Management Of Intrauterine Adhesions Research Articles

Recent Advancement in the Management of Intrauterine Adhesions Using Stem Cell Therapy: A Review Article.

Intrauterine adhesions (IUAs) are the formation of scar tissues in the endometrial cavity. The fibrous tissue in the uterus decreases the space inside the uterine cavity. It includes both endometrium and myometrium. It may lead to hypomenorrhea or amenorrhea, pain, difficulty in conceiving, and recurrent abortion. IUA is caused by uterine tissue damage mostly during surgical procedures such as dilatation and curettage. Other causes may include pregnancy-related complications, miscarriage, abnormal bleeding, infections, fibroid removal, and cesarean section (C-section). Patients generally do not have any symptoms and hence are unaware of the condition. The main therapeutic procedure presently used is hysteroscopic transcervical resection of adhesion (TCRA) with hormonal therapy and nondegradable stent as postoperative adjuvant therapy. It has some major limitations such as failure to prevent recurrence and preserve fertility along with difficulty in endometrial tissue repair due to its anatomical site. These limitations have forced the researchers to think about a better treatment modality. In recent times, a better treatment modality has evolved with stem cell therapy. Therefore, this review presents the recent and advanced therapeutic modalities for the treatment of IUAs.

Management of intrauterine adhesions using human amniotic mesenchymal stromal cells to promote endometrial regeneration and repair through Notch signalling.

Intrauterine adhesions (IUAs) severely hamper women's reproductive functions. Human amniotic mesenchymal stromal cell (hAMSC) transplantation is effective in treating IUAs. Here, we examined the function of Notch signalling in IUA treatment with hAMSC transplantation. Forty‐five Sprague‐Dawley female rats were randomly divided into the sham operation, IUA, IUA + E2, IUA + hAMSCs and IUA + hAMSCs + E2 groups. After IUA induction in the rats, hAMSCs promoted endometrial regeneration and repair via differentiation into endometrial epithelial cells. In all groups, the expression of key proteins in Notch signalling was detected in the uterus by immunohistochemistry. The results indicated Notch signalling activation in the hAMSCs and hAMSCs + E2 groups. We could also induce hAMSC differentiation to generate endometrial epithelial cells in vitro. Furthermore, the inhibition of Notch signalling using the AdR‐dnNotch1 vector suppressed hAMSC differentiation (assessed by epithelial and mesenchymal marker levels), whereas its activation using the AdR‐Jagged1 vector increased differentiation. The above findings indicate Notch signalling mediates the differentiation of hAMSCs into endometrial epithelial cells, thus promoting endometrial regeneration and repair; Notch signalling could have an important function in IUA treatment.

A preliminary study on a patented intrauterine stent in the treatment of recurrent intrauterine adhesions with poor prognosis.

Management of intrauterine adhesions (IUAs) is challenging, mainly because there is no ideal method to prevent its recurrence. Recurrence of moderate to severe IUAs after conventional treatments entails a poorer prognosis in these patients. This study aimed to assess the safety and effectiveness of a patented intrauterine stent as a barrier in the treatment of recurrent IUAs with poor prognosis. This was a retrospective, observational study of 13 women with IUAs, admitted to the Third Xiangya Hospital of Central South University from June 2018 to September 2019. After conventional treatments, moderate to severe adhesions were still evident. Then a patented intrauterine stent was used as a barrier to prevent the reformation of adhesions after hysteroscopic adhesiolysis (HA). All cases received a second-look hysteroscopy after 2-3 menstrual cycles. American Fertility Society (AFS) scores were noted for all cases. Menstrual pattern, recurrence of adhesions, and reproductive outcomes were also evaluated. The mean number of previous HA of the 13 patients was 2.7, and mean AFS score after conventional treatments was still 8.7. Before the use of the stent, 46.2% of the patients had amenorrhea caused by IUAs. After using the intrauterine stent as a barrier, the mean AFS score was 1.7. The menstrual improvement rate was 100%, while the rate of resumption of normal menstrual volume was 53.8%. The second-look hysteroscopy revealed a correct position of the stents and no obvious recurrence of IUAs in all cases. After the removal of the stent, the patients were followed up for 2-13 months (mean: 7 months), and no amenorrhea was observed, the recurrence rate of IUAs was 25.0% and one patient got pregnant. Even in the recurrent IUAs patients with very poor prognosis, the patented intrauterine stent has been proved to be very effective in preventing the recurrence of adhesions, on condition that its correct position inside the uterine cavity is achieved. Due to the extremely poor nature of the studied population, the recurrent rate of IUAs and pregnancy rate after the removal of the stent is still discouraging, although the improvement in menstruation is inspiring.

An experimental model: intrauterine adhesion versus subendometrial fibrosis

Background: Intrauterine adhesions (IUA) remain a major cause of infertility. The prevalence of IUA varies geographically and keeps increasing over the last few decades due to increased hysteroscopic surgeries. Therefore, IUA management has received considerable attention. However, the management of IUAs still presents a big challenge: the recurrence rate could be up to 62.5% in severe IUAs. Intrauterine adhesion (IUA) occurs as a result of endometrial destruction by surgical interventions or infection causing obliteration of uterine cavity by the adhesions which interfere with embryonic implantation. Sub endometrial fibrosis may occurs, which causes narrowing of uterine cavity so no enough space for fetal growth. This leads to recurrent abortion. Aim: We aim in this experiment to apply a method for two models of IUA and or fibrosis by intrauterine injections of two different doses of trichloroacetic acid. Method: This experimental study was performed on 30 albino adult rats which were divided into three groups (n=10 rats/group) as follows, group 1: normal control rats, group 2: induced IUA and/or fibrosis that received low dose trichloroacetic acid, group 3: induced fibrosis that received high dose trichloroacetic acid, the extent of fibrosis, vascularization and inflammation were evaluated by; qRTPCR for IL-6, TNF, VEGF and TG-β immunohistochemistry examination for VEGF and TGF-β and histological assessment. Results: We found significant increase in IL-6, TNF and TGF in high dose group and significant decrease in VEGF in high dose group compared to normal group and low dose group (p<0.05). Discussion: The reproductive cells are the most sensitive to toxic environmental materials. In this study, we found that group II rats (IUAs), unlike control rats, had impaired endometrial epithelial cells, a lower number of endometrial glands, higher inflammatory cell infiltration, poor vascularity, and a severe narrowing of the uterine cavity with dense endometrial fibrosis as confirmed by H&E and Masson’s trichrome staining.

Современные методы профилактики и лечения внутриматочных синехий (обзор литературы)

Intrauterine adhesions (IUA) or Asherman's syndrome - multifaceted condition, which is being diagnosed with increasing frequency in recent years and a major cause of secondary infertility. Despite the widespread adoption of hysteroscopic adhesiolysis, the management of IUAs still presents a big challenge: the recurrence rate could be up to 62.5% in severe IUAs. The literature review highlights the current capabilities of surgical treatment, methods and means of prevention of recurrence, as well as the most promising research into the pathogenesis and treatment of Asherman's syndrome.

Management of intrauterine adhesions: A novel intrauterine device

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.