Application of a Hyaluronic Acid Gel after Intrauterine Surgery May Improve Spontaneous Fertility: A Randomized Controlled Trial in New Zealand White Rabbits

Abstract

ObjectiveIntrauterine adhesions (IUAs) are the most common complication after hysteroscopy in patients of reproductive age. Intra-abdominal anti-adhesion gel reduces the incidence of adhesions, but effects on fertility after uterine surgery are not known. The objective of our work was to evaluate the effect of intrauterine anti-adhesion gel on spontaneous fertility after repeated intrauterine surgery with induced experimental synechiae in the rabbit model.Materials and MethodsTwenty New Zealand White rabbits underwent a double uterine curettage 10 days apart and were randomized into two groups. Each rabbit served as its own control: one uterine tube was the treatment group (A), the second uterine tube was the control group (B) to avoid bias through other causes of infertility. Group A received a post curettage intrauterine instillation of anti-adhesion gel whereas group B, the control group, underwent curettage without instillation of the gel. After a recovery period, the rabbits were mated. An abdominal ultrasound performed 21 days after mating allowed us to diagnose pregnancy and quantify the number of viable fetuses.ResultsThere was a significant difference in total fetuses in favor of group A, with an average of 3.7 (range, 0–9) total fetuses per tube against 2.1 (0–7) in group B (p = .04). The number of viable fetuses shows a trend in favor of group A, with an average of 3.4 (0–7) viable fetuses per tube against 1.9 (0–6) viable fetuses per tube in group B (p = .05).ConclusionThe use of immediate postoperative anti-adhesion gel improved fertility in an animal model after intrauterine surgery likely to cause uterine synechiae. This experimental model will permit comparison of different anti-adhesion solutions, including assessment of their tolerance and potential mucosal toxicity on embryonic development.

Assessment of early damage of endometrium after artificial abortion by shear wave elastography

“…Some investigators found the mechanical damage to the endometrium could reduce the endometrial glandular epithelium and increase the collagen fibers in animal model of artificial abortion [19], leading to the increased proportion of collagen fibers in the endometrium. There is evidence showing that the increased collagen fibers in the organ may significantly compromise the elasticity of this organ and increases its stiffness [20,21].…”

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

“…A further study using animal models supported these findings. Huberlant et al (21) performed bilateral uterine curettage in 20 New Zealand white rabbits where one uterine tube in each rabbit was its own control. The rabbits were randomized into two groups where the second uterine tube was treated with either hyaluronic acid or isotonic saline.…”

Meta-analysis of the use of hyaluronic acid gel to prevent intrauterine adhesions after miscarriage

“…In an animal model of intrauterine adhesions, Huberlant et al [19] showed that the use of hyaluronic acid gel immediately after dilatation and curettage significantly improved fertility, and significantly reduced the incidence of intrauterine adhesions. Acunzo et al [20] randomly divided 132 patients into two groups.…”