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

Abstract

Objective:To investigate the effect of early second-look office hysteroscopy combined with intrauterine balloon dilatation on prognosis and pregnancy rate for women with intrauterine adhesions. Methods:A retrospective analysis of 156 women diagnosed with intrauterine adhesions by hysteroscopy at Shenyang Women's and Children 's Hospital, China, from April 2017 to January 2019. The study women underwent intrauterine balloon dilatation 10 days after transcervical resection of adhesion (TCRA) and hysteroscopy 20 days after TCRA (n=81). The control women underwent hysteroscopy 3 months after TCRA (n=75).Estrogen and aspirin were routinely administered postoperatively to all women. Data, including American Fertility Society (AFS) scores assessed by hysteroscopy, endometrial thickness measured by ultrasound, and menstruation and pregnancy outcomes assessed by interview, were compared between the two groups. Results:The degree of intrauterine adhesions, menstrual status, and endometrial thickness were improved in both groups after TCRA. Greater improvement in AFS score, menstruation, and endometrial thickness was observed in the study group than in the control group. After follow-up, more women in the study group achieved pregnancy (48.1% vs 30.7%, P<0.05). Conclusion:Early second-look of hysteroscopy combined with intrauterine balloon dilatation after hysteroscopic TRCA might improve the prognosis and postoperative pregnancy rate for women with intrauterine adhesions. K E Y W O R D S Balloon dilatation; Early second-look; Intrauterine adhesion; Prognosis; Reproductive outcomes; Transcervical resection of adhesion 1 | INTRODUCTION Intrauterine adhesions (IUA), also known as Asherman syndrome, are a common cause of secondary infertility among women of childbearing age. Endometrial damage caused by intrauterine operations or infections are the major causes of IUA, which lead to partial or complete occlusion of the uterine cavity. 1 IUAs are often secondary to intrauterine operations such as dilation and curettage. 2 Most effected women have hypomenorrhea, amenorrhea, and periodic abdominal pain, but a few also have normal menstruation. 2,3 Due to the high rate of induced abortion in China, the incidence of IUA is also increasing. 4 The prevalence of IUA is reported to be approximately | 193 Sun ET AL.20% after induced abortion, but rises to 40% for women with multiple intrauterine operations. 5Hysteroscopy is the gold standard for clinical diagnosis and treatment of IUA, 6 and most confirmed cases are treated by transcervical resection of adhesion (TCRA). However, the recurrence rate is up to 62.5%. 7 Several methods have been reported for preventing IUA recurrence, such as hyaluronic acid gel, artificial cycle hormone therapy, intrauterine balloon, and intrauterine devices; however, the effects are still uncertain. 8 Therefore, it is important to find a standardized strategy for managing women with IUA after TCRA surgery. Xu et al. 9 reported that early second-look hysteroscopy after hysteroscopic adhesiolysis (within...

The Role of Special Intrauterine Balloon and Intrauterine Contraceptive Device after TCRA in the Treatment of Intrauterine Adhesions

“…After TCRA, placing an IUB can not only block the adhesion of different uterus wall, it is also convenient for drainage of hematometra and in ammatory exudation in uterine cavity, which contribute to minimize the risk of infection and reduce the recurrence rate of intrauterine adhesion. Other study found that menstruation of up to 81.4% IUA patients had improved, who were placed IUB after surgery [1], and the overall conception rate was 33.9%-48.1%, the recurrence rate of IUA after surgery was 13.6%-38.7% [9][10][11][12][13]. Compared with placing IUD after TCRA, IUB could lead to a lower adhesion AFS score and in the meantime result in a lower recurrence rate [1], which was entirely consistent with the results in this study.…”

“…According to the 1988 American Fertility Society (AFS) scoring system [6], patients with IUA are divided into three stages, designed as mild(a score of 1-4), moderate(a score of 5-8) and severe(a score of [9][10][11][12]. This classi cation standard evaluates the extent of cavity involved, type of adhesion and menstrual pattern of patients during hysteroscopic surgery.…”

A Comparison of Special Intrauterine Balloons and Intrauterine Contraceptive Devices in the Treatment of Intrauterine Adhesions

“…Another study found that up to 81.4% of IUA patients had improved menstruation and were implanted with an IUB after surgery [1], the overall conception rate was 33.9%-48.1%, and the recurrence rate of IUA after surgery was 13.6%-38.7% [12][13][14][15][16]. Compared with placing an IUD after TCRA, insertion of an IUB can lead to a lower readhesion AFS score and a lower recurrence rate [1], which is entirely consistent with the results in this study.…”

Applications of Hydrogels in Premature Ovarian Failure and Intrauterine Adhesion

“…Oral administration of 9 mg/diet estrogen before TCRA and 10 mg/ diet after TCRA improved pregnancy rates and menstrual cycles in patients with moderate or severe IUA (Liu AZ et al, 2016); however, estrogen therapy may increase the risk of cancer (Rossouw et al, 2002) and venous thrombosis (Bracamonte and Miller, 2001). Balloon dilatation after TCRA and early second-look hysteroscopy improved pregnancy outcomes (Sun et al, 2020), and the appropriate delay of balloon placement in the uterine cavity prevented re-adhesion but was not effective in severe IUA (Zhang et al, 2021a). The dilated balloon is a nonvariable sphere that is not able to be plasticized according to the shape of the uterine cavity, resulting in ineffective improvement of adhesions in the uterine horns (Sun et al, 2020).…”

“…Balloon dilatation after TCRA and early second-look hysteroscopy improved pregnancy outcomes (Sun et al, 2020), and the appropriate delay of balloon placement in the uterine cavity prevented re-adhesion but was not effective in severe IUA (Zhang et al, 2021a). The dilated balloon is a nonvariable sphere that is not able to be plasticized according to the shape of the uterine cavity, resulting in ineffective improvement of adhesions in the uterine horns (Sun et al, 2020). IVF after TCRA improved reproductive outcomes, but increased the miscarriage rate .…”