Recent trends in therapeutic strategies for repairing endometrial tissue in intrauterine adhesion

Abstract

Intrauterine adhesion (IUA) is a common gynaecological disease that develops from infection or trauma. IUA disease may seriously affect the physical and mental health of women of childbearing age, which may lead to symptoms such as hypomenorrhea or infertility. Presently, hysteroscopic transcervical resection of adhesion (TCRA) is the principal therapy for IUAs, although its function in preventing the recurrence of adhesion and preserving fertility is limited. Pharmaceuticals such as hormones and vasoactive agents and the placement of nondegradable stents are the most common postoperative adjuvant therapy methods. However, the repair of injured endometrium is relatively restricted due to the different anatomical structures of the endometrium. Recently, the treatment outcome of IUAs has improved with the advancement of hysteroscopic techniques. In particular, the application of bioactive scaffolds combined with tissue engineering technology has proven to have high therapeutic potential or endometrial repair in IUA treatment. Herein, this review has summarized past therapeutic strategies, including postoperative adjuvant therapy, cell or therapeutic molecular delivery therapy methods and bioactive scaffold-based tissue engineering methods. Therefore, this review presented the recent therapeutic strategies for repairing endometrium treatment and pointed out the issues of clinical concern to provide alternative methods for the management of IUAs.

Effectiveness of phosphodiesterase type 5 inhibitors on the treatment of thin endometrium and pregnancy outcomes: An systematic review

“…PDE5 inhibitors administration are contraindicated in people who are affected with headaches, hypotension, and flushing. 60 So it is better to use alternative methods such as hormone therapy or with caution, use lower doses in combination with other endometrial thickeners treatments. On the other hand, it should be noted that each drug has its unique effects which should be prescribed according to the patient's condition and underlying problem.…”

“…For example, sildenafil in addition to enhancing blood flow to the uterus, can improve the ovulation success rate and decrease natural killer cell activity, which may be desired treatment for women with recurrent miscarriages. 12,60 One of the limitations of the reviewed studies is the lack of consideration to the side effects of PDE5 inhibitors in some studies and also the lack of evaluation of their outcome in different phases of ART. If so, most studies have evaluated ET on trigger day or the day before (Starting hCG treatment) in fresh cycle embryo transfer or at the end of the estrogen phase during the frozen embryo transfer (FET) period.…”

“…For example, sildenafil in addition to enhancing blood flow to the uterus, can improve the ovulation success rate and decrease natural killer cell activity, which may be desired treatment for women with recurrent miscarriages. 12,60…”

Comparing the Characteristics of Amniotic Membrane-, Endometrium-, and Urinary-Derived ECMs and Their Effects on Endometrial Regeneration in a Rat Uterine Injury Model

“…The d-ECM can mimic the native environment under in vitro conditions (e.g., by creating a biomimetic environment allowing for the growth of stromal cells). Recent studies have confirmed that biomaterials with tissue-specific ECM features can improve regeneration and support gestation in a severe uterine damage model ( Miyazaki and Maruyama, 2014 ; Campo et al, 2021 ), thus demonstrating the value of decellularized tissues ( Ma et al, 2021 ).…”

Recent Developments in Biomaterial-Based Hydrogel as the Delivery System for Repairing Endometrial Injury

“…The introduction of various biological substances that stimulate tissue regeneration can promote endometrial injury repair ( Cervelló et al, 2015 ; Almeida et al, 2021 ; Ma et al, 2021 ). Stem cell therapy is currently the most attractive therapeutic approach to repairing endometrial damage ( Keyhanvar et al, 2021 ; Gharibeh et al, 2022 ).…”