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

Abstract

Intrauterine adhesion (IUA), and its severe form Asherman syndrome (Asherman’s syndrome), is a mysterious disease, often accompanied with severe clinical problems contributing to a significant impairment of reproductive function, such as menstrual disturbance (amenorrhea), infertility or recurrent pregnancy loss. Among these, its correlated infertility may be one of the most challenging problems. Although there are many etiologies for the development of IUA, uterine instrumentation is the main cause of IUA. Additionally, more complicated intrauterine surgeries can be performed by advanced technology, further increasing the risk of IUA. Strategies attempting to minimize the risk and reducing its severity are urgently needed. The current review will expand the level of our knowledge required to face the troublesome disease of IUA. It is separated into six sections, addressing the introduction of the normal cyclic endometrial repairing process and its abruption causing the formation of IUA; the etiology and prevalence of IUA; the diagnosis of IUA; the classification of IUA; the pathophysiology of IUA; and the primary prevention of IUA, including (1) delicate surgical techniques, such as the use of surgical instruments, energy systems, and pre-hysteroscopic management, (2) barrier methods, such as gels, intrauterine devices, intrauterine balloons, as well as membrane structures containing hyaluronate–carboxymethylcellulose or polyethylene oxide–sodium carboxymethylcellulose as anti-adhesive barrier.

Genetically engineered FGF1-sericin hydrogel material treats intrauterine adhesion and restores fertility in rat

“…The functional layer falls off every menstrual cycle, and the basal stromal cells differentiate and regenerate to form the epithelium on the surface of the endometrium [ 2 ]. Uterine adhesions are caused by uterine surgery to damage the basal layer of the endometrium, which leads to the repair of the basal layer of the endometrium, endometrial fibrosis occurs and the functional layer and the basal layer cannot be distinguished [ 3 ]. As a result, the receptivity of the endometrium is decreased, and the uterine cavity and/or cervical canal are partially or completely occluded [ 4 ], leading to amenorrhea, secondary infertility and other diseases [ 5–7 ].…”

Is ultrasound valuable for the diagnosis of women with abnormal detrusor activity?

“…[6][7][8] The power of ultrasound is confirmed for the reproductive medicine, including aiding diagnosis of congenital genital organs abnormalities, iatrogenic lesions and dysfunction, and procedures or monitoring of patients during the assisted reproductive technology (ART) course. 9,10 After getting pregnancy, subsequent obstetric ultrasound, such as evaluation of fetus growth, fetal position, and placenta location provides an immediate and effective tool, which helps to identify any abnormal findings associated with untoward pregnancy outcome, such as an early identification of intrauterine growth restriction, abnormal placentation (placenta accrete spectrum [PAS]), and congenital fetal abnormalities. 8,11 Furthermore, additional fetal well beings can be detected by fetal biophysical profile as well as risk of preterm labor mediated by ultrasound.…”

Special Issue “Reproductive Health Concerns for Women”

“…Besides female hormone-related skin disorders as shown above [1,2], leiomyoma of the uterus may be one of the most common benign disorders in women at reproductive age [4]. Among the various kinds of classification of leiomyomas, submucosal myoma is often associated with symptoms and health problems, which not only results in heavy menstruation and subsequent anemia, but may also impair the fecundity of women, increasing the risk of infertility and pregnancy loss [5]. With advanced technology and the improvement of patient care, minimally invasive procedures have become much more attractive and popular in modern clinical practice [5].…”

“…Among the various kinds of classification of leiomyomas, submucosal myoma is often associated with symptoms and health problems, which not only results in heavy menstruation and subsequent anemia, but may also impair the fecundity of women, increasing the risk of infertility and pregnancy loss [5]. With advanced technology and the improvement of patient care, minimally invasive procedures have become much more attractive and popular in modern clinical practice [5]. The hysteroscopic approach to perform myomectomy is a fast, relatively non-invasive, but effective surgical method for the management of submucosal myoma, although some uncertainties are still debated [5,6].…”

“…With advanced technology and the improvement of patient care, minimally invasive procedures have become much more attractive and popular in modern clinical practice [5]. The hysteroscopic approach to perform myomectomy is a fast, relatively non-invasive, but effective surgical method for the management of submucosal myoma, although some uncertainties are still debated [5,6]. For example, intrauterine adhesion (IUA) after hysteroscopic myomectomy is the biggest challenge and raises great concern owing to the significant impairment of reproductive functions and abnormal uterine bleeding [6].…”