteroscopy one month later. Patients completed a follow-up symptoms questionnaire three and reproductive outcomes questionnaire six months later. Results The demographic and clinical characteristics, as well as severity of IUAs, were comparable in both groups. The mean initial AFS score was 9 and 8.5 in the 4DryField® PH and Hyalobarrier® gel groups, respectively (p = .476). There were no between-group differences in AFS progress (5.9 vs. 5.6, p = .675), need for secondary adhesiolysis (7 vs. 7 patients, p = 1), and the follow-up outcomes. Conclusion 4DryField® PH could be a promising antiadhesive agent for preventing the recurrence of IUAs, showing similar effectiveness and safety to Hyalobarrier® gel. Our findings warrant prospective validation in a larger clinical trial. Clinical trial registry number ISRCTN15630617

Reproductive Outcomes After Hysteroscopic Adhesiolysis in Patients Experiencing Recurrent Pregnancy Loss and Intrauterine Adhesions

ObjectiveThis study aims to evaluate the reproductive outcomes after hysteroscopic adhesiolysis in patients experiencing recurrent pregnancy loss (RPL) combined with intrauterine adhesions (IUA). DesignSingle-center retrospective cohort study. SettingInternational referral hospital for women with IUA and RPL. PatientsBetween January 2018 and June 2022, a cohort of 64 women diagnosed with RPL and IUA were studied, with a follow-up period of at least one year after hysteroscopic adhesiolysis. InterventionsAll patients had a diagnosis of IUA from the diagnostic hysteroscopy and were treated with hysteroscopic adhesiolysis, utilizing intraoperative ultrasound monitoring as required. Main MeasurementsLive birth rate and menstrual pattern change (subjective assessment) after hysteroscopic adhesiolysis. ResultsIn our cohort, 59.38% (38/64) achieved pregnancy following hysteroscopic adhesiolysis, with 92.11% (35/38) conceiving within two years of the procedure. The miscarriage rate was recorded at 17.19% (11/64), and the live birth rate stood at 42.19% (27/64). Throughout the extended follow-up period, 64.06% (41/64) of the patients reported increased menstrual blood volume and improvements in menstrual patterns posthysteroscopic adhesiolysis. Univariate analysis indicated that being aged ≥35 years (p = .026), having a history of infertility (p = .003), the presence of moderate or severe IUA (p = .023), and experiencing menstrual improvements postsurgery (p = .001) were independent predictors of live birth. Multivariate analysis further identified that women with a history of infertility had a reduced chance of live birth following hysteroscopic adhesiolysis (p = .008), while those who reported menstrual pattern improvements postoperatively had an increased probability of achieving a live birth (p = .031). ConclusionsOur findings indicate that RPL and IUA patients without prior infertility and showing menstrual pattern improvement after hysteroscopic adhesiolysis, are more likely to achieve live births. Standardized hysteroscopic treatment, postoperative antiadhesion care, and early pregnancy planning are key to improving fertility outcomes in these patients.

Extended balloon stent placement for reducing intrauterine adhesion recurrence: a retrospective cohort study

Research questionWhat are the efficacy, safety and reproductive outcomes of intrauterine balloon stent placement for 4 or 6 weeks after hysteroscopic adhesiolysis? DesignThis retrospective cohort study was conducted at a university-affiliated hospital, and included 155 women with moderate to severe intrauterine adhesions who underwent hysteroscopic adhesiolysis between March 2016 and December 2019. Participants were divided according to whether the heart-shaped balloon stent was left in place for 4 (group 1) or 6 (group 2) weeks after surgery. Stents removed at the second-look hysteroscopy 4 or 6 weeks after surgery were sent for culturing of common bacteria. The incidence of adhesion reformation, adhesion score reduction, bacterial colonization of the intrauterine balloon stent, live birth rate and time to live birth were analysed. ResultsGroup 2 had a significantly lower adhesion reformation rate (45.7% versus 28.2%, P = 0.024) and a more significant reduction in adhesion score (5.2 ± 2.1 versus 6.3 ± 2.2, P = 0.003) compared with group 1. However, no statistical difference was observed in the percentage of bacterial colonization of the intrauterine balloon stent (55.9% versus 66.7%, P = 0.174), live birth rate (52.4% versus 42.3%, P = 0.331) or time to live birth (hazard ratio 1.09, 95% confidence interval 0.60–1.96, P = 0.778) between the two groups. ConclusionsExtending intrauterine balloon stent use from 4 to 6 weeks further reduces the adhesion reformation rate after hysteroscopic adhesiolysis in patients with moderate to severe intrauterine adhesion. No increase in bacterial colonization of the balloon stent was observed. Extending the duration of intrauterine balloon stent placement did not significantly affect live birth rates.

A retrospective cohort study to examine factors affecting live birth following hysteroscopic treatment of intrauterine adhesions

To evaluate independent factors that affect the chance of live birth following hysteroscopic adhesiolysis in patients with intrauterine adhesions (IUAs). Retrospective cohort study SETTING: Hysteroscopic center of Fuxing Hospital in Beijing, China. Patients diagnosed with Asherman syndrome between June, 2020, and February, 2022. Hysteroscopic adhesiolysis followed by second look hysteroscopy to assess outcome and follow-up for a year. Live birth rate without the use of assisted reproductive technologies at 12 months follow-up. (s): Of the 544 women included in the cohort, the pregnancy rate at the end of one year follow-up was 47.6% (95%CI 45.5%-49.7%) and the live birth rate was 41.0% (95%CI 38.9%-43.1%). Stepwise multiple logistic regression analysis identified 3 independent predictors of live birth in decreasing order of significance: increase in menstrual flow after surgery (OR 3.69, 95%CI 1.77-8.21), postoperative endometrial thickness in the mid-luteal phase (OR 1.53, 95%CI 1.31-1.80), and the severity of recurred adhesion at second-look hysteroscopy (OR 0.62, 95%CI 0.50-0.76). Among subjects with good independent prognostic factors, namely, increased menstrual flow after surgery, postoperative endometrial thickness in the mid luteal phase greater than 6mm, no or minimal recurrence of adhesions at second-look hysteroscopy, the live birth rate was 69.0% (95%CI 65.4%-72.6%). On the other hand, in women (n=26) without any of the three good prognostic factors, none had a successful live birth (0%). (s): Overall, the live birth rate following treatment of Asherman syndrome was 41.0%. The prognosis is dependent on three outcome measures following surgery, namely, improvement in menstrual flow, post-operative endometrial thickness and minimal degree of recurrent adhesions at second-look hysteroscopy.

Auto-Cross Linked Hyaluronan Gel Enhances Effects of Hysteroscopic Adhesiolysis Treatment in Patients with Moderate to Severe Intrauterine Adhesions

Background: Moderate to severe intrauterine adhesions affect women’s reproductive and mental health. Hysteroscopic surgery alone cannot improve the prognosis of IUA patients. The present study was to analyse whether auto-cross linked hyaluronan gel facilitates the hysteroscopic adhesiolysis treatment effect and reproductive performance of patients with moderate to severe IUA. Methods: Patients with moderate to severe IUA and fertility desire were included in this retrospective study. A total of 47 patients received standard hysteroscopic adhesiolysis alone served as control group. A total of 38 patients received cHA gel injection at the end of hysteroscopic adhesiolysis were were included in the treatment group. The IUA recurrence rate, endometrial thickness, AFS score, clinical pregnancy rate, and live birth rate were analysed. Results: The endometrial thickness (6.33±1.160 vs. 5.72±1.16 mm, P=0.029), clinical pregnancy rate [51.7 (26/42) vs. 14.29% (5/35); P=0.000) and live birth rate (36.2 vs.13.2%; P=0.000) were significantly higher in the treatment group compared with the control group, and the American Fertility Society score (P=0.018) was lower in the treatment group compared with the control group. Conclusion: The combination therapy of cHA gel plus hysteroscopic adhesiolysis in patients with moderate to severe IUA resulted in a better outcome in decreasing the severity of IUAs, and improving the quality of endometrium and enhancing the live birth rate compared with hysteroscopic adhesiolysis alone. Trial Registration: Clinical trial register number ChiCTR2100051670. Date of Retrospectively registered on September 30, 2021.

The incidence of placenta related disease after the hysteroscopic adhesiolysis in patients with intrauterine adhesions

ObjectiveTo analyze the correlation between placenta related disease of pregnant women with antecedent hysteroscopic adhesiolysis due to intrauterine adhesions (IUA). Materials and methodsThis is a single center, non-randomized, open-label, retrospective cohort Study. 74 patients who had adhesiolysis and hormone therapy for IUA and progressed into the third trimester were group A and 296 without IUA were group B. The main outcome measure is the incidence of placenta related disease including placenta accreta spectrum, placenta previa, placental abruption, intrauterine growth restriction (IUGR), and pregnancy-induced hypertension (PIH). The second outcome is the perinatal, and intrapartum complications. ResultsPatients in group A had a higher frequency of prior pregnancy times (2.51 ± 1.56 vs.1.84 ± 1.06, p = 0.001) and lower frequency of prior delivery times (0.20 ± 0.41 vs. 1.30 ± 0.51, p < 0.05) than group B at baseline. At delivery, there is no difference between the incidence of PIH and IUGR between two groups. However, a significantly higher frequency of placenta accreta (17.6% vs. 1.4%, OR = 15.56, 95% CI 4.91–49.34), placenta increta (5.4% vs. 0.7%, OR = 8.4, 95% CI 1.51–46.78), placenta previa (8.1% vs. 2.0%, OR = 4.265, 95%CI1.33–13.63) and postpartum hemorrhage (21.6% vs. 3.4%, OR = 7.890, 95% CI 3.41–18.26) were observed in group A than in group B. ConclusionsCompared to general population, the rates of placenta accreta, placenta increta, placenta previa, postpartum hemorrhage are higher among the IUA patients after hysteroscopic adhesiolysis, and special attention is needed at the termination of the pregnancy.

Factors That Impact Fertility after Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: A Retrospective Cohort Study

To identify factors that affect reproductive outcomes after hysteroscopic adhesiolysis in patients with severe intrauterine adhesions (IUAs, scored between 9 and 12 according to the American Fertility Society classification) and amenorrhea. A retrospective cohort study. A university-affiliated hospital. One hundred fifty-one patients with severe IUAs and amenorrhea. Patients were diagnosed via hysteroscopy and underwent at least 1 hysteroscopic adhesiolysis between May 2012 and January 2016. Of 151 patients, 12 were lost to follow-up, and 139 were included in the study with a follow-up period ranging from 2 to 6 years. Of the 139 evaluable patients, 107 (77%) recovered with a normal uterine cavity (free of IUAs), 28 (20.1%) had improved uterine cavity (fewer IUAs), and 4 (2.9%) showed no improvement. Moreover, 79 patients (56.8%) recovered with normal menstruation, 54 (38.9%) showed increased frequency of menstruation, and 6 (4.3%) had persistent amenorrhea. Seventy-seven (55.4%) became pregnant, of whom 13 had a spontaneous miscarriage, 11 birthed prematurely (at 31-36 gestational weeks), 44 experienced term delivery, and 9 were still pregnant at the end of the study. Age >32 years (p = .002, odds ratio [OR] = 3.442), >2 surgeries (p = .027, OR = 2.969), cervical canal adhesions (p = .047, OR = 2.112), and disease course >6 months (p = .037, OR = 2.335) were risk factors for infertility in patients with severe IUAs and amenorrhea. Younger age, earlier treatment within the disease course, fewer cervical canal adhesions, and fewer surgical procedures improve the reproductive outcome in patients with severe IUAs and amenorrhea.

New Crosslinked Hyaluronan Gel, Intrauterine Device, or Both for the Prevention of Intrauterine Adhesions.

Background and Objectives:To compare the efficacy of 3 different techniques for prevention of adhesion reformation after hysteroscopic adhesiolysis in patients with moderate-to-severe intrauterine adhesions. Short-term assisted reproductive outcomes were also compared.Study Design:Total of 72 cases were randomized to Lippes loop intrauterine device (IUD) only, IUD plus a new crosslinked hyaluronan (NCH) gel, or NCH gel only following hysteroscopic adhesiolysis. All cases received hormonal therapy and a second hysteroscopy was carried out. Endometrial thickness values were measured using transvaginal ultrasonography and American Fertility Society adhesion scores were noted during first and second hysteroscopy in all groups. Reproductive outcomes were also compared for those who received in vitro fertilization treatment.Results:Transvaginal ultrasonography revealed significantly better endometrial thickness in the IUD+NCH (7.5 mm) and NCH-only groups (6.5 mm) than the IUD-only group (5 mm) (P < .001). All groups revealed enhanced but comparable American Fertility Society adhesion scores on second-look hysteroscopy. A total of 37 patients received in vitro fertilization treatment after surgical management of adhesions. Ongoing pregnancy rates after in vitro fertilization were 27%, 40%, and 36% in IUD, IUD+NCH, and NCH groups, respectively. However, the difference between the groups did not reach statistically significant difference.Conclusion:All interventions are of similar efficacy in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate to severe intrauterine adhesions. However, better endometrial thickness values were observed in those who received NCH gel either alone or in combination with IUD. Assisted reproductive outcomes of both groups were comparable for ongoing pregnancy rates.

Effect of early second-look hysteroscopy on reproductive outcomes after hysteroscopic adhesiolysis in patients with intrauterine adhesion, a retrospective study in China

ObjectiveThe aim of this study was to assess the effect of early second-look hysteroscopy after hysteroscopic adhesiolysis for intrauterine adhesions (IUAs) on the pregnancy rate (PR) and live birth rate (LBR). Study designIt is a retrospective, observational study of 151 women were referred to our institution from January 2010 to January 2016. Operative hysteroscopy for treatment of IUAs and office hysteroscopic follow-up to assess IUAs. We investigated demographic characteristics, menstrual pattern, previous intrauterine surgery, reproductive history, ovarian preservation assessment, tubal patency examination, husband's semen test, obstetric parameters, and surgical variables to evaluate the effect of early second-look hysteroscopy after hysteroscopic adhesiolysis on the PR and LBR. ResultsOf 151 women treated for IUAs, the general PR was 71.5% and LBR was 53.0%. The PR and LBR were higher in the earlier second-look group (compared with second hysteroscopy later than 2 months group) and the group which received less than three times adhesiolysis (p < 0.05). The PR was higher in the amenorrhea group (compared with normal menses group) and recurrent miscarriage group (compared with infertility group) (p < 0.05). Logistic regression showed that the second-look time interval, times of operation to relieve adhesion, and pregnancy history were associated with the PR, while age and the second-look time interval were associated with the LBR. ConclusionsEarly second-look hysteroscopic examinations within 2 months may increase the cumulative PR and LBR.

A prospective, randomized, controlled trial comparing two doses of oestrogen therapy after hysteroscopic adhesiolysis to prevent intrauterine adhesion recurrence

The aim of this prospective, randomized, controlled trial was to evaluate the efficacy of different doses of oestrogen treatment (2 mg and 6 mg daily) after hysteroscopic adhesiolysis in patients with moderate to severe adhesion according to the American Fertility Society (AFS) classification of intrauterine adhesions. A total of 121 patients were included in the final analysis. Fifty-nine patients received 2 mg oestrogen daily (low-dose group), and 62 received 6 mg oestrogen daily (high-dose group) for three cycles after surgery. Second- and third-look outpatient hysteroscopy was performed 4 and 8 weeks after the initial surgery. There was no difference in the menstrual pattern and AFS scores before and after surgery between the two groups, and AFS scores at the second- and third-look hysteroscopy were found to be significantly lower than the scores before surgery in both groups (both P < 0.01). While this study did not address the fundamental question of whether oestrogen adjuvant therapy prevents the recurrence of intrauterine adhesions, the findings do not support the use of high-dose oestrogen therapy after hysteroscopic adhesiolysis.

Hysteroscopic adhesiolysis: efficacy and safety.

To evaluate the efficacy and safety of hysteroscopic adhesiolysis in patients with intrauterine adhesions (IUAs). Minia Maternity University Hospital, Egypt. Prospective cohort study. This study included 61 patients presented with infertility (primary or secondary) or recurrent pregnancy losses caused by IUAs. The adhesions were divided by semi-rigid scissors introduced under direct vision through hysteroscopy. Three months later, second-look hysteroscopy was performed. Primary outcome parameters were reproductive parameters (pregnancy rate, duration of pregnancies, life births rate, time lag between the intervention and diagnosis of pregnancy). Secondary outcome parameters were the changes in post-operative menstrual pattern, number and duration of intervention and type of intra- and post-operative complications. Pregnancy rate changed from 18 to 65.5%, while live birth rate improved from 14.7 to 36%. The mean time until the first conception was 10.2months (range 2-60months) after the operation. There was significant negative correlation between the degree of IUAs and the improvement in reproductive performance. Hysteroscopic adhesiolysis significantly improved menstrual pattern in 60.7% of patients complaining of hypomenorrhea or amenorrhea. (p=0.0017). The average operative time was 29±10.2 (10-52)min and the hospital stay was 12.5±2.1 (9-24)h. Uterine perforation occurred on 3 (4.9%), and cervical laceration occurred in one case (1.6%). Hysteroscopic adhesiolysis of IUAs is safe and effective in terms of reproductive outcome. The outcome is significantly affected by degree of intrauterine adhesions rather than the main complaint before the procedure.

Intracytoplasmic sperm injection following hysteroscopic adhesiolysis in patients with moderate intrauterine adhesions

Intracytoplasmic sperm injection following hysteroscopic adhesiolysis in patients with moderate intrauterine adhesions

Reproductive Outcome following Hysteroscopic Adhesiolysis in Patients with Asherman's Syndrome

Reproductive Outcome following Hysteroscopic Adhesiolysis in Patients with Asherman's Syndrome

Reproductive Outcome Following Hysteroscopic Adhesiolysis in Patients with Infertility Due to Asherman's Syndrome

Reproductive Outcome Following Hysteroscopic Adhesiolysis in Patients with Infertility Due to Asherman's Syndrome

Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome

To evaluate the outcome of hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome. This was a retrospective clinical analysis of 89 patients who underwent hysteroscopic adhesiolysis by monopolar electrode knife. A second-look office hysteroscopy was performed in all cases after 2 months. On second-look hysteroscopy, 12 patients showed reformation of adhesions and needed a repeat procedure. The mean age of the patient was 28.4 years. In the majority (64%) of patients, the possible cause of Asherman's syndrome was previous curettage on gravid uterus. The overall conception rate was 40.4% after hysteroscopic adhesiolysis. The mean conception time after surgery was 12.8 months. There was no conception in patients who needed repeat adhesiolysis. The conception rate was higher (58%) in mild Asherman's syndrome compared to 30% conception rate in moderate and 33.3% conception rate in severe cases. There was no significant association between conception rate and preoperative menstrual pattern. There was significant higher likelihood of conception rate (44.3%) in those who continued to have improved menstrual pattern compared to only 10% likelihood of conception in those who continued to have amenorrhea after adhesiolysis. The live birth rate was 86.1% and miscarriage rate was 11.1%. Cumulative pregnancy rate showed that 97.2% patients conceived within 24 months. There was increased incidence (43.8%) of cesarean section. Four (12.5%) patients had postpartum hemorrhage for adherent placenta. Hysteroscopic adhesiolysis for Asherman's syndrome is a safe and effective method of choice for restoring menstrual function and fertility.

Hysteroscopic treatment of severe Asherman's syndrome and subsequent fertility.

In a retrospective case report series, we evaluated the efficacy of hysteroscopic adhesiolysis in patients with severe Asherman's syndrome. In 31 patients with permanent severe adhesions, hysteroscopic treatment was performed. In all patients, uterine cavity with at least one free ostial area was restored after one (n = 16), two (n = 7), three (n = 7), and four (n = 1) surgical procedures. All previously amenorrhoeic patients (n = 16) had resumption of menses. Twenty-eight patients were followed-up with a mean time of 31 months (range 2-84). Fifteen pregnancies were obtained in 12 patients and the outcomes were the following: two first trimester missed abortions, three second trimester fetal losses, one second trimester termination of pregnancy for multiple fetal abnormalities and nine live births in nine different patients. Pregnancy rate after treatment was 12/28 (42.8%) and live birth rate was 9/28 (32.1%). In patients </=35 years, 10 out of 16 conceived (62.5%) versus two out of 12 (16.6%) in patients >35 years (P = 0. 01). Three patients were lost to follow-up and their results omitted. In nine patients with live births, one Caesarean hysterectomy for placenta accreta and one hypogastric arteries ligation for severe haemorrhage and placenta accreta were performed. Hysteroscopic treatment of severe Asherman's syndrome appeared to be effective for the reconstruction of a functional uterine cavity with a 42.8% pregnancy rate. However, these pregnancies were at risk for haemorrhage with abnormal placentation.

Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility

Objective: To assess the safety and efficacy of hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. Design: Retrospective case report series. Setting: The obstetrics and gynecology clinic of a medical school. Patient(s): Forty women with recurrent pregnancy loss or infertility resulting from intrauterine adhesions. Intervention(s): Hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. Main Outcome Measure(s): Postoperative adhesion formation, intraoperative complication, conceivement after surgery, pregnancy rate, and pregnancies resulted in term or viable preterm infants. Result(s): Most patients with minimal or moderate adhesions were free of adhesions when compared with postoperative control subjects. However, adhesion re-formation was noted in 60% of the patients who initially had severe adhesions. Normal menstrual flow was restored in 81% of the patients. All the patients who had recurrent pregnancy loss conceived after treatment, and 71% of the pregnancies resulted in a term or viable preterm infant. Of the 16 infertile patients treated, 10 (63%) conceived and 6 (37%) were delivered of viable infants. Conclusion(s): Hysteroscopic adhesiolysis is a safe and effective procedure for restoring the normal menstrual pattern and fertility. The initial severity of the adhesions appears to correlate best with the reproductive outcome.