Intrauterine adhesions: from pathogenesis to effective coping technologies

Abstract

Intrauterine adhesions (IUDs) are one of the unresolved and unsolved problems of modern reproductive medicine worldwide. Adhesive lesions lead to partial or complete obliteration of the uterine cavity and/or cervical canal. The main clinical manifestations of IUDs are menstrual irregularities, cyclical pain, infertility and other various reproductive disorders. Reproductive outcomes in women with IUDs remain poorly understood and difficult to verify. At the same time, there is currently no understanding of the basic mechanisms of IUD development, including the processes explaining the failures of the above complications. The problem of overcoming IUD recurrences after adhesiolysis remains far from being finally resolved. The gold-standard treatment for IUD is hysteroscopic adhesiolysis, which, however, is associated with a high frequency of complications and relapses, highlighting the need for preventive approaches to the management of IUD. The drugs with enzymatic activity inhibiting abnormal connective tissue include bovhyaluronidase azoximer created by the Russian developers back in 2005. The drug consists of two components – hyaluronidase and azoximer bromide. The former is an enzyme, and the latter is a stabilizer that prolongs the action of hyaluronidase. Several studies have shown that bovhyaluronidase azoximer causes the destruction of intrauterine adhesions and restores the endometrium status in inflammatory pelvic diseases. Due to prolonged antifibrotic effect of bovhyaluronidase, azoximer can be used to treat women with IUDs to reduce the risk of the subsequent development of adhesive process in the uterine cavity.