Comparison of autocross-linked hyaluronic acid gel and intrauterine device for preventing intrauterine adhesions in infertile patients: A randomized clinical trial

Abstract

Objectives: The objective of this study is to evaluate the efficacy of autocross-linked hyaluronic acid (HA) compared with intrauterine device (IUD) for preventing intrauterine adhesions (IUAs) in infertile patients after hysteroscopic adhesiolysis. Materials and Methods: A randomized clinical trial (ChiCTR-IOR-16007746). Upon completion of adhesiolysis, 3 ml of HA gel was placed into the uterine cavity in Group A; 3 ml of HA gel and an IUD were placed in Group B; and only an IUD was placed in Group C. A second hysteroscopic examination was performed in all patients at approximately 1 month postoperatively for the evaluation of IUA. The primary outcome measure was the effective rate of IUA prevention based on the American Fertility Society (AFS) scoring system. Results: Eighty-nine women were randomly distributed into two groups for intention to treat with 30 patients in Group A, 24 patients in Group B, and 35 patients in Group C. Patients were scored and stratified into three degrees and were enrolled using the simple random sampling method. The three groups were well balanced. There were no significant differences in age, endometrial thickness, the previous number of pregnancy, and the distribution of adhesion categories across mild, moderate, and severe between the three groups. The effective rate of IUA prevention, the AFS score after therapy, and the percentage improvements of Chinese score and AFS score before and after surgery were statistically significant difference between Groups A and C. The clinical pregnancy rate in Group A was higher than those in Groups B and C, but the difference was not statistically significant. Conclusion: HA gel has an advantage over an IUD in reducing IUA recurrence and decreasing adhesions.

Chitosan combined with intrauterine device prevents intrauterine adhesions after hysteroscopic adhesiolysis: A target trial emulation study

“…25,26 However, combining an IUD with subsequent hormone therapy has shown unsatisfactory efficacy in several clinical trials. 14,27,28 Our data also showed that patients in group B had poorer postoperative AFS scores and menstruation conditions. Thus, exploring more effective treatments to improve clinical outcomes after hysteroscopic adhesiolysis is still needed.…”

Focus on the Primary Prevention of Intrauterine Adhesions: Current Concept and Vision

“…The exact prevalence or real incidence of IUA is unknown, and may be underestimated, partly because of a lack of symptoms or the presence of vague symptoms, and partly because of neglect leading to the disease not being discovered even in those patients with clear symptoms [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]; as well as partly because of the uncertain predisposing and causal factors [ 30 , 35 ]. Additionally, IUA varies with geographic location, study population, and the availability of investigations for diagnosis [ 29 , 36 ].…”

“…Many strategies or principles for decreasing the risk of developing IUA, such as the reduced use of electrosurgery and the minimization of trauma to the healthy endometrium and myometrium, have been proposed [ 73 , 74 , 75 , 76 , 77 , 78 , 79 ]. Additionally, many biomaterial agents, barrier methods, and cell or bio-agent therapies have been applied [ 14 , 16 , 24 , 27 , 28 , 29 , 30 , 31 , 35 , 37 , 40 , 43 , 44 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Figure 3 shows the recent development of agents available for the primary prevention of IUA after uterine surgery.…”

“…One involves the avoidance of over- or purulent inflammatory processes or over-traumatic injury; the second is a barrier method to prevent the attachment of the bilateral traumatic surface; the third is the enhancement of regeneration ability; the last is early intervention via repeat hysteroscopy to remove the thin or immature adhesion band ( Figure 3 ). The tools include agents (drugs) or physical (mechanical) barriers to cover the uterine lining side, or separate the opposing sides of the uterine linings immediately after hysteroscopic surgery; the prescription of estrogen use postoperatively, postoperative gonadotropin-releasing hormone agonist injection, or immediate postoperative antibiotics use; and the use of biomaterials or new technologies such as cellular therapy [ 5 , 6 , 7 , 8 , 9 , 10 , 14 , 23 , 24 , 27 , 28 , 29 , 30 , 31 , 32 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 56 , 57 , 58 , 59 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 86 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , …”

“…In cases of extreme severity, the endometrial lining might be partially or totally absent, contributing to the approximation and fusion of surfaces of opposing uterine walls. As a result, IUA or Asherman syndrome (Asherman’s syndrome) develops [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”