A comprehensive review of Asherman's syndrome: causes, symptoms and treatment options

Salazar, Christina; Isaacson, Keith; Morris, Stephanie N.

doi:10.1097/gco.0000000000000378

Cited by 146 publications

(116 citation statements)

References 39 publications

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“…Currently, there are no ideal treatments for severe IUA. Surgical release, hormone application or IUDs show their defects, respectively, such as failure in complete lysis and dosage control, and mismatch of IUD size (Salazar et al, 2017). Thus, they cannot fully repair injured endometrium and uterus.…”

Section: Discussionmentioning

confidence: 99%

Advances in the Application of Biomimetic Endometrium Interfaces for Uterine Bioengineering in Female Infertility

Han

2020

Front. Bioeng. Biotechnol.

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The Asherman's syndrome, also known as intrauterine adhesion, often follows endometrium injuries resulting from dilation and curettage, hysteroscopic resection, and myomectomy as well as infection. It often leads to scarring formation and female infertility. Pathological changes mainly include gland atrophy, lack of vascular stromal tissues and hypoxia and anemia microenvironment in the adhesion areas. Surgical intervention, hormone therapy and intrauterine device implantation are the present clinical treatments for Asherman's syndrome. However, they do not result in functional endometrium recovery or pregnancy rate improvement. Instead, an increasing number of researches have paid attention to the reconstruction of biomimetic endometrium interfaces with advanced tissue engineering technology in recent decades. From micro-scale cell sheet engineering and cell-seeded biological scaffolds to nanoscale extracellular vesicles and bioactive molecule delivery, biomimetic endometrium interfaces not only recreate physiological multi-layered structures but also restore an appropriate nutritional microenvironment by increasing vascularization and reducing immune responses. This review comprehensively discusses the advances in the application of novel biocompatible functionalized endometrium interface scaffolds for uterine tissue regeneration in female infertility.

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Section: Discussionmentioning

confidence: 99%

Advances in the Application of Biomimetic Endometrium Interfaces for Uterine Bioengineering in Female Infertility

Han

2020

Front. Bioeng. Biotechnol.

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“…There are various therapeutic approaches available for repairing the endometrium after injury, or protecting it from recurrent IUAs. The most common among them is hysteroscopic adhesiolysis, but there is also increased interest in anti-adhesives, hormone therapy and intrauterine devices [7, 8]. Additionally, there are a number of exploratory new therapies that are currently being tested on animals and in small scale clinical trials.…”

Section: Current Treatment Optionsmentioning

confidence: 99%

“…AS, also referred to as intrauterine adhesions (IUAs), or intrauterine synechiae, is a complex gynecological abnormality caused by procedures that impart damage to the endometrium, such as dilation and curettage (D&C), hysteroscopic resection, hysteroscopic septum resection, hysteroscopic myomectomy and abdominal myomectomy [7]. Symptoms include recurrent pregnancy loss, hypomenorrhea, amenorrhea and infertility [8].…”

Section: Introductionmentioning

confidence: 99%

Cell and biomaterial-based approaches to uterus regeneration

Liu

Wang

et al. 2019

Regenerative Biomaterials

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Asherman’s syndrome (AS) is an endometrial disorder in which intrauterine adhesions crowd the uterine cavity and wall. The fibrotic adhesions are primarily the result of invasive uterine procedures that usually involve the insertion of surgical equipment into the uterus. This syndrome is accompanied by a number of clinical manifestations, including irregular or painful menstruation and infertility. The most prevalent treatment is hysteroscopy, which involves the physical removal of the fibrous strands. Within the last decade, however, the field has been exploring the use of cell-based therapeutics, in conjunction with biomaterials, to treat AS. This review is a recapitulation of the literature focused on cellular therapies for treating AS.

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“…Intrauterine adhesions (IUA), also known as Asherman's syndrome, were first described in 1948 by Joseph G. Asherman (1). The causes of IUA include dilatation/curettage, postpartum hemorrhage, hysteromyomectomy, hysteroscopic operation and genital tuberculosis (2)(3)(4). The main clinical manifestations of IUAs are hypomenorrhea, recurrent abortion, amenorrhea, periodic hypogastralgia, infertility and altered placental implantation, which are conditions that can cause harm to patient health (5).…”

Section: Introductionmentioning

confidence: 99%

Meta‑analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations

Zheng¹,

Xin

He³

et al. 2020

Exp Ther Med

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Intrauterine adhesion (IUA) is a severe complication that occurs following abortion, and hyaluronic acid gel has been used to prevent IUA following intrauterine operation. The present study aimed to systematically evaluate the efficacy of hyaluronic acid gel in preventing IUA following intrauterine operation. In the current study, a literature search was performed using PubMed, Cochrane Library and EMbase databases for randomized controlled clinical trials that used hyaluronic acid gel as an adjuvant therapy following intrauterine operation. The terms 'hyaluronic acid', 'intrauterine adhesions', 'Asherman's syndrome', 'IUA', 'dilatation and curettage', 'abortion' and 'hysteroscopic' were used to search for articles published online before July 31, 2018. RevMan 5.3 software was used to analyze the indicators of uterine cavity adhesion formation and pregnancy rates following intrauterine operation. A total of seven randomized controlled clinical studies were included, consisting of 952 patients who underwent intrauterine operation. The meta-analysis indicated that the use of hyaluronic acid gel reduced the incidence of IUA [relative risk (RR)=0.42; 95% confidence interval (CI)=0.30-0.57; P<0.001] and the score for IUA after an intrauterine operation (mean difference=-1.29; 95%=-1.73 to-0.84; P<0.001). A subgroup analysis revealed that the preventive effect of hyaluronic acid gel on IUA was not affected by the type of intrauterine operation, namely abortion (RR=0.40; 95% CI=0.26-0.62; P<0.001) and hysteroscopy (RR=0.44; 95% CI=0.28-0.68; P<0.001). The preventive effect of hyaluronic acid gel on IUA was also not affected by primary disorders/diseases including the following: Abortion (RR=0.48; 95% CI=0.29-0.78; P=0.003); IUA (RR=0.38; 95% CI=0.21-0.67; P<0.001) and submucosal myoma of the uterus, endometrial polyps or mediastinum uterus (RR=0.40; 95% CI=0.18-0.90; P=0.03). Hyaluronic acid gel improved pregnancy rates after intrauterine operations (RR=1.94; 95% CI=1.46-2.60; P<0.001). In conclusion, hyaluronic acid gel was indicated to significantly reduce the incidence of IUA following intrauterine operation, regardless of the type of intrauterine operation or the presence of primary diseases. Treatment with hyaluronic acid gel was also revealed to increase pregnancy rates following intrauterine operation.

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A comprehensive review of Asherman's syndrome: causes, symptoms and treatment options

Abstract: Increased awareness of the symptoms suggestive of intrauterine adhesive disease, as well as recognition of common causes and preceding events, is crucial for early diagnosis, patient counselling and treatment. VIDEO ABSTRACT: http://links.lww.com/COOG/A36.

Cited by 146 publications

References 39 publications

Advances in the Application of Biomimetic Endometrium Interfaces for Uterine Bioengineering in Female Infertility

Advances in the Application of Biomimetic Endometrium Interfaces for Uterine Bioengineering in Female Infertility

Cell and biomaterial-based approaches to uterus regeneration

Meta‑analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations

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