Role of hyaluronic acid intrauterine injection in the prevention of Asherman’s syndrome in women undergoing uterine septum resection: An RCT

Abstract

Background: Adhesion due to intrauterine surgery such as septal resection associated with damaged endometrium can increase the risk of Asherman’s syndrome. The main goal of treatment in this syndrome is to repair the damaged endometrium for creating a physiological pregnancy.
 Objective: To investigate the effect of intrauterine injection of hyaluronic acid on the prevention of Asherman’s syndrome in women undergoing uterine septum resection.
 Materials and Methods: In this double-blind randomized clinical trial, 65 women undergoing the uterine septum resection were divided into two groups; the case group (n = 34) and the control group (n = 31). Immediately after the septal resection with a resectoscope, 1cc of hyaluronic acid gel in the case group and 1cc normal saline solution as a placebo in the control group was injected into the uterine cavity. After two months, existence of intrauterine adhesions in the both groups was examined by the hysteroscope and assessment of menstrual patterns, according to the American Society for Reproductive Medicine criteria.
 Results: Our results showed that after intervention, the incidence of Asherman’s syndrome in the control group was higher than the case group (p = 0.012). In the case group, only four women had poor adhesion (Asherman’s syndrome) at the end of the study, while the rest of them were free of any adhesions in the uterine cavity. In the control group, however, only 19 were free of intrauterine adhesions and 12 had mild symptoms.
 Conclusion: The results of the study exhibited the hyaluronic acid capacity to reduce the risk of Asherman’s syndrome in women with endometrial damage following a septal resection surgery.
 Key words: Asherman’s syndrome, Septum, Uterine, Hyaluronic acid, Resection.

Cyclical endometrial repair and regeneration: Molecular mechanisms, diseases, and therapeutic interventions

“…In a study, SeiedeZahra Ghanadzadeh Tafti found that HA could better reduce the production of fibrotic tissue and improve endometrial repair than the control group. 231 Another study found that the incidence of IUA decreased significantly after postoperative use of HA (OR 0.39, 95% CI 0.29-0.52). 326 High molecular weight HA is often present in the ECM, while low molecular weight HA is frequently employed as an extracellular signaling molecule.…”

“…230 In early clinical trials of HA alone, SeiedeZahra Ghanadzade-hTafti found that HA can reduce area of fibrotic tissue after hysteroscopic surgery. 231 Several prospective studies have shown that HA reduces adhesions compared with IUDs or balloons. Endometrial regeneration and menstruation were also better in patients with postoperative HA implants during long-term follow-up.…”

“…The clinical trade name is “Ankang Gong” (related properties and cutting‐edge research will be described later) 230 . In early clinical trials of HA alone, SeiedeZahra GhanadzadehTafti found that HA can reduce area of fibrotic tissue after hysteroscopic surgery 231 . Several prospective studies have shown that HA reduces adhesions compared with IUDs or balloons.…”

“…Currently, most clinical studies generally recognize the endometrial repair effect of HA. In a study, SeiedeZahra Ghanadzadeh Tafti found that HA could better reduce the production of fibrotic tissue and improve endometrial repair than the control group 231 . Another study found that the incidence of IUA decreased significantly after postoperative use of HA (OR 0.39, 95% CI 0.29–0.52) 326 .…”

A Novel Intrauterine Estrogen-Releasing System for Preventing the Postoperative Recurrence of Intrauterine Adhesion: A Multicenter Randomized Controlled Study

“…They found that sodium hyaluronate gel can effectively prevent the reoccurrence of mild IUA, but cannot effectively prevent adhesion recurrence in patients with severe IUA 4 . Moreover, sodium hyaluronate gel has a relatively rapid degradation rate, limiting its effectiveness for preventing adhesions to only 48-72 hours 5 . Consequently, sodium hyaluronate gel is only appropriate for early postoperative use.…”