New Crosslinked Hyaluronan Gel, Intrauterine Device, or Both for the Prevention of Intrauterine Adhesions

Abstract

Background and Objectives: To compare the efficacy of 3 different techniques for prevention of adhesion reformation after hysteroscopic adhesiolysis in patients with moderate-to-severe intrauterine adhesions. Short-term assisted reproductive outcomes were also compared. Study Design: Total of 72 cases were randomized to Lippes loop intrauterine device (IUD) only, IUD plus a new crosslinked hyaluronan (NCH) gel, or NCH gel only following hysteroscopic adhesiolysis. All cases received hormonal therapy and a second hysteroscopy was carried out. Endometrial thickness values were measured using transvaginal ultrasonography and American Fertility Society adhesion scores were noted during first and second hysteroscopy in all groups. Reproductive outcomes were also compared for those who received in vitro fertilization treatment. Results: Transvaginal ultrasonography revealed significantly better endometrial thickness in the IUD+NCH (7.5 mm) and NCH-only groups (6.5 mm) than the IUD-only group (5 mm) ( P < .001). All groups revealed enhanced but comparable American Fertility Society adhesion scores on second-look hysteroscopy. A total of 37 patients received in vitro fertilization treatment after surgical management of adhesions. Ongoing pregnancy rates after in vitro fertilization were 27%, 40%, and 36% in IUD, IUD+NCH, and NCH groups, respectively. However, the difference between the groups did not reach statistically significant difference. Conclusion: All interventions are of similar efficacy in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate to severe intrauterine adhesions. However, better endometrial thickness values were observed in those who received NCH gel either alone or in combination with IUD. Assisted reproductive outcomes of both groups were comparable for ongoing pregnancy rates.

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

“…A study reported that these three methods are of similar efficacy in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate-to-severe IUAs. [ 25 ] Another study reported that for moderate-to-severe IUAs, HA gel combined with IUD may be an alternative approach for reducing adhesion recurrence after hysteroscopic adhesiolysis. [ 21 ] However, another study showed that the insertion of IUD is more effective than the use of HA in the prevention of IUA.…”

Effectiveness of Hyaluronic Acid Gel and Intrauterine Devices in Prevention of Intrauterine Adhesions after Hysteroscopic Adhesiolysis in Infertile Women

“…We feel that the recurrent rate, defined by de novo adhesion formation, is the most optimal outcome for evaluating the prevention of re-adhesions. Another study conducted by Pabuçcu et al suggested that the combination of HA gel and IUD provides a non-significant improvement in post-treatment AFS score but a significant enhancement in EMT after treatment 26 . In this trial, the authors excluded patients with mild adhesions before treatment.…”

“…Despite much research investigating HA gel and IUD following hysteroscopic adhesiolysis, there have only been a few studies that have compared the effectiveness of the combination of them with HA gel alone and IUD alone 26,27 . Our study's results are in contrast with a previous randomized controlled trial of 89 patients 27 .…”

Application of Bioactive Hydrogels for Functional Treatment of Intrauterine Adhesion

“…Lin et al ( Lin et al, 2013 ) found that the insertion of an intrauterine balloon or IUD was more effective than the use of HA gel alone in the prevention of IUA reformation. Furthermore, Pabuçcu et al ( Pabuçcu et al, 2019 ) found that endometrial thickness was significantly enhanced when applying a new crosslinked hyaluronan gel with an IUD after hysteroscopic adhesiolysis. Although many studies have shown that an IUD combined with hydrogels can reduce IUA recurrence, in some cases the clinical pregnancy rate of these patients is not improved.…”