Controversy in the management of oestrogen therapy before hysteroscopic adhesiolysis: a systematic review and meta-analysis

Chang, Yanan; Duan, Hua; Shen, Xue; Wang, Sha; Guo, Zhengchen; Chen, Shujian

doi:10.1016/j.rbmo.2020.06.012

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…Nor through the oral estrogen administration have better results been obtained [ 137 , 139 , 140 ]. A recent systematic review and meta-analysis conducted by Chang et al [ 141 ] also exposed the relatively low efficiency of estrogen therapy, the quality of evidence ranging from moderate to very low with only a short-term or negative effect.…”

Section: Introduction Our Current Knowledge About the Asherman Symentioning

confidence: 99%

Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome—Where Are We after One Hundred and Twenty-Six Years?

et al. 2020

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Asherman syndrome is a multifaceted condition describing the partial or complete removal of the uterine cavity and/or cervical canal. It is a highly debatable topic because of its pronounced influence on both reproductive outcomes and gynaecologic symptoms. The latest reports demonstrated that trauma to the endometrium is the main cause of intrauterine adhesion formation. Left untreated, such adhesions gradually lead to a range of repercussions ranging from mild to severe. Considering the lack of non-invasive approaches, the advent of hysteroscopy has revolutionized the entire field, being otherwise considered the most efficient tool offering new directions and amplifying the chances of treating the Asherman syndrome.

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Section: Introduction Our Current Knowledge About the Asherman Symentioning

confidence: 99%

Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome—Where Are We after One Hundred and Twenty-Six Years?

et al. 2020

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“…A recent systematic review and meta-analysis concluded that preoperative estrogen treatment did not change the long-term prognosis and fertility outcome of treated patients. 26 However, every group but the group with Class I adhesions received postoperative oral estrogens In our study, all patients with Class 2-5 adhesions received intrauterine hyaluronic acid gel application after adhesiolysis.…”

Section: Advantages and Limitations Of Different Classification Systemsmentioning

confidence: 71%

Fertility and anatomical outcomes following hysteroscopic adhesiolysis: An 11‐year retrospective cohort study to validate a new classification system for intrauterine adhesions (Urman‐Vitale Classification System)

Urman,

Yakin,

Ertas

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo propose a new classification system (Urman‐Vitale Classification System) for intrauterine adhesions (IUAs) and to evaluate anatomical and fertility outcomes after hysteroscopic adhesiolysis accordingly.MethodsA retrospective analysis of consecutive patients treated over 11 years by a single operator in a tertiary care hospital. Women with sonographic suspicion of IUAs were scheduled for hysterosalpingography (HSG) and hysteroscopy for confirmation and treatment. IUAs were divided into five classes according to symptoms, ultrasound, HSG findings, and postsurgical hysteroscopic appearance. Hysteroscopic adhesiolysis was performed using a bipolar cutting electrode in an office setting. Evaluated outcomes were restoration of the uterine cavity, clinical pregnancy, pregnancy loss, and live birth rates.ResultsA total of 227 patients (479 procedures) were included. Mean number of hysteroscopies increased in frequency with class of adhesions from Class 1 to Class 5 (1.0 ± 0.2 vs 2.3 ± 0.5; P = 0.001). Full restoration of the cavity was achieved in 100% of patients with Class 1 compared with 18.5% for Class 5 (43/43 vs 5/27; P = 0.001). Clinical pregnancy (Class 1 vs Class 4: P = 0.034; 1 vs 5: P = 0.006; 2 vs 5: P = 0.024) and live birth (Class 1 vs Class 4: P = 0.001; 1 vs 5: P = 0.006; 2 vs 4: P = 0.007; 2 vs 5: P = 0.0208) rates decreased with increasing severity of IUAs. Pregnancy loss rate was related to IUA severity (Class 1 vs Class 4: P = 0.012; 1 vs 5: P = 0.003: 2 vs 4: P = 0.014; 2 vs 5: P = 0.021).ConclusionA classification based on symptoms, imaging findings, and postsurgical macroscopic appearance of the uterine cavity could be useful in predicting prognosis and fertility in women with IUAs.

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“… 9 This can be attributed to a suboptimal regeneration of functional endometrum. 10 The transplantation of mesenchymal stem cells (MSCs) into the uterine cavity could efficiently induce endometrial regeneration and remove IUAs. 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

Management of intrauterine adhesions using human amniotic mesenchymal stromal cells to promote endometrial regeneration and repair through Notch signalling

Zhang

Huang

et al. 2021

J Cellular Molecular Medi

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Intrauterine adhesions (IUAs) severely hamper women's reproductive functions. Human amniotic mesenchymal stromal cell (hAMSC) transplantation is effective in treating IUAs. Here, we examined the function of Notch signalling in IUA treatment with hAMSC transplantation. Forty‐five Sprague‐Dawley female rats were randomly divided into the sham operation, IUA, IUA + E2, IUA + hAMSCs and IUA + hAMSCs + E2 groups. After IUA induction in the rats, hAMSCs promoted endometrial regeneration and repair via differentiation into endometrial epithelial cells. In all groups, the expression of key proteins in Notch signalling was detected in the uterus by immunohistochemistry. The results indicated Notch signalling activation in the hAMSCs and hAMSCs + E2 groups. We could also induce hAMSC differentiation to generate endometrial epithelial cells in vitro. Furthermore, the inhibition of Notch signalling using the AdR‐dnNotch1 vector suppressed hAMSC differentiation (assessed by epithelial and mesenchymal marker levels), whereas its activation using the AdR‐Jagged1 vector increased differentiation. The above findings indicate Notch signalling mediates the differentiation of hAMSCs into endometrial epithelial cells, thus promoting endometrial regeneration and repair; Notch signalling could have an important function in IUA treatment.

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Controversy in the management of oestrogen therapy before hysteroscopic adhesiolysis: a systematic review and meta-analysis

Cited by 11 publications

References 23 publications

Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome—Where Are We after One Hundred and Twenty-Six Years?

Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome—Where Are We after One Hundred and Twenty-Six Years?

Fertility and anatomical outcomes following hysteroscopic adhesiolysis: An 11‐year retrospective cohort study to validate a new classification system for intrauterine adhesions (Urman‐Vitale Classification System)

Management of intrauterine adhesions using human amniotic mesenchymal stromal cells to promote endometrial regeneration and repair through Notch signalling

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