Effects of Aspirin and Intrauterine Balloon on Endometrial Repair and Reproductive Prognosis in Patients with Severe Intrauterine Adhesion: A Prospective Cohort Study

Abstract

This study aimed to investigate the effects of estrogen in combination with aspirin and intrauterine balloon on the uterine endometrial repair and reproductive prognosis in patients after surgery for severe intrauterine adhesion (sIUA). We prospectively recruited 114 patients with sIUA. Intrauterine device (IUD) was placed and oral estrogen was administered after surgery. Patients were divided into control group and aspirin group. In addition, patients in aspirin group were subdivided into nonballoon group and balloon group. Results showed that, after therapy, the increase in endometrial thickness of aspirin groups was superior to control group (P < 0.05). The scores of intrauterine adhesion and menstruation were significantly improved in balloon group as compared to nonballoon group and control group, and significant differences were also observed between nonballoon group and control group (P < 0.05). Of 97 patients, 44.3% became pregnant after surgery, the live birth rate was 27.8%, and the miscarriage rate was 37.2%, but there were no significant differences among three groups (P > 0.05). Thus, aspirin may promote the uterine endometrial growth and repair after surgery for sIUA, and IUD in combination with intrauterine balloon may reduce the recurrence of intrauterine adhesion, but their effect on the reproductive prognosis is required to be further studied.

Aspirin inhibits endometrial fibrosis by suppressing the�TGF‑β1‑Smad2/Smad3 pathway in intrauterine adhesions

“…Recent studies have suggested that aspirin is more effective in preventing adhesion recurrence following TcRA surgery, as it can increase endometrial angiogenesis (28). A prospective study revealed that aspirin combined with an intrauterine balloon and intrauterine device significantly increased endometrial thickness following TcRA surgery, and AFS scores and menstrual scores also improved significantly (23). Chi et al (28) demonstrated that compared with transdermal oestrogen alone therapy, transdermal oestrogen combined with aspirin following TcRA surgery resulted in an improved effect on increasing the endometrial thickness, increasing menstrual flow, preventing adhesion recurrence and improving endometrial receptivity, which may be associated with increased uterus intimal angiogenesis and decreased resistant index and pulsatility index in uterine arteries.…”

“…of endometrial microvascular formation and improvement of local blood circulation by aspirin, thereby decreasing IUA recurrence, improving menstruation and increasing the pregnancy rate (23). To the best of our knowledge, there are no previous studies investigating whether aspirin inhibits endometrial fibrosis by inhibiting the TGF-β1-Smad2/Smad3 pathway and decreases postoperative recurrence of IUAs.…”

“…In addition, aspirin has a positive effect on improving cardiac fibrosis (22). A recent study has demonstrated that aspirin has a positive effect on the growth and repair of the endometrium following IUAs (23), suggesting that this may be associated with the promotion…”

Effects of early second‐look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions

“…The use of low‐dose aspirin to reduce the risk of thrombosis caused by estrogen has also been gaining attention; furthermore, aspirin facilitates blood supply to the uterine artery and spiral artery, promoting endometrial growth . Further studies have reported that postoperative application of aspirin might enhance endometrial receptivity and improve reproductive outcomes in IUA cases …”

“…In addition, all women underwent transvaginal ultrasonography at the early follicular phase to assess the thickness of the endometrium. Menstruation was evaluated by the women using a method similar to the visual analogue scale (0 indicating amenorrhea, 10 indicating normal menstruation) …”