Intrauterine adhesions: What is the pregnancy rate after hysteroscopic management?

Capmas, P.; Mihalache, Andreï; Duminil, L.; Hor, Lat Soriya; Pourcelot, Anne-Gaëlle; Fernandez, H.

doi:10.1016/j.jogoh.2020.101797

Cited by 22 publications

(15 citation statements)

References 33 publications

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“…Sanad et al [17] reported that pregnancies in patients after IUA treatment increased significantly from 18% preoperatively to 65.5% postoperatively. A recent retrospective study showed that surgical treatment in patients with IUAs resulted in 51.8% of the patients achieving pregnancy [18]. In the current study, the number of patients who achieved pregnancy in the TCRA group was close to this level, confirming the reliability of the aforementioned studies.…”

Section: Discussionsupporting

confidence: 85%

Reproductive Outcomes of In Vitro Fertilization–Intracytoplasmic Sperm Injection after Transcervical Resection of Adhesions: A Retrospective Cohort Study

Wang¹,

Yao²,

Zhao³

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: To investigate pregnancy and obstetric outcomes of patients with intrauterine adhesions (IUAs) after treatment with in vitro fertilization−intracytoplasmic sperm injection (IVF-ICSI) and fresh embryo transplantation after transcervical resection of adhesions (TCRA). Design: Retrospective cohort study. Setting: University-based reproductive medical center. Patients: A total of 535 patients with IUAs and with a history of TCRA and 1605 matched patients without a history of IUAs underwent IVF-ICSI and received fresh embryo transfers. Interventions: Between January 2014 and December 2018, all patients underwent IVF-ICSI treatment and received fresh embryo transfers. Measurements and Main Results: The patients in the TCRA group were matched with the control group according to strict criteria. Pregnancy and obstetric outcomes were compared. There were no significant differences in clinical pregnancies, ectopic pregnancies, live births, preterm births, and obstetric outcomes between the 2 groups (p >.05). However, the TCRA group had a higher risk of miscarriage than the control group (p = .048). Conclusion: TCRA improved the reproductive outcomes of patients with IUAs, but the risk of miscarriage was higher than that in the general population. To avoid miscarriage, careful monitoring is critical for pregnant patients with a history of TCRA who undergo embryo transfers during IVF treatment.

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Section: Discussionsupporting

confidence: 85%

Reproductive Outcomes of In Vitro Fertilization–Intracytoplasmic Sperm Injection after Transcervical Resection of Adhesions: A Retrospective Cohort Study

Wang¹,

Yao²,

Zhao³

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Foreign studies (35) reported that the pregnancy rate after TCRA could reach 52%, but in the case of severe adhesion, this figure would significantly decrease. However, domestic data show a significantly lower value, with one study reporting a pregnancy rate of only 22.5-33.3% (8).…”

Section: Pregnancy Rate Post Tcramentioning

confidence: 97%

Comparison of therapeutic efficacy of three methods to prevent re-adhesion after hysteroscopic intrauterine adhesion separation: a parallel, randomized and single-center trial

Zhang¹,

Liu²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: This research aims to study the efficacy of an integrated approach to prevent and treat the recurrence of intrauterine adhesions (IUA) after hysteroscopic adhesiolysis.Methods: A total of 96 patients diagnosed with moderate-to-severe intrauterine adhesions (IUA) in Nantong Maternal and Child Health Hospital from January 2016 to December 2019 were included in this parallel, randomized and single-center trial. Moderate (48 cases) and severe (48 cases) patients were randomly divided into three groups by a computer random generator: Group A (IUD, n=16), Group B, (Foley1w+IUD, n=16) and Group C (Foley1m+IUD, n=16). All patients received sequential treatment of estrogen and progesterone on the day of operation. Follow-up was performed at 1 and 3 months after treatment of uterine cavity, endometrial thickness, menstruation and pregnancy. Surgeons who performed the second-look and third-look hysteroscopy and postsurgical assessors were blinded to the randomization.Results: In total, 96 patients (48 cases in each degree) were included in the final analysis, with 16 cases in each group. No cases were lost to follow up. The primary outcome measure was AFS score, which was significantly lower in Group C than that of women in group A and Group B at 1 month (P<0.05). Similar results were observed at 3-month follow up. In patients with moderate adhesions, the pregnancy rate in Group C (Foley1m+IUD) was higher than that in Group A and Group B (P<0.05). However, in patients with severe adhesions, there was no significant difference in the pregnancy rate among the three groups (P>0.05).There was no statistical significance in infection indicators among the three groups of moderate and severe patients (P>0.05). Postoperative complications such as uterine perforation, severe bleeding, water poisoning and intrauterine infection were not observed. Conclusions:The effect of a Foley intrauterine balloon combined with IUD in preventing re-adhesion was better than that of an IUD alone. For patients with moderate adhesion, the prolongation of placement time could prevent intrauterine re-adhesion and significantly improve the pregnancy rate with strong safety.However, for patients with severe adhesions, the prolongation of intrauterine Foley balloon placement did not better prevent intrauterine re-adhesions, improve menstruation, or improve pregnancy rates.

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“…However, the postoperative recurrence rate is high, especially for severe adhesion, which can be as high as 20-62.5% [4]. The pregnancy rate of patients who have suffered from severe IUA post-treatment is only up to 40.5% [6]. Currently, various therapies are adopted to prevent postoperative adhesion recurrence, including IUD, Foley balloon [3], estrogen [7], hyaluronic acid gel [8], and amniotic membrane transplantation [9].…”

Section: Introductionmentioning

confidence: 99%

Human amniotic mesenchymal stem cells combined with PPCNg facilitate injured endometrial regeneration

Huang

Zhang

et al. 2022

Stem Cell Res Ther

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Background Caused by the injury to the endometrial basal layer, intrauterine adhesions (IUA) are characterized by uterine cavity obliteration, leading to impaired fertility. Human amniotic mesenchymal stem cells (hAMSCs) have the potential to promote endometrial regeneration mainly through paracrine ability. PPCNg is a thermoresponsive biomaterial consisted of Poly (polyethylene glycol citrate-co-N-isopropylacrylamide) (PPCN) mixed with gelatin, which has been reported as a scaffold for stem cell transplantation. This study aims to investigate the therapeutic effect of hAMSCs combined with PPCNg transplantation in promoting the regeneration of injured endometrium. Methods hAMSCs were cultured in different concentrates of PPCNg in vitro, and their proliferation, apoptosis and cell cycle were examined by CCK-8 assay and flow cytometry. Immunofluorescence was used to determine the MSCs specific surface markers. The expression of pluripotent genes was analyzed by qRT-PCR. The multiple-lineage differentiation potential was further evaluated by detecting the differentiation-related genes using qRT-PCR and specific staining. The Sprague–Dawley (SD) rat IUA model was established with 95% ethanol. hAMSCs combined with PPCNg were transplanted through intrauterine injection. The retention of DiR-labeled hAMSCs was observed by vivo fluorescence imaging. The endometrium morphology was assessed using hematoxylin and eosin (H&E) and Masson staining. Immunohistochemistry staining was performed to detect biomarkers related to endometrial proliferation, re-epithelialization, angiogenesis and endometrial receptivity. The function of regenerated endometrium was evaluated by pregnancy tests. Results hAMSCs maintained normal cell proliferation, apoptosis and cell cycle in PPCNg. Immunofluorescence and qRT-PCR showed that hAMSCs cultured in PPCNg and hAMSCs cultured alone expressed the same surface markers and pluripotent genes. hAMSCs exhibited normal multilineage differentiation potential in PPCNg. Vivo fluorescence imaging results revealed that the fluorescence intensity of hAMSCs combined with PPCNg intrauterine transplantation was stronger than that of direct hAMSCs intrauterine transplantation. Histological assays showed the increase in the thickness of endometrial and the number of endometrial glands, and the remarkably decrease in the fibrosis area in the PPCNg/hAMSCs group. The expressions of Ki-67, CK7, CK19, VEGF, ER and PR were significantly increased in the PPCNg/hAMSCs group. Moreover, the number of implanted embryos and pregnancy rate were significantly higher in the PPCNg/hAMSCs group than in the hAMSCs group. Conclusions PPCNg is suitable for growth, phenotype maintenance and multilineage differentiation of hAMSCs. hAMSCs combined with PPCNg intrauterine transplantation can facilitate the regeneration of injured endometrium by improving utilization rates of hAMSCs, and eventually restore reproductive capacity.

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Intrauterine adhesions: What is the pregnancy rate after hysteroscopic management?

Cited by 22 publications

References 33 publications

Reproductive Outcomes of In Vitro Fertilization–Intracytoplasmic Sperm Injection after Transcervical Resection of Adhesions: A Retrospective Cohort Study

Reproductive Outcomes of In Vitro Fertilization–Intracytoplasmic Sperm Injection after Transcervical Resection of Adhesions: A Retrospective Cohort Study

Comparison of therapeutic efficacy of three methods to prevent re-adhesion after hysteroscopic intrauterine adhesion separation: a parallel, randomized and single-center trial

Human amniotic mesenchymal stem cells combined with PPCNg facilitate injured endometrial regeneration

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