Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility

Bosteels, Jan; Weyers, Steven; D’Hooghe, Thomas; Torrance, Helen L.; Broekmans, Frank J.; Chua, Su Jen; Mol, Ben Willem J.

doi:10.1002/14651858.cd011110.pub3

Cited by 62 publications

(65 citation statements)

References 79 publications

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“…There is risk of IUAs after the procedure. Various methods (copper intrauterine device [IUD], hormonal treatment with estrogen, combination therapy with IUD and hormonal treatment or intrauterine auto‐crosslinked hyaluronic acid gel) have been used to prevent IUAs after operative hysteroscopy . Intrauterine postoperative hormone treatment, especially if preoperative GnRH agonist has been given, is frequently used to enhance endometrial proliferation and to reduce adhesion formation but the evidence of its efficacy is lacking .…”

Section: Management Optionsmentioning

confidence: 99%

“…Various methods (copper intrauterine device [IUD], hormonal treatment with estrogen, combination therapy with IUD and hormonal treatment or intrauterine auto‐crosslinked hyaluronic acid gel) have been used to prevent IUAs after operative hysteroscopy . Intrauterine postoperative hormone treatment, especially if preoperative GnRH agonist has been given, is frequently used to enhance endometrial proliferation and to reduce adhesion formation but the evidence of its efficacy is lacking . While there is no evidence of benefit of using IUDs or an intrauterine balloon to reduce the risk of adhesions after hysteroscopic septum resection, there is some evidence that intrauterine auto‐crosslinked hyaluronic acid gel can reduce the risk of IUAs after septum division .…”

Section: Management Optionsmentioning

confidence: 99%

See 1 more Smart Citation

Reproductive Implications and Management of Congenital Uterine Anomalies

Akhtar¹,

Saravelos²,

Li³

et al. 2019

BJOG

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Plain language summary Congenital uterine anomalies (CUAs) are malformations of the womb that develop during fetal life. When a baby girl is in her mother’s womb, her womb develops as two separate halves from two tubular structures called ‘müllerian ducts’, which fuse together before she is born. Abnormalities that occur during the baby’s development can be variable from complete absence of a womb through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good in screening for CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex womb abnormality is suspected, MRI scanning may also be used, with a combination of laparoscopy in which a camera is inserted into the cavity of the abdomen, and hysteroscopy, when the camera is placed in the womb cavity. As there can be a link between CUAs and abnormalities of the kidney and bladder, scans of these organs are also usually requested. Although CUAs are present at birth, adult women typically do not have any symptoms, although some may experience painful periods. Most cases of CUA do not cause a woman to have difficulty in becoming pregnant and the outcome of pregnancy is good. However, these womb anomalies are often discovered during investigations for infertility or miscarriage. Moreover, depending upon the type and severity of CUA, there may be increased risk of first and second trimester miscarriages, preterm birth, poor growth of the baby in the mother’s womb (fetal growth restriction), pre‐eclampsia and difficult positioning of the baby for birth (fetal malpresentation). Surgical treatment is only recommended to a woman who has had recurrent miscarriages and has a septate uterus, i.e., the womb cavity is divided by a partition. In this case, surgery may improve her chances for a successful pregnancy, although the risks of surgery, especially scarring of the womb should be considered. However, further evidence from randomised controlled trials are required to provide conclusive evidence‐based recommendations for surgical treatment for septate uterus. Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These women, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up using an appropriate protocol for preterm birth as outlined in UK Preterm Birth Clinical Network Guidance.1>

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Section: Management Optionsmentioning

confidence: 99%

Section: Management Optionsmentioning

confidence: 99%

Reproductive Implications and Management of Congenital Uterine Anomalies

Akhtar¹,

Saravelos²,

Li³

et al. 2019

BJOG

View full text Add to dashboard Cite

show abstract

“…Intrauterine adhesions (IUAs) can occur following an invasive intrauterine procedure as a result of the normal healing process of the damaged endometrium/myometrium. Although several interventions have been proposed for preventing the occurrence of IUAs, such as use of hyaluronic acid gel or polyethylene oxide‐sodium carboxymethylcellulose gel, estrogen therapy and use of an intrauterine balloon or intrauterine device, their effectiveness is still uncertain.…”

Section: Techniquementioning

confidence: 99%

Ultrasound‐guided repeat intrauterine balloon dilatation for prevention of adhesions

Ludwin

Martins

Ludwin

2019

Ultrasound in Obstet & Gyne

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“…The treatment of IUAs poses a challenge, and the prognosis of severe disease remains poor . Thus the prevention of IUAs is of great importance, and should focus on the management of any retained products of conception …”

Section: Introductionmentioning

confidence: 99%

“…There are conflicting data concerning the incidence of IUAs, however . The overall incidence of IUAs is related to the method used for diagnosis (routine hysteroscopy versus examination after clinical symptoms) . A Canadian tertiary clinic reported a rate of IUAs of 0.7% following treatment for early failure of pregnancy .…”

Section: Introductionmentioning

confidence: 99%

Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study

Mentula

Männistö

Gissler

et al. 2018

BJOG

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Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility

Abstract: Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility.

Cited by 62 publications

References 79 publications

Reproductive Implications and Management of Congenital Uterine Anomalies

Reproductive Implications and Management of Congenital Uterine Anomalies

Ultrasound‐guided repeat intrauterine balloon dilatation for prevention of adhesions

Intrauterine adhesions following an induced termination of pregnancy: a nationwide cohort study

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