1
|
Xiang L, Sun D, He J, Zhuang Y. Prolonged adhesiolysis to pregnancy interval is associated with placenta accreta spectrum in women with intrauterine adhesion. J OBSTET GYNAECOL 2024; 44:2378420. [PMID: 39007802 DOI: 10.1080/01443615.2024.2378420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 07/05/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Both the trauma of endometrium and hysteroscopic adhesiolysis can lead to a high rate of placenta accreta spectrum (PAS) in women with intrauterine adhesion (IUA). This study analysed the impact of time interval from adhesiolysis to pregnancy on PAS in IUA women. METHODS Patients diagnosed with IUA who underwent adhesiolysis in Anhui Women and Children's Medical Centre between January 2016 and December 2020 were included in this case-series study. Clinical data were obtained from electronic medical records and telephone interviews. RESULTS Among a total of 102 IUA women with successful pregnancies, 8 (7.8%) suffered from miscarriages with PAS, and 94 (92.2%), 47 with PAS and 47 without PAS, had successful delivery. The total prevalence of PAS in pregnant women with IUA was 53.9% (55/102). The average time from adhesiolysis to pregnancy in the PAS group was significantly longer than in the non-PAS group (14.2 ± 5.7 vs. 10.3 ± 4.4 months, p = 0.000). Regression analysis showed that AFS grade (OR = 7.40, 95% CI 1.38-39.73, p = 0.020) and adhesiolysis to pregnancy interval time between 12 and 24 months (OR = 12.09, 95% CI 3.76-38.83, p = 0.000) were closely related to PAS. A Kaplan-Meier analysis showed the median interval time to PAS was 16.00 months (95% CI 15.11-16.89). CONCLUSIONS We assume that prolonged adhesiolysis to pregnancy interval may be considered a significant risk factor for PAS in IUA women.
Collapse
Affiliation(s)
- Lan Xiang
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, China
| | - Duoxiang Sun
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, China
| | - Juan He
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, China
| | - Yali Zhuang
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, China
| |
Collapse
|
2
|
Luo Y, Liu Y, Xie W, Guo Y, Xiao Y. Extended balloon stent placement for reducing intrauterine adhesion recurrence: a retrospective cohort study. Reprod Biomed Online 2024; 49:103947. [PMID: 38810315 DOI: 10.1016/j.rbmo.2024.103947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 05/31/2024]
Abstract
RESEARCH QUESTION What are the efficacy, safety and reproductive outcomes of intrauterine balloon stent placement for 4 or 6 weeks after hysteroscopic adhesiolysis? DESIGN This retrospective cohort study was conducted at a university-affiliated hospital, and included 155 women with moderate to severe intrauterine adhesions who underwent hysteroscopic adhesiolysis between March 2016 and December 2019. Participants were divided according to whether the heart-shaped balloon stent was left in place for 4 (group 1) or 6 (group 2) weeks after surgery. Stents removed at the second-look hysteroscopy 4 or 6 weeks after surgery were sent for culturing of common bacteria. The incidence of adhesion reformation, adhesion score reduction, bacterial colonization of the intrauterine balloon stent, live birth rate and time to live birth were analysed. RESULTS Group 2 had a significantly lower adhesion reformation rate (45.7% versus 28.2%, P = 0.024) and a more significant reduction in adhesion score (5.2 ± 2.1 versus 6.3 ± 2.2, P = 0.003) compared with group 1. However, no statistical difference was observed in the percentage of bacterial colonization of the intrauterine balloon stent (55.9% versus 66.7%, P = 0.174), live birth rate (52.4% versus 42.3%, P = 0.331) or time to live birth (hazard ratio 1.09, 95% confidence interval 0.60-1.96, P = 0.778) between the two groups. CONCLUSIONS Extending intrauterine balloon stent use from 4 to 6 weeks further reduces the adhesion reformation rate after hysteroscopic adhesiolysis in patients with moderate to severe intrauterine adhesion. No increase in bacterial colonization of the balloon stent was observed. Extending the duration of intrauterine balloon stent placement did not significantly affect live birth rates.
Collapse
Affiliation(s)
- Yiyang Luo
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Yuhuan Liu
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China.
| | - Wei Xie
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Yan Guo
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Yu Xiao
- Hysteroscopic Center, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Deans R, Moses D, Sach TA, Vancaillie T, Ledger B, Abbott JA. Perfusion magnetic resonance imaging in Asherman syndrome. Aust N Z J Obstet Gynaecol 2024; 64:341-346. [PMID: 38361497 DOI: 10.1111/ajo.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS). AIMS To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS. MATERIALS AND METHODS A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE-MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre- and post-operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA. RESULTS There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher-grade and inoperable IUA. CONCLUSIONS Reduced perfusion on DCE-MRI as assessed by ROC predicted higher-stage AS. The results of this study support further investigation of DCE-MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.
Collapse
Affiliation(s)
- Rebecca Deans
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Daniel Moses
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- Spectrum Medical Imaging, Sydney, New South Wales, Australia
- School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Thierry Vancaillie
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Bill Ledger
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason A Abbott
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Royal Hospital for Women, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Rodríguez-Eguren A, Bueno-Fernandez C, Gómez-Álvarez M, Francés-Herrero E, Pellicer A, Bellver J, Seli E, Cervelló I. Evolution of biotechnological advances and regenerative therapies for endometrial disorders: a systematic review. Hum Reprod Update 2024:dmae013. [PMID: 38796750 DOI: 10.1093/humupd/dmae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/12/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND The establishment and maintenance of pregnancy depend on endometrial competence. Asherman syndrome (AS) and intrauterine adhesions (IUA), or endometrial atrophy (EA) and thin endometrium (TE), can either originate autonomously or arise as a result from conditions (i.e. endometritis or congenital hypoplasia), or medical interventions (e.g. surgeries, hormonal therapies, uterine curettage or radiotherapy). Affected patients may present an altered or inadequate endometrial lining that hinders embryo implantation and increases the risk of poor pregnancy outcomes and miscarriage. In humans, AS/IUA and EA/TE are mainly treated with surgeries or pharmacotherapy, however the reported efficacy of these therapeutic approaches remains unclear. Thus, novel regenerative techniques utilizing stem cells, growth factors, or tissue engineering have emerged to improve reproductive outcomes. OBJECTIVE AND RATIONALE This review comprehensively summarizes the methodologies and outcomes of emerging biotechnologies (cellular, acellular, and bioengineering approaches) to treat human endometrial pathologies. Regenerative therapies derived from human tissues or blood which were studied in preclinical models (in vitro and in vivo) and clinical trials are discussed. SEARCH METHODS A systematic search of full-text articles available in PubMed and Embase was conducted to identify original peer-reviewed studies published in English between January 2000 and September 2023. The search terms included: human, uterus, endometrium, Asherman syndrome, intrauterine adhesions, endometrial atrophy, thin endometrium, endometritis, congenital hypoplasia, curettage, radiotherapy, regenerative therapy, bioengineering, stem cells, vesicles, platelet-rich plasma, biomaterials, microfluidic, bioprinting, organoids, hydrogel, scaffold, sheet, miRNA, sildenafil, nitroglycerine, aspirin, growth hormone, progesterone, and estrogen. Preclinical and clinical studies on cellular, acellular, and bioengineering strategies to repair or regenerate the human endometrium were included. Additional studies were identified through manual searches. OUTCOMES From a total of 4366 records identified, 164 studies (3.8%) were included for systematic review. Due to heterogeneity in the study design and measured outcome parameters in both preclinical and clinical studies, the findings were evaluated qualitatively and quantitatively without meta-analysis. Groups using stem cell-based treatments for endometrial pathologies commonly employed mesenchymal stem cells (MSCs) derived from the human bone marrow or umbilical cord. Alternatively, acellular therapies based on platelet-rich plasma (PRP) or extracellular vesicles are gaining popularity. These are accompanied by the emergence of bioengineering strategies based on extracellular matrix (ECM)-derived hydrogels or synthetic biosimilars that sustain local delivery of cells and growth factors, reporting promising results. Combined therapies that target multiple aspects of tissue repair and regeneration remain in preclinical testing but have shown translational value. This review highlights the myriad of therapeutic material sources, administration methods, and carriers that have been tested. WIDER IMPLICATIONS Therapies that promote endometrial proliferation, vascular development, and tissue repair may help restore endometrial function and, ultimately, fertility. Based on the existing evidence, cost, accessibility, and availability of the therapies, we propose the development of triple-hit regenerative strategies, potentially combining high-yield MSCs (e.g. from bone marrow or umbilical cord) with acellular treatments (PRP), possibly integrated in ECM hydrogels. Advances in biotechnologies together with insights from preclinical models will pave the way for developing personalized treatment regimens for patients with infertility-causing endometrial disorders such as AS/IUA, EA/TE, and endometritis. REGISTRATION NUMBER https://osf.io/th8yf/.
Collapse
Affiliation(s)
- Adolfo Rodríguez-Eguren
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Clara Bueno-Fernandez
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Department of Paediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - María Gómez-Álvarez
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Emilio Francés-Herrero
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Department of Paediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Antonio Pellicer
- Department of Paediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, Spain
- IVIRMA Global Research Alliance, IVI Rome, Rome, Italy
| | - José Bellver
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Department of Paediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, Spain
- IVIRMA Global Research Alliance, IVI Valencia, Valencia, Spain
| | - Emre Seli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
- IVIRMA Global Research Alliance, IVIRMA New Jersey, Basking Ridge, NJ, USA
| | - Irene Cervelló
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| |
Collapse
|
5
|
Lisa Z, Richtarova A, Hlinecka K, Boudova B, Kuzel D, Fanta M, Mara M. 4DryField vs. hyalobarrier gel for preventing the recurrence of intrauterine adhesions - a pilot study. MINIM INVASIV THER 2024:1-7. [PMID: 38771725 DOI: 10.1080/13645706.2024.2351829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/08/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION This was a single-center pilot study that sought to describe an innovative use of 4DryField® PH (premix) for preventing the recurrence of intrauterine adhesions (IUAs) after hysteroscopic adhesiolysis in patients with Asherman's syndrome (AS). MATERIAL AND METHODS Twenty-three patients with AS were enrolled and 20 were randomized (1:1 ratio) to intrauterine application of 4DryField® PH (n = 10) or Hyalobarrier® gel (n = 10) in a single-blind manner. We evaluated IUAs (American Fertility Society [AFS] score) during initial hysteroscopy and second-look hysteroscopy one month later. Patients completed a follow-up symptoms questionnaire three and reproductive outcomes questionnaire six months later. RESULTS The demographic and clinical characteristics, as well as severity of IUAs, were comparable in both groups. The mean initial AFS score was 9 and 8.5 in the 4DryField® PH and Hyalobarrier® gel groups, respectively (p = .476). There were no between-group differences in AFS progress (5.9 vs. 5.6, p = .675), need for secondary adhesiolysis (7 vs. 7 patients, p = 1), and the follow-up outcomes. CONCLUSION 4DryField® PH could be a promising antiadhesive agent for preventing the recurrence of IUAs, showing similar effectiveness and safety to Hyalobarrier® gel. Our findings warrant prospective validation in a larger clinical trial. CLINICAL TRIAL REGISTRY NUMBER ISRCTN15630617.
Collapse
Affiliation(s)
- Zdenka Lisa
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, The Czech Republic
| | - Adela Richtarova
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, The Czech Republic
| | - Kristyna Hlinecka
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, The Czech Republic
| | - Barbora Boudova
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, The Czech Republic
| | - David Kuzel
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, The Czech Republic
| | - Michael Fanta
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, The Czech Republic
| | - Michal Mara
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, The Czech Republic
| |
Collapse
|
6
|
Mortimer RM, Lanes A, Srouji SS, Waldman I, Ginsburg E. Treatment of intrauterine adhesions and subsequent pregnancy outcomes in an in vitro fertilization population. Am J Obstet Gynecol 2024:S0002-9378(24)00608-2. [PMID: 38777163 DOI: 10.1016/j.ajog.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Asherman syndrome refers to the presence of intrauterine adhesions, which have clinical implications, including infertility. There are few studies assessing the effect of serial hysteroscopies for adhesiolysis on reproductive and pregnancy outcomes among women who subsequently undergo in vitro fertilization, and none have looked at maternal, neonatal, or placental pregnancy complications. OBJECTIVE This study aimed to explore the effect of hysteroscopic adhesiolysis among a cohort of patients who subsequently undergo in vitro fertilization. STUDY DESIGN This was a retrospective cohort study of all patients who underwent hysteroscopic adhesiolysis for intrauterine adhesions at our center between 2005-2020 and subsequently attempted conception by in vitro fertilization. A control group of patients who underwent in vitro fertilization for nonuterine factor infertility and had no history of intrauterine adhesions was chosen for comparison. RESULTS There were 691 patients included in this study, of whom 168 were intrauterine adhesion cases. The implantation rate (41.3% in both groups) and live birth rate (adjusted relative risk, 0.93 [95% confidence interval, 0.76-1.14]) were not statistically different between cases and controls. When grouped by number of previous adhesiolysis surgeries, patients who underwent ≥2 adhesiolysis surgeries had a lower live birth rate than controls (adjusted relative risk, 0.53 [95% confidence interval, 0.28-0.99]). Endometrial thickness before the transfer was significantly reduced in cases vs controls (8.23 vs 10.25 mm; adjusted relative risk, 0.84 [95% confidence interval, 0.78-0.90]). Adverse placental outcomes, including placenta accreta spectrum, placenta previa, or vasa previa, were significantly more likely to occur in cases than controls (adjusted relative risk, 2.08 [95% confidence interval, 1.25-3.46]). When grouped by the number of adhesiolysis surgeries, the risk appeared to increase as the number of prior surgeries increased. This is likely because of the increased severity of these adhesions. CONCLUSION Overall, patients with a history of treated intrauterine adhesions have the same live birth rate as patients undergoing in vitro fertilization for nonuterine factor indications. However, the subgroup of patients who require multiple surgeries for correction of intrauterine adhesions had a lower live birth rate after in vitro fertilization than controls. Patients with a history of treated intrauterine adhesions are at significantly greater risk of placenta accreta syndrome disorder than control patients who underwent in vitro fertilization for nonuterine factor indications.
Collapse
Affiliation(s)
- Roisin M Mortimer
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA.
| | - Andrea Lanes
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | - Serene S Srouji
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | | | - Elizabeth Ginsburg
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| |
Collapse
|
7
|
Zhang W, He Y, Chu Y, Zhai Y, Qian S, Wang X, Jiang P, Cui P, Zhang Y, Wang J. Amorphous curcumin-based hydrogels to reduce the incidence of post-surgical intrauterine adhesions. Regen Biomater 2024; 11:rbae043. [PMID: 38779348 PMCID: PMC11110854 DOI: 10.1093/rb/rbae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/25/2024] Open
Abstract
The incidence of intrauterine adhesions (IUA) has increased with the rising utilization of intrauterine surgery. The postoperative physical barrier methods commonly used, such as balloons and other fillers, have limited effectiveness and may even cause further damage to the remaining endometrial tissue. Herein, we developed an injectable thermosensitive hydrogel using Pluronic F127/F68 as pharmaceutical excipients and curcumin as a natural active molecule. The hydrogel effectively addresses solubility and low bioavailability issues associated with curcumin. In vitro, drug release assays revealed that the amorphous curcumin hydrogel promotes dissolution and sustained release of curcumin. In vitro experiments reveal high biocompatibility of the hydrogel and its ability to enhance vascular formation while inhibiting the expression of fibrotic factor TGF-β1. To assess the effectiveness of preventing IUAs, in vivo experiments were conducted using IUA rats and compared with a class III medical device, a new-crosslinked hyaluronic acid (NCHA) gel. According to the study, curcumin hydrogel is more effective than the NCHA group in improving the regeneration of the endometrium, increasing the blood supply to the endometrium and reducing the abnormal deposition of fibrin, thus preventing IUA more effectively. This study provides a promising strategy for treating and preventing IUA.
Collapse
Affiliation(s)
- Wenya Zhang
- School of Pharmacy, Changzhou University, Changzhou 213164, P. R. China
| | - Yuxin He
- School of Pharmacy, Changzhou University, Changzhou 213164, P. R. China
| | - Yun Chu
- Jiangsu Trautec Medical Technology Co., Ltd, Changzhou 213200, P. R. China
| | - Yuanxin Zhai
- Jiangsu Trautec Medical Technology Co., Ltd, Changzhou 213200, P. R. China
| | - Song Qian
- Jiangsu Trautec Medical Technology Co., Ltd, Changzhou 213200, P. R. China
| | - Xinhui Wang
- School of Pharmacy, Changzhou University, Changzhou 213164, P. R. China
- Jiangsu Trautec Medical Technology Co., Ltd, Changzhou 213200, P. R. China
| | - Pengju Jiang
- School of Pharmacy, Changzhou University, Changzhou 213164, P. R. China
| | - Pengfei Cui
- School of Pharmacy, Changzhou University, Changzhou 213164, P. R. China
| | - Yin Zhang
- Department of Gynecology, Changzhou Traditional Chinese Medicine Hospital, Changzhou 213004, P. R. China
| | - Jianhao Wang
- School of Pharmacy, Changzhou University, Changzhou 213164, P. R. China
| |
Collapse
|
8
|
Xu P, Xu H, Lu Q, Ling S, Hu E, Song Y, Liu J, Yi B. Reproductive outcomes following copper‑containing intrauterine device after hysteroscopic lysis for intrauterine adhesions. Exp Ther Med 2024; 27:175. [PMID: 38476904 PMCID: PMC10928823 DOI: 10.3892/etm.2024.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
The present study aimed to investigate the reproductive outcomes of copper-containing intrauterine devices (IUDs) after hysteroscopic lysis in patients with mild to severe intrauterine adhesions (IUAs), according to the American Fertility Society (AFS) classification. Therefore, a prospective randomized controlled study was conducted at the Affiliated Jinhua Hospital of Wenzhou Medical University (Jinhua, China). A total of 173 women with IUAs were initially recruited between January 2020 and June 2021 and were then randomized to the copper-containing IUD group or the no barrier device group. Following hysteroscopic procedure, the fertility and obstetric outcomes were analyzed. Among the 173 patients enrolled, a total of 109 participants completed the study protocol. The results showed that AFS scores were not significantly different between the two groups prior to hysteroscopy. In addition, no statistically significant differences were recorded in pregnancy and live birth rates between the copper-containing IUD and no barrier device groups. Overall, the results of the current study indicated that the copper-containing IUDs had no positive effect on pregnancy and live birth rates in patients with mild to severe IUAs after hysteroscopic adhesiolysis. The present trial was retrospectively registered in the Chinese Clinical Trial Registry on 28th December 2023 (registration no. ChiCTR2300079233).
Collapse
Affiliation(s)
- Pan Xu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Heng Xu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Qiaoqiao Lu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Shanshan Ling
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - E Hu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Ying Song
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Jie Liu
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Bixia Yi
- Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| |
Collapse
|
9
|
Hong W, Wu Z, Li L, Wang B, Li X. Intrauterine adhesions treated with hysteroscopic adhesiolysis and subsequent obstetric outcome: A retrospective matched cohort study. BJOG 2024. [PMID: 38418403 DOI: 10.1111/1471-0528.17793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To examine whether a history of hysteroscopic adhesiolysis (HA)-treated intrauterine adhesions (IUAs) was associated with an increased risk of adverse obstetrical outcomes in subsequent pregnancies. DESIGN Retrospective cohort study. SETTING A tertiary-care hospital in Shanghai, China. POPULATION A cohort of 114 142 pregnant women who were issued an antenatal card and received routine antenatal care in Shanghai First Maternity and Infant Hospital, between January 2016 and October 2021. METHODS From the cohort of 114 142 pregnant women, each woman with a history of HA-treated IUA prior to the current pregnancy (n = 780) was matched with four women without a history of IUAs (n = 3010) using propensity score matching. The matching variables were maternal age and parity, mode of conception, pre-pregnancy body mass index and prior history of abortion. MAIN OUTCOME MEASURES Pregnancy complications, placental abnormalities, postpartum haemorrhage and adverse birth outcomes. RESULTS Compared with women with no history of IUAs, women with a history of HA-treated IUAs were at higher risk of pre-eclampsia (RR 1.69, 95% CI 1.23-2.33), placenta accreta spectrum (RR 4.72, 95% CI 3.9-5.73), placenta praevia (RR 4.23, 95% CI 2.85-6.30), postpartum haemorrhage (RR 2.86, 95% CI 1.94-4.23), preterm premature rupture of membranes (RR 3.02, 95% CI 1.97-4.64) and iatrogenic preterm birth (RR 2.86, 95% CI 2.14-3.81). Those women were also more likely to receive cervical cerclage (RR 5.63, 95% CI 3.95-8.02) during pregnancy and haemostatic therapies after delivery (RR 2.17, 95% CI 1.75-2.69). Moreover, we observed that the RRs of those adverse obstetrical outcomes increased with the increasing number of hysteroscopic surgeries. CONCLUSIONS This study found that a history of HA-treated IUAs, especially a history of repeated HAs, was associated with an increased risk of adverse obstetrical outcomes.
Collapse
Affiliation(s)
- Wei Hong
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhiping Wu
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Li
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Beiying Wang
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaocui Li
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
10
|
Siferih M, Gebre T, Hunduma F, Abebe A, Gebremichael A, Sewunet H, Shibabaw T. Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting. BMC Womens Health 2024; 24:99. [PMID: 38326846 PMCID: PMC10848492 DOI: 10.1186/s12905-024-02944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Asherman syndrome is one of the endometrial factors that influence a woman's reproductive capacity. However, in our context, it needs to be well-documented. This study aimed to evaluate the clinical characteristics and hysteroscopic treatment outcomes of Asherman syndrome. METHOD A retrospective follow-up study from January 1, 2019, to December 31, 2022, was conducted on cases of Asherman syndrome after hysteroscopic adhesiolysis at St.Paul's Hospital in Addis Ababa, Ethiopia. Clinical data were collected via telephone survey and checklist. Epidata-4.2 and SPSS-26 were employed for data entry and analysis, respectively. RESULT A total of 177 study participants were included in the final analysis. The mean patient age was 31 years (range: 21-39) at the initial presentation, and 32.3 years (range: 22-40) during the phone interview. The majority of the patients (97.7%) had infertility, followed by menstrual abnormalities (73.5%). Among them, nearly half (47.5%) had severe, 38.4% had moderate, and 14.1% had mild Asherman syndrome. The review identified no factor for 51.4% of the participants. Endometrial tuberculosis affected 42 patients (23.7%). It was also the most frequent factor in both moderate and severe cases of Asherman syndrome. Only 14.7% of patients reported menstrual correction. Overall, 11% of women conceived. Nine patients miscarried, three delivered viable babies, and six were still pregnant. The overall rate of adhesion reformation was 36.2%. Four individuals had complications (3 uterine perforations and one fluid overload) making a complication rate of 2.3%. CONCLUSION Our study revealed that severe forms of Asherman syndrome, which are marked by amenorrhea and infertility, were more common, leading to incredibly low rates of conception and the resumption of regular menstruation, as well as high recurrence rates. A high index of suspicion for Asherman syndrome, quick and sensitive diagnostic testing, and the development of a special algorithm to identify endometrial tuberculosis are therefore essential. Future multi-centered studies should focus on adhesion preventive techniques.
Collapse
Affiliation(s)
- Melkamu Siferih
- Department of Obstetrics and Gynecology, School of Medicine, Debremarkos University, Debremarkos, Ethiopia.
| | - Thomas Gebre
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fufa Hunduma
- Field Epidemiology, Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Abebe
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Akebom Gebremichael
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Habtamu Sewunet
- Department of Midwifery, Debremarkos Comprehensive Specialized Hospital, Debremarkos, Ethiopia
| | - Tewodros Shibabaw
- School of Medicine, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
| |
Collapse
|
11
|
Zhu H, Li T, Xu P, Ding L, Zhu X, Wang B, Tang X, Li J, Zhu P, Wang H, Dai C, Sun H, Dai J, Hu Y. Effect of autologous bone marrow stem cells-scaffold transplantation on the ongoing pregnancy rate in intrauterine adhesion women: a randomized, controlled trial. SCIENCE CHINA. LIFE SCIENCES 2024; 67:113-121. [PMID: 37751064 DOI: 10.1007/s11427-023-2403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/20/2023] [Indexed: 09/27/2023]
Abstract
Intrauterine adhesion is a major cause of female reproductive disorders. Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe intrauterine adhesion obtain live birth, no large sample randomized controlled studies on this therapeutic strategy in such patients have been reported so far. To verify if the therapy of autologous bone marrow stem cells-scaffold is superior to traditional treatment in moderate to severe intrauterine adhesion patients in increasing their ongoing pregnancy rate, we conducted this randomized controlled clinical trial. Totally 195 participants with moderate to severe intrauterine adhesion were screened and 152 of them were randomly assigned in a 1:1 ratio to either group with autologous bone marrow stem cells-scaffold plus Foley balloon catheter or group with only Foley balloon catheter (control group) from February 2016 to January 2020. The per-protocol analysis included 140 participants: 72 in bone marrow stem cells-scaffold group and 68 in control group. The ongoing pregnancy occurred in 45/72 (62.5%) participants in the bone marrow stem cells-scaffold group which was significantly higher than that in the control group (28/68, 41.2%) (RR=1.52, 95%CI 1.08-2.12, P=0.012). The situation was similar in live birth rate (bone marrow stem cells-scaffold group 56.9% (41/72) vs. control group 38.2% (26/68), RR=1.49, 95%CI 1.04-2.14, P=0.027). Compared with control group, participants in bone marrow stem cells-scaffold group showed more menstrual blood volume in the 3rd and 6th cycles and maximal endometrial thickness in the 6th cycle after hysteroscopic adhesiolysis. The incidence of mild placenta accrete was increased in bone marrow stem cells-scaffold group and no severe adverse effects were observed. In conclusion, transplantation of bone marrow stem cells-scaffold into uterine cavities of the participants with moderate to severe intrauterine adhesion increased their ongoing pregnancy and live birth rates, and this therapy was relatively safe.
Collapse
Affiliation(s)
- Hui Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Taishun Li
- Department of Biostatistics, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Peizhen Xu
- Department of Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Lijun Ding
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Xianghong Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Bin Wang
- Clinical Center for Stem Cell Research, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Xiaoqiu Tang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Juan Li
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Pengfeng Zhu
- Department of Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Chenyan Dai
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Haixiang Sun
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
| | - Jianwu Dai
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
| |
Collapse
|
12
|
Schmerold L, Martin C, Mehta A, Sobti D, Jaiswal AK, Kumar J, Feldberg I, Munro MG, Lee WC. A cost-effectiveness analysis of intrauterine spacers used to prevent the formation of intrauterine adhesions following endometrial cavity surgery. J Med Econ 2024; 27:170-183. [PMID: 38131367 DOI: 10.1080/13696998.2023.2298584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023]
Abstract
AIM To assess, from a United States (US) payer's perspective, the cost-effectiveness of gels designed to separate the endometrial surfaces (intrauterine spacers) placed following intrauterine surgery. MATERIALS AND METHODS A decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results. RESULTS In this model, using intrauterine spacers for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of $19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan. LIMITATIONS There are no available data on the effects of intrauterine spacers or IUAs on patients' quality of life. Resultingly, the model could not evaluate patients' utility related to treatment with or without intrauterine spacers and instead focused on costs and events avoided. CONCLUSION This analysis robustly demonstrated that intrauterine spacers would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a reduction in IUAs and improvements to patients' pregnancy-related outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | |
Collapse
|
13
|
Hu X, Wu H, Yong X, Wang Y, Yang S, Fan D, Xiao Y, Che L, Shi K, Li K, Xiong C, Zhu H, Qian Z. Cyclical endometrial repair and regeneration: Molecular mechanisms, diseases, and therapeutic interventions. MedComm (Beijing) 2023; 4:e425. [PMID: 38045828 PMCID: PMC10691302 DOI: 10.1002/mco2.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/21/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
The endometrium is a unique human tissue with an extraordinary ability to undergo a hormone-regulated cycle encompassing shedding, bleeding, scarless repair, and regeneration throughout the female reproductive cycle. The cyclical repair and regeneration of the endometrium manifest as changes in endometrial epithelialization, glandular regeneration, and vascularization. The mechanisms encompass inflammation, coagulation, and fibrinolytic system balance. However, specific conditions such as endometriosis or TCRA treatment can disrupt the process of cyclical endometrial repair and regeneration. There is uncertainty about traditional clinical treatments' efficacy and side effects, and finding new therapeutic interventions is essential. Researchers have made substantial progress in the perspective of regenerative medicine toward maintaining cyclical endometrial repair and regeneration in recent years. Such progress encompasses the integration of biomaterials, tissue-engineered scaffolds, stem cell therapies, and 3D printing. This review analyzes the mechanisms, diseases, and interventions associated with cyclical endometrial repair and regeneration. The review discusses the advantages and disadvantages of the regenerative interventions currently employed in clinical practice. Additionally, it highlights the significant advantages of regenerative medicine in this domain. Finally, we review stem cells and biologics among the available interventions in regenerative medicine, providing insights into future therapeutic strategies.
Collapse
Affiliation(s)
- Xulin Hu
- Clinical Medical College and Affiliated Hospital of Chengdu UniversityChengdu UniversityChengduSichuanChina
- Department of BiotherapyCancer Center and State Key Laboratory of BiotherapyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Haoming Wu
- Clinical Medical College and Affiliated Hospital of Chengdu UniversityChengdu UniversityChengduSichuanChina
| | - Xin Yong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Department of Paediatrics, West China Second University Hospital, State Key Laboratory of Biotherapy and Collaborative Innovation Center of BiotherapySichuan UniversityChengduSichuanChina
| | - Yao Wang
- Clinical Medical College and Affiliated Hospital of Chengdu UniversityChengdu UniversityChengduSichuanChina
| | - Shuhao Yang
- Department of OrthopedicsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Diyi Fan
- Clinical Medical College and Affiliated Hospital of Chengdu UniversityChengdu UniversityChengduSichuanChina
| | - Yibo Xiao
- Clinical Medical College and Affiliated Hospital of Chengdu UniversityChengdu UniversityChengduSichuanChina
| | - Lanyu Che
- Clinical Medical College and Affiliated Hospital of Chengdu UniversityChengdu UniversityChengduSichuanChina
| | - Kun Shi
- Department of BiotherapyCancer Center and State Key Laboratory of BiotherapyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Kainan Li
- Clinical Medical College and Affiliated Hospital of Chengdu UniversityChengdu UniversityChengduSichuanChina
| | | | - Huili Zhu
- Department of Reproductive Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of EducationWest China Second University Hospital of Sichuan UniversityChengduSichuanChina
| | - Zhiyong Qian
- Department of BiotherapyCancer Center and State Key Laboratory of BiotherapyWest China HospitalSichuan UniversityChengduSichuanChina
| |
Collapse
|
14
|
Abstract
The uterine lining (endometrium) regenerates repeatedly over the life span as part of its normal physiology. Substantial portions of the endometrium are shed during childbirth (parturition) and, in some species, menstruation, but the tissue is rapidly rebuilt without scarring, rendering it a powerful model of regeneration in mammals. Nonetheless, following some assaults, including medical procedures and infections, the endometrium fails to regenerate and instead forms scars that may interfere with normal endometrial function and contribute to infertility. Thus, the endometrium provides an exceptional platform to answer a central question of regenerative medicine: Why do some systems regenerate while others scar? Here, we review our current understanding of diverse endometrial disruption events in humans, nonhuman primates, and rodents, and the associated mechanisms of regenerative success and failure. Elucidating the determinants of these disparate repair processes promises insights into fundamental mechanisms of mammalian regeneration with substantial implications for reproductive health.
Collapse
Affiliation(s)
- Claire J Ang
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts, USA;
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Taylor D Skokan
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts, USA;
| | - Kara L McKinley
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts, USA;
- Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, Massachusetts, USA
| |
Collapse
|
15
|
Zhang W, French H, O'Brien M, Movilla P, Isaacson K, Morris S. Incidence of Intrauterine Adhesions After Hysteroscopic Myomectomy in Patients Seeking Fertility. J Minim Invasive Gynecol 2023; 30:805-812. [PMID: 37247808 DOI: 10.1016/j.jmig.2023.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023]
Abstract
STUDY OBJECTIVE To study the incidence of intrauterine adhesions (IUAs) after hysteroscopic myomectomy. Previous studies report a range of incidence for IUAs after hysteroscopic myomectomy. DESIGN A retrospective review study. SETTING An academic community hospital in the Boston metropolitan area. PATIENTS Patients undergoing hysteroscopic myomectomy at our institution from January 2019 to February 2022. Patients were excluded if they did not have plans for future fertility or had a new diagnosis of cancer. INTERVENTIONS All patients underwent hysteroscopic myomectomy using bipolar resectoscope without postoperative medical or barrier treatment. All procedures were performed by 1 of 4 fellowship-trained high-volume gynecologic surgeons with resident and fellow assistance. Incidence of postoperative IUAs was assessed and treated using second-look office hysteroscopy. MEASUREMENTS AND MAIN RESULTS A total of 44 patients without preoperative IUAs underwent hysteroscopic myomectomy during our study period, and 4 patients (9.1%) developed new IUAs. Among 9 patients who were found to have preoperative IUAs and underwent concurrent hysteroscopic myomectomy and lysis of adhesions, we found a recurrence of IUAs in 5 patients (55.6%). We found the number, size, and deepest type of myoma removed were not correlated to an increased risk of new IUA formation. In addition, removing myomas on opposing walls during the same operation did not increase the incidence of new IUAs. CONCLUSION Formation of IUAs after hysteroscopic myomectomy is a well-documented consequence. Our reported incidence of 9.1% of new IUAs that are not affected by the number, size, deepest type of myoma resected, and resection of myomas on opposing uterine walls contributes to the current literature. In addition, our finding of 55.6% of recurrent IUAs in patients undergoing both hysteroscopic myomectomy and lysis of adhesions highlights a high-risk population requiring additional study.
Collapse
Affiliation(s)
- Wenjia Zhang
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors).
| | - Hannah French
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Mollie O'Brien
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Peter Movilla
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Keith Isaacson
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| | - Stephanie Morris
- Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors)
| |
Collapse
|
16
|
Guangwei W, Ling M, Qing Y, Yue Y, Yanqiu Y, Silei C, Xiaohan C, Yaoxing R, Zhe C, Yu W. Comparison of the efficacy of autologous platelet gel and medical chitosan in the prevention of recurrence of intrauterine adhesions after transcervical resection of adhesion: a prospective, randomized, controlled trial. Arch Gynecol Obstet 2023; 308:1369-1378. [PMID: 37552284 DOI: 10.1007/s00404-023-07175-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Intrauterine adhesion (IUAs) in women is a debatable topic and there is no clear consensus in its management and treatment strategies. Previous treatment measures have limitations which necessitates to consider effective measures for prevention of recurrence of IUAs. Hence, the aim of this study to explore the efficacy and safety of intrauterine infusion of autologous platelet gel (APG) and medical chitosan in preventing recurrence of IUAs in females after transcervical resection of adhesion (TCRA). METHODS A prospective, randomized controlled trial was conducted among 80 patients presented with moderate to severe IUAs. Patients were randomized into two groups, APG group (n = 40) and medical chitosan group (n = 40). All patients were injected with either APG or medical chitosan after TCRA. RESULTS The postoperative recurrence rate of adhesions in APG group was significantly lower than those in medical chitosan group (21% vs 49%). The median AFS score during the second-look hysteroscopy was significantly lower in APG group than in medical chitosan group (P = 0.008). The median AFS score reduction after TCRA surgery was significantly higher in APG group than in medical chitosan group (median, 95% CI 7.000, 6.0 to 8.3 vs. 6.000, 5.0 to 7.0, P = 0.004). Subgroup analysis of platelet concentration (1000 as cut-off value) into high- and low-dose subgroups reported no significant correlation existed between APG and baseline characteristics, recurrence rate and postoperative AFS reduction score except for previous intrauterine operation (P < 0.05). CONCLUSION Thus, after TCRA, intrauterine injections of APG provides better efficacy and safety compared with intrauterine injections of medical chitosan in preventing recurrence of intrauterine adhesions.
Collapse
Affiliation(s)
- Wang Guangwei
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Ma Ling
- Department of Pathophysiology, China Medical University, Taichung, China
| | - Yang Qing
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - You Yue
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Yu Yanqiu
- Department of Pathophysiology, China Medical University, Taichung, China
- Shenyang Cell Therapy Engineering Technology R&D Center Co., Ltd., Jiading, China
| | - Chen Silei
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Chang Xiaohan
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Rong Yaoxing
- Shenyang Cell Therapy Engineering Technology R&D Center Co., Ltd., Jiading, China
| | - Chen Zhe
- Shenyang Cell Therapy Engineering Technology R&D Center Co., Ltd., Jiading, China
| | - Wang Yu
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China.
| |
Collapse
|
17
|
Le TTV, Lam HM, Nguyen MTN, Phan NTH, Huynh TNK, Le HNT, Pham CTH, Tang VKH, Hoang TTT, Hoang TTD, Tran HLB. Effect of Blood Gel Derivatives on Wound Healing in Mouse Injured Tissue Models. Gels 2023; 9:785. [PMID: 37888358 PMCID: PMC10606021 DOI: 10.3390/gels9100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Several previous studies in the field of assisted reproduction have focused on the use of blood gel derivatives, such as platelet-rich fibrin (PRF), as a treatment for endometrial rehabilitation. However, the ability to release growth factors and the gel form of this product led to the evolution of platelet lysates. In this study, blood gel derivatives, including PRF lysate, which was in liquid form, and PRF gel, were collected and evaluated for growth factors. It was shown to be effective in endometrial wound healing and regeneration in mouse injured uterine tissue models through structure and function (pinopode expression, embryo implantation) evaluation. The results demonstrated that the concentrations of growth factors, including PDGF-AB and VEGF-A, were higher in the PRF lysate compared to the PRF gel (p < 0.05). PRF lysate could release these growth factors for 8 days. Furthermore, both PRF gel and PRF lysate restored the morphology of injured endometrial tissues in terms of luminal and glandular epithelia, as well as uterine gland secretory activity. However, the presence of pinopodes and embryonic implantation were only observed in the PRF lysate group. It can be concluded that PRF lysate promotes wound healing in mouse injured tissue models in vitro, which can act as healing products in tissue repair.
Collapse
Affiliation(s)
- Tuyet Thi Vi Le
- Department of Physiology and Animal Biotechnology, Faculty of Biology and Biotechnology, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam; (T.T.V.L.); (M.T.N.N.); (N.T.H.P.)
- Laboratory of Tissue Engineering and Biomedical Materials, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam;
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
| | - Hoang Minh Lam
- Laboratory of Tissue Engineering and Biomedical Materials, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam;
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
| | - My Thi Ngoc Nguyen
- Department of Physiology and Animal Biotechnology, Faculty of Biology and Biotechnology, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam; (T.T.V.L.); (M.T.N.N.); (N.T.H.P.)
- Laboratory of Tissue Engineering and Biomedical Materials, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam;
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
| | - Nghia Thi Hieu Phan
- Department of Physiology and Animal Biotechnology, Faculty of Biology and Biotechnology, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam; (T.T.V.L.); (M.T.N.N.); (N.T.H.P.)
- Laboratory of Tissue Engineering and Biomedical Materials, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam;
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
| | - Trang Nguyen Khanh Huynh
- Hung Vuong Hospital, Ho Chi Minh City 700000, Vietnam; (T.N.K.H.); (H.N.T.L.); (C.T.H.P.); (V.K.H.T.); (T.T.T.H.); (T.T.D.H.)
| | - Hien Nguyen Trong Le
- Hung Vuong Hospital, Ho Chi Minh City 700000, Vietnam; (T.N.K.H.); (H.N.T.L.); (C.T.H.P.); (V.K.H.T.); (T.T.T.H.); (T.T.D.H.)
| | - Chau Thi Hai Pham
- Hung Vuong Hospital, Ho Chi Minh City 700000, Vietnam; (T.N.K.H.); (H.N.T.L.); (C.T.H.P.); (V.K.H.T.); (T.T.T.H.); (T.T.D.H.)
| | - Van Kim Hoang Tang
- Hung Vuong Hospital, Ho Chi Minh City 700000, Vietnam; (T.N.K.H.); (H.N.T.L.); (C.T.H.P.); (V.K.H.T.); (T.T.T.H.); (T.T.D.H.)
| | - Trang Thi Thuy Hoang
- Hung Vuong Hospital, Ho Chi Minh City 700000, Vietnam; (T.N.K.H.); (H.N.T.L.); (C.T.H.P.); (V.K.H.T.); (T.T.T.H.); (T.T.D.H.)
| | - Tuyet Thi Diem Hoang
- Hung Vuong Hospital, Ho Chi Minh City 700000, Vietnam; (T.N.K.H.); (H.N.T.L.); (C.T.H.P.); (V.K.H.T.); (T.T.T.H.); (T.T.D.H.)
| | - Ha Le Bao Tran
- Department of Physiology and Animal Biotechnology, Faculty of Biology and Biotechnology, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam; (T.T.V.L.); (M.T.N.N.); (N.T.H.P.)
- Laboratory of Tissue Engineering and Biomedical Materials, University of Science, VNU-HCM, Ho Chi Minh City 700000, Vietnam;
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
| |
Collapse
|
18
|
Chen Y, Wang Y, Zhao Y, Zhang C. Clinical efficacy of hysteroscopic adhesiolysis combined with periodic balloon dilation for intrauterine adhesion in IVF treatment. Front Endocrinol (Lausanne) 2023; 14:1236447. [PMID: 37822593 PMCID: PMC10562708 DOI: 10.3389/fendo.2023.1236447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
Background Intrauterine adhesions (IUA), arising from diverse etiological factors, pose a significant threat to female fertility, particularly during in vitro fertilization (IVF) treatment. Objective To assess the effectiveness of hysteroscopic adhesiolysis (HA) combined with periodic balloon dilation in treating IUA and its impact on reproductive outcomes in women undergoing IVF treatment. Methods A total of 234 patients diagnosed with IUA were included in this study. The IUA women were categorized into three subgroups based on the severity of adhesion. All IUA patients underwent HA separation followed by periodic balloon dilation along with hormone replacement therapy (HRT). Frozen embryo transfer was performed post-treatment, and a comparative analysis of the general characteristics and clinical outcomes among the subgroups was conducted. The control group consisted of patients who underwent their first embryo transfer of HRT cycle without any uterine abnormalities, as assessed by the propensity score matching (PSM). The clinical outcomes of IUA group and control group were compared. Multivariate logistic regression analyses were employed to investigate the risk factors associated with live birth. Results ① The endometrial thickness was significantly increased post-operation compared to pre-operation in all three IUA subgroups (all P <0.001), with the most pronounced change observed in the severe IUA group. After treatment, normal uterine cavity was restored in 218 women (93.16%). ② The overall clinical pregnancy rate was 49.57% (116/234) and live birth rate was 29.91% (70/234). The clinical outcomes were similar among the three subgroups after first embryo transfer (all P>0.05). Multivariate logistic regression analyses revealed that age (aOR 0.878, 95% CI 0.817~0.944, P=0.001) and endometrial thickness after treatment (aOR 1.292, 95% CI 1.046~1.597, P=0.018) were the two significant risk factors for live birth rate. ③ Following the process of matching, a total of 114 patients were successfully enrolled in the control group. The baselines and the clinical outcomes were all comparable between the IUA group and control group (all P>0.05). Conclusion The combination of HA and periodic balloon dilation is beneficial for improving endometrial receptivity and has a significant clinical impact on patients with IUA undergoing IVF.
Collapse
Affiliation(s)
- Yuanhui Chen
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yiwen Wang
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yan Zhao
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Cuilian Zhang
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
19
|
Lv H, Sun H, Wang L, Yao S, Liu D, Zhang X, Pei Z, Zhou J, Wang H, Dai J, Yan G, Ding L, Wang Z, Cao C, Zhao G, Hu Y. Targeting CD301 + macrophages inhibits endometrial fibrosis and improves pregnancy outcome. EMBO Mol Med 2023; 15:e17601. [PMID: 37519221 PMCID: PMC10493587 DOI: 10.15252/emmm.202317601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
Macrophages are a key and heterogeneous cell population involved in endometrial repair and regeneration during the menstrual cycle, but their role in the development of intrauterine adhesion (IUA) and sequential endometrial fibrosis remains unclear. Here, we reported that CD301+ macrophages were significantly increased and showed their most active interaction with profibrotic cells in the endometria of IUA patients compared with the normal endometria by single-cell RNA sequencing, bulk RNA sequencing, and experimental verification. Increasing CD301+ macrophages promoted the differentiation of endometrial stromal cells into myofibroblasts and resulted in extracellular matrix accumulation, which destroyed the physiological architecture of endometrial tissue, drove endometrial fibrosis, and ultimately led to female infertility or adverse pregnancy outcomes. Mechanistically, CD301+ macrophages secreted GAS6 to activate the AXL/NF-κB pathway, upregulating the profibrotic protein synthesis. Targeted deletion of CD301+ macrophages or inhibition of AXL by Bemcentinib blunted the pathology and improved the outcomes of pregnancy in mice, supporting the therapeutic potential of targeting CD301+ macrophages for treating endometrial fibrosis.
Collapse
Affiliation(s)
- Haining Lv
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Haixiang Sun
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Limin Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Simin Yao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Dan Liu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xiwen Zhang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Zhongrui Pei
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western MedicineNanjing University of Chinese MedicineNanjingChina
| | - Jianjun Zhou
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Jianwu Dai
- Institute of Genetics and Developmental BiologyChinese Academy of SciencesBeijingChina
| | - Guijun Yan
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Lijun Ding
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Zhiyin Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Chenrui Cao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Guangfeng Zhao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
- State Key Laboratory of Pharmaceutical BiotechnologyNanjing UniversityNanjingChina
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
- State Key Laboratory of Pharmaceutical BiotechnologyNanjing UniversityNanjingChina
| |
Collapse
|
20
|
Khan Z. Etiology, Risk Factors, and Management of Asherman Syndrome. Obstet Gynecol 2023; 142:543-554. [PMID: 37490750 DOI: 10.1097/aog.0000000000005309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
Asherman syndrome is characterized by a triad of symptoms including pain, menstrual abnormalities, and infertility and is a result of intrauterine scar tissue after instrumentation of a gravid uterus. Saline sonohysterogram is typically the most sensitive diagnostic tool; however, hysteroscopy is the criterion standard for diagnosis. Treatment includes hysteroscopic-guided lysis of adhesion, with restoration of the anatomy of the uterine cavity. Several modalities are used in an attempt to reduce the reformation of scar tissue after surgery; however, there is no consensus on the ideal method. Stem cells and platelet-rich plasma are being explored as means of regenerative therapy for the endometrium, but data remain limited. At present, most individuals can have restoration of menstrual function; however, lower pregnancy rates and obstetric complications are not uncommon. These complications are worse for patients with a higher grade of disease. Efforts are needed in standardizing classification, reducing uterine instrumentation of the gravid uterus, and referring patients to health care professionals with clinical expertise in this area.
Collapse
Affiliation(s)
- Zaraq Khan
- Division of Reproductive Endocrinology & Infertility and the Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
21
|
Feng L, Wang L, Ma Y, Duan W, Martin-Saldaña S, Zhu Y, Zhang X, Zhu B, Li C, Hu S, Bao M, Wang T, Zhu Y, Yang F, Bu Y. Engineering self-healing adhesive hydrogels with antioxidant properties for intrauterine adhesion prevention. Bioact Mater 2023; 27:82-97. [PMID: 37006827 PMCID: PMC10063385 DOI: 10.1016/j.bioactmat.2023.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 03/31/2023] Open
Abstract
Intrauterine adhesion (IUA) is the fibrosis within the uterine cavity. It is the second most common cause of female infertility, significantly affecting women's physical and mental health. Current treatment strategies fail to provide a satisfactory therapeutic outcome for IUA patients, leaving an enormous challenge for reproductive science. A self-healing adhesive hydrogel with antioxidant properties will be highly helpful in IUA prevention. In this work, we prepare a series of self-healing hydrogels (P10G15, P10G20, and P10G25) with antioxidant and adhesive properties. Those hydrogels exhibit good self-healing properties and can adapt themselves to different structures. They possess good injectability and fit the shape of the human uterus. Moreover, the hydrogels exhibit good tissue adhesiveness, which is desirable for stable retention and therapeutic efficacy. The in vitro experiments using P10G20 show that the adhesive effectively scavenges ABTS+, DPPH, and hydroxyl radicals, rescuing cells from oxidative stress. In addition, P10G20 offers good hemocompatibility and in vitro and in vivo biocompatibility. Furthermore, P10G20 lowers down the in vivo oxidative stress and prevents IUA with less fibrotic tissue and better endometrial regeneration in the animal model. It can effectively downregulate fibrosis-related transforming growth factor beta 1 (TGF-β1) and vascular endothelial growth factor (VEGF). Altogether, these adhesives may be a good alternative for the clinical treatment of intrauterine adhesion.
Collapse
Affiliation(s)
- Luyao Feng
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Liqun Wang
- Department of Reproductive Health, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Yao Ma
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Wanglin Duan
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Sergio Martin-Saldaña
- POLYMAT, Applied Chemistry Department, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel de Lardizabal 3, 20018, Donostia-San Sebastián, Spain
| | - Ye Zhu
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xianpeng Zhang
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Bin Zhu
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chaowei Li
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Shibo Hu
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Mingjie Bao
- JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Ting Wang
- JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Yuan Zhu
- Department of Reproductive Health, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
- JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
- Corresponding author. Department of Reproductive Health, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.
| | - Fei Yang
- School of Chemical Sciences, University of Chinese Academy of Sciences, Beijing, 100049, China
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics & Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- Corresponding author. School of Chemical Sciences, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Yazhong Bu
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
- Corresponding author.
| |
Collapse
|
22
|
Mao L, Wang X, Sun Y, Yang M, Chen X, Cui L, Bai W. Platelet-rich fibrin improves repair and regeneration of damaged endometrium in rats. Front Endocrinol (Lausanne) 2023; 14:1154958. [PMID: 37614713 PMCID: PMC10443704 DOI: 10.3389/fendo.2023.1154958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023] Open
Abstract
Purpose Intrauterine adhesion (IUA) is the most common cause of uterine infertility. This study aims to evaluate whether platelet-rich fibrin (PRF) treatment can stimulate damaged endometrium regeneration in rats. Methods First, hematoxylin and eosin (HE) staining, scanning and transmission electron microscopy, and ELISAs were used to evaluate the microstructure of PRF. Then, mechanical damage was used to establish an IUA rat model. A total of 40 SD female rats were randomized to three groups: PRF transplantation group, IUA group, and sham group. Rats were sacrificed at 3, 7, and 14 days and uteruses were obtained for further analysis. Finally, functional and histological recovery of the damaged endometrium was analyzed by pregnancy test, HE staining, Masson's staining, and immunohistochemistry. Results PRF has two distinct zones, platelets and fibrin zone. Long and narrow fibrin fibers interconnected with each other and formed a three-dimensional, flexible, and elastic structure; platelet aggregates were trapped in fibrin fibers, and each platelet is associated with several fibrin fibers. PRF exudates promoted endometrial stromal cell proliferation and migration in vitro. PRF transplantation was beneficial for maintaining uterine structure, promoting endometrial luminal epithelium and endometrial gland regeneration, and decreasing fibrotic areas in vivo. Conclusion Intrauterine administration of PRF was demonstrated to be effective in preventing IUA and stimulating damaged endometrium regeneration in rats. This study not only provided a promising method for its potential in endometrial regeneration in women who suffer from uterine infertility but also may prevent IUA after intrauterine surgery in clinical cases.
Collapse
Affiliation(s)
- Lele Mao
- Department of Obstetrics and Gynecology, Ninth Clinical Medical College, Peking University, Beijing Shijitan Hospital, Beijing, China
| | - XiaoXue Wang
- Department of Obstetrics and Gynecology, Ninth Clinical Medical College, Peking University, Beijing Shijitan Hospital, Beijing, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Mukun Yang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xing Chen
- Department of Obstetrics and Gynecology, Ninth Clinical Medical College, Peking University, Beijing Shijitan Hospital, Beijing, China
| | - Lei Cui
- Department of Obstetrics and Gynecology, Ninth Clinical Medical College, Peking University, Beijing Shijitan Hospital, Beijing, China
- Department of Plastic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wenpei Bai
- Department of Obstetrics and Gynecology, Ninth Clinical Medical College, Peking University, Beijing Shijitan Hospital, Beijing, China
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
23
|
D'Urso V, Gulino FA, Incognito GG, Cimino M, Dilisi V, Di Stefano A, Gulisano M, Cannone F, Capriglione S, Palumbo M. Hysteroscopic Findings and Operative Treatment: All at Once? J Clin Med 2023; 12:4232. [PMID: 37445266 DOI: 10.3390/jcm12134232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Hysteroscopy is considered not only a diagnostic instrument but also a therapeutic tool for many uterine pathologies. In the early 1990s, advances in technology and techniques made hysteroscopy less painful and invasive, allowing to increase in the number of gynecological procedures performed in an ambulatory setting without significant patient discomfort and with potentially significant cost savings. This is the so-called "office hysteroscopy" or "see-and-treat hysteroscopy", whose spread has permitted the decrease of the number of procedures performed in the operating room with the benefit of obviating the need for anesthesia and dilatation of the cervical canal.
Collapse
Affiliation(s)
- Valentina D'Urso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Monia Cimino
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Valentina Dilisi
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Alessandra Di Stefano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Marianna Gulisano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Francesco Cannone
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Ospedale "Santa Maria Alla Gruccia" Piazza del Volontariato 2, 52025 Montevarchi, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| |
Collapse
|
24
|
Mára M, Borčinová M, Lisá Z, Boudová B, Richtárová A, Kužel D. The perinatal outcomes of women treated for Asherman syndrome: a propensity score-matched cohort study. Hum Reprod 2023:7169437. [PMID: 37196339 DOI: 10.1093/humrep/dead092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Indexed: 05/19/2023] Open
Abstract
STUDY QUESTION Do the perinatal outcomes of patients following hysteroscopic treatment for Asherman syndrome (AS) differ from that of a control population? SUMMARY ANSWER Perinatal complications including placental issues, high blood loss, and prematurity in women after treatment for AS should be considered as moderate to high risk, especially in patients who have undergone more than one hysteroscopy (HS) or repeated postpartum instrumental revisions of the uterine cavity (Dilation and Curettage; D&C). WHAT IS KNOWN ALREADY The detrimental impact of AS on obstetrics outcomes is commonly recognized. However, prospective studies evaluating perinatal/neonatal outcomes in women with AS history are sparse, and the characteristics accounting for the respective morbidity of AS patients remain to be elucidated. STUDY DESIGN, SIZE, DURATION We conducted a prospective cohort study utilizing data from patients who underwent HS treatment for moderate to severe AS in a single tertiary University-affiliated hospital (enrolled between 01 January 2009 and March 2021), and who consequently conceived and progressed to at least 22nd gestational week of pregnancy. Perinatal outcomes were compared to a control population without an AS history, retrospectively enrolled concomitantly at the time of delivery for each patient with AS. Maternal and neonatal morbidity was assessed as well as the characteristics-related risk factors of AS patients. PARTICIPANTS/MATERIALS, SETTING, METHODS Our analytic cohort included a total of 198 patients, 66 prospectively enrolled patients with moderate to severe AS and 132 controls. We used multivariable logistic regression to calculate a propensity score to match 1-1 women with and without AS history based on demographic and clinical factors. After matching, 60 pairs of patients were analysed. Chi-square test was used to compare perinatal outcomes between the pairs. Spearman's correlation analysis was utilized to investigate the correlation between perinatal/neonatal morbidity and the characteristics-related factors of AS patients. The odds ratio (OR) for the associations was calculated by logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE Among the 60 propensity matched pairs, the AS group more frequently experienced overall perinatal morbidity, including abnormally invasive placenta (41.7% vs 0%; P < 0.001), retained placenta requiring manual or surgical removal (46.7% vs 6.7%; P < 0.001), and peripartum haemorrhage occurrence (31.7% vs 3.3%; P < 0.001). Premature delivery (<37 gestational weeks) was reported more frequently also for patients with AS (28.3% vs 5.0%; P < 0.001). However, no increased frequency of intra-uterine growth restriction or worsened neonatal outcomes were observed in AS group. Univariable analysis of risk factors for AS group morbidity outcomes revealed that the main factor related to abnormally invasive placenta was two or more HS procedures (OR 11.0; 95% CI: 1.33-91.23), followed by two or more D&Cs preceding AS treatment (OR 5.11; 95% CI: 1.69-15.45), and D&C performed postpartum as compared to post abortion (OR 3.0; 95% CI: 1.03-8.71). Similarly, two or more HS procedures were observed as the most important factor for retained placenta (OR 13.75; 95% CI: 1.66-114.14), followed by two or more preceding D&Cs (OR 5.16; 95% CI: 1.67-15.9). Premature birth was significantly associated with the number of preceding D&Cs (OR for two or more, 4.29; 95% CI: 1.12-14.91). LIMITATIONS, REASONS FOR CAUTION Although the cohort of patients with AS was enrolled prospectively, a baseline imbalance was intrinsically involved in the retrospective enrolment of the control group. However, to reduce the risk of bias, confounding factors were adjusted for using propensity score matching. The limitation to the generalization of our reported results is the single institution design in which all patients were treated for AS in one tertiary medical centre. WIDER IMPLICATIONS OF THE FINDINGS Within our search scope, our study represents one of the first and largest prospective studies of perinatal and neonatal outcomes in moderate to severe AS patients with a prospectively analysis of the risks factors of characteristics significantly influencing reported morbidities among patients with AS. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the Charles University in Prague [UNCE 204065] and by the institutional grant of The General Faculty Hospital in Prague [00064165]. No competing interests were declared. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- M Mára
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - M Borčinová
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Z Lisá
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - B Boudová
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - A Richtárová
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - D Kužel
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| |
Collapse
|
25
|
Robinson JK, Ramanathan A, Thompson R. An Argument for Quality Improvement in Asherman Syndrome Counseling. J Minim Invasive Gynecol 2023; 30:165-166. [PMID: 36642214 DOI: 10.1016/j.jmig.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Affiliation(s)
- James K Robinson
- Medstar Washington Hospital Center and the National Center for Advanced Pelvic Surgery (all authors), Washington, District of Columbia.
| | - Aparna Ramanathan
- Medstar Washington Hospital Center and the National Center for Advanced Pelvic Surgery (all authors), Washington, District of Columbia
| | - Rebecca Thompson
- Medstar Washington Hospital Center and the National Center for Advanced Pelvic Surgery (all authors), Washington, District of Columbia
| |
Collapse
|
26
|
Hanstede MMF, van Stralen KJ, Molkenboer JFM, Veersema S, Emanuel MH. Hormonal support in women with Asherman syndrome does not lead to better outcomes: A randomized trial. Reprod Med Biol 2023; 22:e12526. [PMID: 37396823 PMCID: PMC10308500 DOI: 10.1002/rmb2.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose The purpose of the study was to investigate if adjuvant hormones after successful adhesiolysis lead to a reduction in spontaneous recurrence of adhesions and influence reproductive outcomes. Methods A single-blind randomized controlled trial comparing administration of oral estrogen (the usual care group) with not giving estrogen (no estrogen) in women after successful adhesiolysis for Asherman syndrome. Women were included between September 2013 and February 2017, with a follow-up of 3 years to monitor recurrences and reproductive outcomes. Analyses were based on an intention to treat analyses. This study was registered under NL9655. Results A total of 114 women were included. At 1 year, virtually all patients (except 3) were either having a recurrence or were pregnant. Women who did not receive estrogen did not have more recurrences of adhesions in the first year prior to pregnancy (66.1% in the usual care group, 52.7% in the no-estrogen group, p = 0.15). Of the women in usual care, 89.8% got pregnant within 3 years, and 67.8% got a living child; this was 83.6% and 60.0%, respectively, in the no-estrogen group (p = 0.33 and p = 0.39, respectively). Conclusion Usual care does not lead to better outcomes as compared with not giving exogenous estrogen but is associated with side effects.
Collapse
Affiliation(s)
- Miriam M. F. Hanstede
- Department of Obstetrics and Gynecology, Spaarne Gasthuis HaarlemHaarlemThe Netherlands
| | | | - Jan F. M. Molkenboer
- Department of Obstetrics and Gynecology, Spaarne Gasthuis HaarlemHaarlemThe Netherlands
| | | | - Mark Hans Emanuel
- Universitair Medisch Centrum Utrecht (UMC Utrecht)UtrechtThe Netherlands
- Bergman Clinics VrouwenzorgHilversumThe Netherlands
| |
Collapse
|
27
|
Chen K, Zheng S, Fang F. Endometrial Stem Cells and Their Applications in Intrauterine Adhesion. Cell Transplant 2023; 32:9636897231159561. [PMID: 36891869 PMCID: PMC9998408 DOI: 10.1177/09636897231159561] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Intrauterine adhesion (IUA), resulting from pregnancy or nonpregnant uterine trauma, is one of the major causes of abnormal menstruation, infertility, or repeated pregnancy loss. Although a few methods, including hysteroscopy and hormone therapy, are routinely used for its diagnosis and treatment, they cannot restore tissue regeneration. Stem cells, which have self-renewal and tissue regeneration abilities, have been proposed as a promising therapy for patients with severe IUAs. In this review, we summarize the origin and features of endometrium-associated stem cells and their applications in the treatment of IUAs based on animal models and human clinical trials. We expect that this information will help to elucidate the underlying mechanism for tissue regeneration and to improve the design of stem cell-based therapies for IUAs.
Collapse
Affiliation(s)
- Kai Chen
- Reproductive Medicine Center & Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,Wannan Medical College, Wuhu, China
| | - Shengxia Zheng
- Reproductive Medicine Center & Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.,The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Fang Fang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| |
Collapse
|
28
|
van Wessel S, Wauters L, Weyers S, Hamerlynck T. The use of an intrauterine balloon in preventing adhesion recurrence after hysteroscopic adhesiolysis: a feasibility study. J OBSTET GYNAECOL 2022; 42:3720-3724. [PMID: 36541390 DOI: 10.1080/01443615.2022.2158320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We aimed to evaluate the feasibility of a heart-shaped intrauterine balloon as antiadhesion method immediately after hysteroscopic adhesiolysis in terms of surgeon's and patient's experience. This feasibility study was performed at the Ghent University Hospital (Belgium) from 2018 to 2020. A heart-shaped intrauterine balloon was inserted in 10 women immediately after hysteroscopic adhesiolysis and left in place for 7 days under antibiotic prophylaxis. Insertion and removal of the balloon was easy in 7 women out of 10 (5-point Likert scale), and successful in all cases. The median pain score during balloon wearing on a visual analogue scale (VAS) was 1.7 (IQR 1.0-4.2). Seven out of 10 women were satisfied (5-point Likert scale). Eight out of 10 women would probably or certainly recommend the procedure to a friend (5-point Likert scale) and would use the balloon again. The heart-shaped intrauterine balloon as antiadhesion method is feasible in terms of surgeon's and patient's experience. Designing a proper Randomised Controlled Trial (RCT) is worth the effort. Clinical trial registration: https://clinicaltrials.gov (NCT03446755). Initial release on 27th February 2018.IMPACT STATEMENTWhat is already known on this subject? Intrauterine adhesion (IUA) reformation is high and different methods to prevent this subsequent to an operative hysteroscopy have been assessed. The use of antiadhesion gel, acting as a mechanical barrier, may decrease the occurrence of IUAs compared to no treatment or placebo. A heart-shaped intrauterine balloon is another example of a mechanical barrier. A small number of studies, of varying quality and with heterogeneous results, have been performed. A proper RCT, comparing the intrauterine balloon to no treatment or placebo, is needed.What the results of this study add? The heart-shaped intrauterine balloon as antiadhesion method is feasible in terms of surgeon's and patient's experience.What the implications are of these findings for clinical practice and/or further research? Designing a proper RCT is worth the effort.
Collapse
Affiliation(s)
| | - Lieselot Wauters
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Steven Weyers
- Women’s Clinic, Ghent University Hospital, Ghent, Belgium
| | | |
Collapse
|
29
|
Hooker AB, de Leeuw RA, Emanuel MH, Mijatovic V, Brolmann HAM, Huirne JA. The link between intrauterine adhesions and impaired reproductive performance: a systematic review of the literature. BMC Pregnancy Childbirth 2022; 22:837. [PMID: 36376829 PMCID: PMC9664654 DOI: 10.1186/s12884-022-05164-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Intrauterine adhesions (IUAs) are one of the main reproductive system diseases in women worldwide. Fusion between the injured opposing walls leads to partial-to-complete obliteration of the cavity and/or cervical canal. The main clinical manifestations in case of IUAs are menstrual disturbances, cyclic pain and reproductive disorders. The reproductive outcomes of women with IUAs remain limited and inefficient compared to women without IUAs, even after adhesiolysis. An exact understanding of the underlying mechanisms and processes to explain the compromised reproductive performance and outcomes in case of IUAs are lacking. Methods A systematic literature review of MEDLINE-PubMed (1966 to January 2022) and EMBASE (1974 to January 2022) was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported underlying causes, related mechanisms and processes to explain the association between IUAs and impaired reproductive performance, pregnancy and obstetric complications. Results After an extensive review of the literature, 58 articles were identified reporting underlying mechanisms to explain the association between IUAs and impaired fertility. Intrauterine scarring influences the process of fertilization, reproductive performance and ultimately reproductive outcome. IUAs can disturb the cervico-utero-tubal sperm transport and result in an avascular and unresponsive endometrium with decreased receptivity and thickness. Abnormal decidualization and abnormal trophoblastic infiltration leads to placental attachment disorders. Moreover, the risk for premature delivery, intrauterine fetal growth restriction and fetal anomalies is increased in case of IUAs. Conclusion The impact of IUAs on reproductive performance, even after adhesiolysis, is becoming more apparent. The postulated mechanisms to explain the association are related to sperm transport, embryo implantation and placentation. Prevention, by preserving the basal layer of the endometrium is essential. Effective and evidence-based strategies for the prevention of endometrial injury and formation of IUAs, are urgently needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05164-2.
Collapse
|
30
|
Fouks Y, Kidron A, Lavie I, Shapira Z, Cohen Y, Levin I, Azem F, Cohen A. Reproductive Outcomes and Overall Prognosis of Women with Asherman's Syndrome Undergoing IVF. J Minim Invasive Gynecol 2022; 29:1253-1259. [PMID: 35970266 DOI: 10.1016/j.jmig.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of Asherman syndrome (AS) following hysteroscopic adhesiolysis on reproductive outcomes and the time to achieve pregnancy in women with infertility undergoing in vitro fertilization (IVF) treatment. DESIGN Case-control study. SETTING Tertiary university-affiliated medical center. PATIENTS Fifty-one infertile women who were treated for AS and underwent IVF (study group) matched for age and etiology of infertility with non-AS controls at a 1:1 ratio. INTERVENTIONS Medical records search, chart review, and phone survey were used to assess reproductive outcomes. MEASUREMENTS AND MAIN RESULTS A multivariate logistic regression analyses was used to assess live birth, accounting for patient age at stimulation cycle start, parity, number of embryos transferred, and endometrial thickness. A survival analysis was performed to assess the times that had lapsed from interventions to conception. The study group of 51 women included 38 (74.5%) with moderate to severe disease. The mean number of embryo transfers per woman was similar for the study and control groups (4.9 ± 4.6 vs 6.22 ± 4.3, respectively, p = .78). The controls had a significantly higher mean endometrial thickness before embryo transfer (8.7 ± 1.8 mm vs 6.95 ± 1.7 mm, p = .001). The overall time to achieve live birth was significantly longer in women with AS (p = .022). In a logistic regression analysis, the presence of moderate to severe AS was shown to be an independent factor for achieving a live birth (adjusted odds ratio 0.174, 95% confidence interval [CI], 0.032-0.955, p = .004). Women with AS who had live births had a significantly thicker mean endometrial thickness (8.2 ± 1.4 mm vs 6.9 ± 1.2, p = .001). CONCLUSION Moderate and severe AS has a detrimental effect on reproductive performance in infertile women. Endometrial thickness is an important predictor for live births among women with AS who undergo IVF.
Collapse
Affiliation(s)
- Yuval Fouks
- Fertility Division, Department of Obstetrics and Gynecology (Drs. Fouks, Kidron, Shapira, Y. Cohen, Levin, Azem, and A. Cohen), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Boston IVF-Eugin Group (Dr. Fouks, Lavie), Waltham, Massachusetts
| | - Adi Kidron
- Fertility Division, Department of Obstetrics and Gynecology (Drs. Fouks, Kidron, Shapira, Y. Cohen, Levin, Azem, and A. Cohen), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Lavie
- Boston IVF-Eugin Group (Dr. Fouks, Lavie), Waltham, Massachusetts
| | - Ziv Shapira
- Fertility Division, Department of Obstetrics and Gynecology (Drs. Fouks, Kidron, Shapira, Y. Cohen, Levin, Azem, and A. Cohen), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoni Cohen
- Fertility Division, Department of Obstetrics and Gynecology (Drs. Fouks, Kidron, Shapira, Y. Cohen, Levin, Azem, and A. Cohen), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ishai Levin
- Fertility Division, Department of Obstetrics and Gynecology (Drs. Fouks, Kidron, Shapira, Y. Cohen, Levin, Azem, and A. Cohen), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Fertility Division, Department of Obstetrics and Gynecology (Drs. Fouks, Kidron, Shapira, Y. Cohen, Levin, Azem, and A. Cohen), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Cohen
- Fertility Division, Department of Obstetrics and Gynecology (Drs. Fouks, Kidron, Shapira, Y. Cohen, Levin, Azem, and A. Cohen), Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
31
|
Li B, Zhang L, Xie Y, Lei L, Qu W, Sui L. Evaluation of pharmacokinetics and safety of a long-term estradiol-releasing stent in rat uterine. Regen Ther 2022; 21:494-501. [PMID: 36313395 PMCID: PMC9596602 DOI: 10.1016/j.reth.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Intrauterine adhesion (IUA), often leading to gynecological complications including amenorrhea, abdominal pain and infertility, is frequently induced by injuries to the endometrium. Hence it would be of great benefit to take efforts to prevent adhesion after intrauterine operations. Orally administration of 17β-estradiol (E2) is commonly used to promote endometrium regeneration, but is limited by low concentrations at the injured sites. We aim at preparing an E2-releasing uterine stent, which could improve the efficiency of E2 therapy and be utilized for IUA prevention. Methods We designed a silicone rubber stent, which could be implanted in the uterine cavity and continuously release E2 in long term. Stents were placed in rodent uterine, and removed at different time points. Remaining E2 in stent was measured by high performance liquid chromatography (HPLC), and organ E2 concentrations were detected by enzyme-linked immuno sorbent assay (ELISA). Endometrium morphology was examined by histological staining of paraffin sections. Results Our stent showed a controlled release of E2 in rodent uterine for over 60 days, and significantly increased E2 concentration in serum and in situ uterine. After the stent was removed from uterine, E2 rapidly reverted to a normal level. Also, the stent did not induce pathological changes in endometrium. Conclusions The uterine stent provided abundant local E2 in uterine cavity with satisfactory safety. The silicone rubber based E2-releasing uterine stent could be further advanced by adjusting its shape and E2 load for its clinical application, and might promisingly help lowering the incidence of IUA. The silicone rubber uterine stent continuously released E2 in long term. The E2-releasing uterine stent revealed more efficient E2 delivery capacity than orally administrated E2. The E2-releasing uterine stent is safe for endometrium and remote organs.
Collapse
Affiliation(s)
- Boning Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Lu Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China,Obstetrics and Gynecology Hospital, Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Yu Xie
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Lei Lei
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Wenjie Qu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Long Sui
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China,Obstetrics and Gynecology Hospital, Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China,Corresponding author. Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.
| |
Collapse
|
32
|
Zanolli NC, Bishop KC, Kuller JA, Price TM, Harris BS. Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes. Obstet Gynecol Surv 2022; 77:485-494. [DOI: 10.1097/ogx.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Jacobs EA, Van Voorhis B, Kawwass JF, Kondapalli LA, Liu K, Dokras A. Endometrial thickness: How thin is too thin? Fertil Steril 2022; 118:249-259. [PMID: 35878944 DOI: 10.1016/j.fertnstert.2022.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Emily A Jacobs
- Division of Reproductive Endocrinology and Infertility, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Brad Van Voorhis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, Georgia
| | | | - Kimberly Liu
- Mount Sinai Fertility, University of Toronto, Toronto, Ontario, Canada
| | - Anuja Dokras
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
34
|
The Role of Endometrial Stem/Progenitor Cells in Recurrent Reproductive Failure. J Pers Med 2022; 12:jpm12050775. [PMID: 35629197 PMCID: PMC9143189 DOI: 10.3390/jpm12050775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023] Open
Abstract
Recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL), collectively referred to as recurrent reproductive failure (RRF), are both challenging conditions with many unanswered questions relating to causes and management options. Both conditions are proposed to be related to an aberrant endometrial microenvironment, with different proposed aetiologies related to a restrictive or permissive endometrium for an invading embryo. The impressive regenerative capacity of the human endometrium has been well-established and has led to the isolation and characterisation of several subtypes of endometrial stem/progenitor cells (eSPCs). eSPCs are known to be involved in the pathogenesis of endometrium-related disorders (such as endometriosis) and have been proposed to be implicated in the pathogenesis of RRF. This review appraises the current knowledge of eSPCs, and their involvement in RRF, highlighting the considerable unknown aspects in this field, and providing avenues for future research to facilitate much-needed advances in the diagnosis and management of millions of women suffering with RRF.
Collapse
|
35
|
Direk L, Salman M, Alchami A, Saridogan E. Reproductive performance following hysteroscopic treatment of intrauterine adhesions: single surgeon data. Facts Views Vis Obgyn 2022; 14:51-58. [PMID: 35373548 PMCID: PMC9612855 DOI: 10.52054/fvvo.14.1.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Intrauterine adhesions can negatively affect reproductive outcomes by causing infertility, miscarriage and preterm birth in women. Hysteroscopic surgery is now widely accepted as the treatment of choice in symptomatic women to restore reproductive function. Objectives To analyse the patient characteristics and long-term reproductive outcomes of women who received treatment for intrauterine adhesions under the care of a single surgeon. Materials and Methods In this retrospective analysis, all women who underwent hysteroscopic surgery for intrauterine adhesions under the care of the same surgeon between January 2001 and December 2019 were identified and their data were evaluated. Relevant demographic, diagnostic and reproductive outcome data was procured from patient notes. Referring doctors and patients were contacted to obtain missing information. Main outcome measures Live birth and miscarriage rates. Results 126 women were treated for intrauterine adhesions. Of those women who were trying to conceive, 71.4% (65/91) achieved pregnancy, 58.2% (53/91) had live births and 13.2% (12/91) had miscarriages. No statistically significant difference was found in the live birth rates when data was analysed in subgroups based on age, reason for referral/aetiology and severity of pathology. Conclusions Hysteroscopic surgery leads to live birth in the majority of women with intrauterine adhesions. The lack of statistically significant difference in live birth rates across subgroups, including advanced age and severe pathology, suggests that surgery in all women wanting to conceive can be justified. What is new? Hysteroscopic treatment can lead to successful outcomes even in the presence of severe adhesions and in older women with appropriate treatment.
Collapse
|
36
|
Chung RK, Salari S, Findley J, Richards EG, Flyckt RLR. Uterine Transplantation: Recipient Patient Populations. Clin Obstet Gynecol 2022; 65:15-23. [PMID: 35045021 DOI: 10.1097/grf.0000000000000672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Uterine transplantation is an emerging treatment for patients with uterine factor infertility (UFI). In order to determine patient candidacy for transplant, it is imperative to understand how to identify, counsel and treat uterine transplant recipients. In this article, we focus on patient populations with UFI, whether congenital or acquired, including Mayer-Rokitansky-Kuster-Hauser, complete androgen insensitivity syndrome, hysterectomy, and other causes of nonabsolute UFI. Complete preoperative screening of recipients should be required to assess the candidacy of each individual prior to undergoing this extensive treatment option.
Collapse
Affiliation(s)
- Rebecca K Chung
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Beachwood
| | - Salomeh Salari
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Beachwood
| | - Joseph Findley
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Beachwood
| | | | - Rebecca L R Flyckt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Beachwood
| |
Collapse
|
37
|
Zhu R, Duan H, Xu W, Wang S, Gan L, Xu Q, Li J. Decision tree model predicts live birth after surgery for moderate-to-severe intrauterine adhesions. BMC Pregnancy Childbirth 2022; 22:78. [PMID: 35093014 PMCID: PMC8801068 DOI: 10.1186/s12884-022-04375-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 12/28/2021] [Indexed: 11/11/2022] Open
Abstract
Background After treatment of intrauterine adhesions, the rate of re-adhesion is high and the pregnancy outcome unpredictable and unsatisfactory. This study established and verified a decision tree predictive model of live birth in patients after surgery for moderate-to-severe intrauterine adhesions (IUAs). Methods A retrospective observational study initially comprised 394 patients with moderate-to-severe IUAs diagnosed via hysteroscopy. The patients underwent hysteroscopic adhesiolysis from January 2013 to January 2017, in a university-affiliated hospital. Follow-ups to determine the rate of live birth were conducted by telephone for at least the first postoperative year. A classification and regression tree algorithm was applied to establish a decision tree model of live birth after surgery. Results Within the final population of 374 patients, the total live birth rate after treatment was 29.7%. The accuracy of the model was 83.8%, and the area under the receiver operating characteristic curve (AUC) was 0.870 (95% CI 7.699–0.989). The root node variable was postoperative menstrual pattern. The predictive accuracy of the multivariate logistic regression model was 70.3%, and the AUC was 0.835 (95% CI 0.667–0.962). Conclusions The decision tree predictive model is useful for predicting live birth after surgery for IUAs; postoperative menstrual pattern is a key factor in the model. This model will help clinicians make appropriate clinical decisions during patient consultations.
Collapse
|
38
|
Making More Womb: Clinical Perspectives Supporting the Development and Utilization of Mesenchymal Stem Cell Therapy for Endometrial Regeneration and Infertility. J Pers Med 2021; 11:jpm11121364. [PMID: 34945836 PMCID: PMC8707522 DOI: 10.3390/jpm11121364] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/02/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022] Open
Abstract
The uterus is a homeostatic organ, unwavering in the setting of monthly endometrial turnover, placental invasion, and parturition. In response to ovarian steroid hormones, the endometrium autologously prepares for embryo implantation and in its absence will shed and regenerate. Dysfunctional endometrial repair and regeneration may present clinically with infertility and abnormal menses. Asherman's syndrome is characterized by intrauterine adhesions and atrophic endometrium, which often impacts fertility. Clinical management of infertility associated with abnormal endometrium represents a significant challenge. Endometrial mesenchymal stem cells (MSC) occupy a perivascular niche and contain regenerative and immunomodulatory properties. Given these characteristics, mesenchymal stem cells of endometrial and non-endometrial origin (bone marrow, adipose, placental) have been investigated for therapeutic purposes. Local administration of human MSC in animal models of endometrial injury reduces collagen deposition, improves angiogenesis, decreases inflammation, and improves fertility. Small clinical studies of autologous MSC administration in infertile women with Asherman's Syndrome suggested their potential to restore endometrial function as evidenced by increased endometrial thickness, decreased adhesions, and fertility. The objective of this review is to highlight translational and clinical studies investigating the use of MSC for endometrial dysfunction and infertility and to summarize the current state of the art in this promising area.
Collapse
|
39
|
Chen JM, Huang QY, Zhao YX, Chen WH, Lin S, Shi QY. The Latest Developments in Immunomodulation of Mesenchymal Stem Cells in the Treatment of Intrauterine Adhesions, Both Allogeneic and Autologous. Front Immunol 2021; 12:785717. [PMID: 34868069 PMCID: PMC8634714 DOI: 10.3389/fimmu.2021.785717] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022] Open
Abstract
Intrauterine adhesion (IUA) is an endometrial fibrosis disease caused by repeated operations of the uterus and is a common cause of female infertility. In recent years, treatment using mesenchymal stem cells (MSCs) has been proposed by many researchers and is now widely used in clinics because of the low immunogenicity of MSCs. It is believed that allogeneic MSCs can be used to treat IUA because MSCs express only low levels of MHC class I molecules and no MHC class II or co-stimulatory molecules. However, many scholars still believe that the use of allogeneic MSCs to treat IUA may lead to immune rejection. Compared with allogeneic MSCs, autologous MSCs are safer, more ethical, and can better adapt to the body. Here, we review recently published articles on the immunomodulation of allogeneic and autologous MSCs in IUA therapy, with the aim of proving that the use of autologous MSCs can reduce the possibility of immune rejection in the treatment of IUAs.
Collapse
Affiliation(s)
- Jia-Ming Chen
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Qiao-Yi Huang
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yun-Xia Zhao
- Department of Gynaecology and Obstetrics, Shenzhen Hospital of University of Hong Kong, Shenzhen, China
| | - Wei-Hong Chen
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Qi-Yang Shi
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| |
Collapse
|
40
|
Sun D, Jiang Z, Chen Y, Shang D, Miao P, Gao J. MiR-455-5p upregulation in umbilical cord mesenchymal stem cells attenuates endometrial injury and promotes repair of damaged endometrium via Janus kinase/signal transducer and activator of transcription 3 signaling. Bioengineered 2021; 12:12891-12904. [PMID: 34784837 PMCID: PMC8810187 DOI: 10.1080/21655979.2021.2006976] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Umbilical cord mesenchymal stem cells (UCMSCs) are regarded as an ideal source for clinical use. Increasing evidence has suggested that microRNAs (miRNAs) work as a crucial regulator in the development of plentiful diseases, including intrauterine adhesions (IUA). Herein, we investigated the specific impacts of UCMSCs overexpressing miR-455-5p in IUA. UCMSCs were cocultured with endometrial stromal cells (ESCs). Thirty-two female mice were divided into four different treated groups: sham, model, model + UCMSC-miR-NC and model + UCMSC-miR-455-5p. Mice in model groups were induced by uterine curettage. MiR-455-5p overexpressed UCMSCs facilitated the proliferation and cell cycle progression of ESCs according to 5-ethynyl-2′-deoxyuridine assay and flow cytometry analysis. Hematoxylin-eosin and Masson staining revealed that miR-455-5p upregulation in UCMSCs increased the number of endometrial glands and suppressed endometrial fibrosis in murine uterine tissues. Western blotting displayed that miR-455-5p overexpressed UCMSCs promoted the activation of Janus kinase/signal transducer and activator of transcription 3 (JAK/STAT3) signaling in ESCs and murine uterine tissues. Mechanistically, miR-455-5p targeted 3’ untranslated region of suppressor of cytokine signaling 3 (SOCS3), which was confirmed by luciferase reporter assay. Reverse transcription quantitative polymerase chain reaction demonstrated that miR-455-5p was lowly expressed and SOCS3 was highly expressed in murine uterine tissues of IUA model. Moreover, Pearson correlation analysis showed that their expression was inversely correlated. Rescue assays suggested that inhibiting JAK/STAT3 signaling reversed effects of miR-455-5p on the behaviors of ESCs. The results indicated that miR-455-5p overexpression in UCMSCs helps to attenuate endometrial injury and repair damaged endometrium by activating SOCS3-mediated JAK/STAT3 signaling.
Collapse
Affiliation(s)
- Dongyan Sun
- Department of Gynecology, Maternity and Child Health Care Hospital of Hubei Province, Wuhan 430000, Hubei, China
| | - Zhihe Jiang
- Department of Obstetrics and Gynecology, School of Medicine, Wuhan University of Science and Technology, Wuhan 430072, Hubei, China
| | - Yanling Chen
- Department of Obstetrics and Gynecology, School of Medicine, Wuhan University of Science and Technology, Wuhan 430072, Hubei, China
| | - Di Shang
- Department of Obstetrics and Gynecology, School of Medicine, Wuhan University of Science and Technology, Wuhan 430072, Hubei, China
| | - Pan Miao
- Yangtze University Health Science Center, Jingzhou 430199, Hubei, China
| | - Jian Gao
- Department of Obstetrics and Gynecology, School of Medicine, Wuhan University of Science and Technology, Wuhan 430072, Hubei, China
| |
Collapse
|
41
|
Yu J, Zhang W, Huang J, Gou Y, Sun C, Zhang Y, Mao Y, Wu B, Li C, Liu N, Wang T, Huang J, Wang J. Management of intrauterine adhesions using human amniotic mesenchymal stromal cells to promote endometrial regeneration and repair through Notch signalling. J Cell Mol Med 2021; 25:11002-11015. [PMID: 34724320 PMCID: PMC8642679 DOI: 10.1111/jcmm.17023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jie Yu
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Wenwen Zhang
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayue Huang
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yating Gou
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Congcong Sun
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yingfeng Zhang
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yanhua Mao
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Benyuan Wu
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Changjiang Li
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Nizhou Liu
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Wang
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Jiren Huang
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Wang
- Department of Obstetrics and Gynecology, University-Town Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
42
|
Aghajanova L, Sundaram V, Kao CN, Letourneau JM, Manvelyan E, Cedars MI, Huddleston HG. Autologous platelet-rich plasma treatment for moderate-severe Asherman syndrome: the first experience. J Assist Reprod Genet 2021; 38:2955-2963. [PMID: 34613578 DOI: 10.1007/s10815-021-02328-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/20/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Treatment of Asherman syndrome (AS) presents a significant clinical challenge. Based on our in vitro data showing that PRP could activate endometrial cell proliferation and migration, we hypothesized that intrauterine infusion of autologous platelet-rich plasma (PRP) may improve endometrial regeneration and fertility outcomes in patients with moderate-severe AS. MATERIALS AND METHODS Subjects with moderate-severe AS were randomized to PRP or saline control administered following hysteroscopic adhesiolysis. Due to relative inability to randomize patients to the control group, after initial randomization of 10 subjects (6 in PRP and 4 in control groups), the remainder were prospectively enrolled in PRP group (n = 9), with 11 historic controls added to control group, for a total of 30 subjects (PRP n = 15; saline control n = 15). Right after hysteroscopy, 0.5-1 mL of PRP or saline was infused into the uterus via a Wallace catheter, followed by estrogen therapy. The primary outcomes were changes in endometrial thickness (EMT, checked in 3 weeks) and in menstrual flow; secondary outcomes were pregnancy and live birth rates. EMT and menstrual bleeding pattern were assessed before and after the intervention. Pregnancy was assessed over a 6-month period. RESULTS There were no statistically significant differences in age, gravidity/parity, cause of AS, preoperative menses assessment, AS hysteroscopy score, and intrauterine balloon placement between the groups. There was no statistically significant difference (p = 0.79) in EMT pre-PRP infusion for control (5.7 mm, 4.0-6.0) and study arm (5.3 mm, 4.9-6.0). There was no statistically significant change (p = 0.78) in EMT after PRP infusion (1.4 mm, - 0.5-2.4) vs saline (1.0 mm, 0.0-2.5). Patients tolerated the procedure well, with no adverse effects. There was no difference in the predicted likelihood of pregnancy (p = 0.45) between the control (0.67, 0.41-0.85) and study arm (0.53, 0.29-0.76). CONCLUSIONS PRP was well accepted and tolerated in AS patients. However, we did not observe any significant EMT increase or improved pregnancy rates after adding PRP infusion, compared to standard treatment only. The use of intrauterine PRP infusion may be a feasible option, and its potential use must be tested on a larger sample size of AS patients.
Collapse
Affiliation(s)
- Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA.
| | - Viji Sundaram
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Chia-Ning Kao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Joseph M Letourneau
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Evelyna Manvelyan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Marcelle I Cedars
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Heather G Huddleston
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
43
|
Lv H, Wu B, Song J, Wu W, Cai W, Xu J. Hydrogel, a novel therapeutic and delivery strategy, in the treatment of intrauterine adhesions. J Mater Chem B 2021; 9:6536-6552. [PMID: 34324619 DOI: 10.1039/d1tb01005k] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intrauterine adhesions (IUAs) are caused by damage to the underlying lining of the endometrium. They' re related to disorder of endometrial repair. In recent years, hydrogels with controllable biological activity have been widely used for treating IUAs. They encapsulate estrogen, cytokines, cells, or exosomes, forming a delivery system to release therapeutic components for the treatment of IUAs. In addition, the hydrogel acting as a barrier can be degraded in the body automatically, reducing the risk of infection caused by secondary surgeries. In this review, we summarize the recent progress of hydrogels and their application in IUAs as both a novel alternative therapeutic and an artificial delivery strategy.
Collapse
Affiliation(s)
- Houyi Lv
- Department of Reproductive Medicine, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | | | | | | | | | | |
Collapse
|
44
|
de Miguel-Gómez L, Romeu M, Pellicer A, Cervelló I. Strategies for managing asherman's syndrome and endometrial atrophy: Since the classical experimental models to the new bioengineering approach. Mol Reprod Dev 2021; 88:527-543. [PMID: 34293229 DOI: 10.1002/mrd.23523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 11/07/2022]
Abstract
Endometrial function is essential for embryo implantation and pregnancy, but managing endometrial thickness that is too thin to support pregnancy or an endometrium of compromised functionality due to intrauterine adhesions is an ongoing challenge in reproductive medicine. Here, we review current and emerging therapeutic and experimental options for endometrial regeneration with a focus on animal models used to study solutions for Asherman's syndrome and endometrial atrophy, which both involve a damaged endometrium. A review of existing literature was performed that confirmed the lack of consensus on endometrial therapeutic options, though promising new alternatives have emerged in recent years (platelet-rich plasma, exosomes derived from stem cells, bioengineering-based techniques, endometrial organoids, among others). In the future, basic research using established experimental models of endometrial pathologies (combined with new high-tech solutions) and human clinical trials with large population sizes are needed to evaluate these emerging and new endometrial therapies.
Collapse
Affiliation(s)
- Lucía de Miguel-Gómez
- Fundación Instituto Valenciano de Infertilidad (FIVI), La Fe Health Research Institute, Valencia, Spain
- University of Valencia, Valencia, Spain
| | - Mónica Romeu
- Reproductive Medicine Research Group, La Fe Health Research Institute, La Fe University Hospital, Valencia, Spain
- Women's Health Area, Human Reproduction Unit, La Fe University Hospital, Valencia, Spain
| | | | - Irene Cervelló
- Fundación Instituto Valenciano de Infertilidad (FIVI), La Fe Health Research Institute, Valencia, Spain
| |
Collapse
|
45
|
Hanstede MMF, van der Meij E, Veersema S, Emanuel MH. Live births after Asherman syndrome treatment. Fertil Steril 2021; 116:1181-1187. [PMID: 34130799 DOI: 10.1016/j.fertnstert.2021.05.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To study the reproductive outcomes after surgical management of women with Asherman syndrome (AS). DESIGN Cohort study. SETTING International referral hospital for women with AS. PATIENT(S) A total of 500 women who were diagnosed with and treated for AS between January 2003 and December 2016 and followed for a minimum of 2 years. INTERVENTION(S) Hysteroscopic adhesiolysis using conventional instruments with concomitant fluoroscopy as a guidance method. MAIN OUTCOME MEASURE(S) Live birth rate. RESULT(S) Of the 500 women included in the cohort, 569 pregnancies were achieved within 3 years after surgery. The miscarriage rate was 33.0%, and the live birth rate was 67.4%. Age, the causal procedure, and at least one miscarriage after adhesiolysis strongly predicted the outcome of a live birth. CONCLUSION(S) The overall take-home newborn rate was 67.4% after adhesiolysis in women with AS. Women with AS who are relatively young, with a first-trimester procedure preceding AS, and with low grades of adhesions and no miscarriage after adhesiolysis have the best chance of a newborn delivery.
Collapse
Affiliation(s)
- Miriam M F Hanstede
- Spaarne Gasthuis, Department of Obstetrics and Gynecology, Asherman Expertise Center, Haarlem, The Netherlands.
| | - Eva van der Meij
- Spaarne Gasthuis, Department of Obstetrics and Gynecology, Asherman Expertise Center, Haarlem, The Netherlands
| | - Sebastiaan Veersema
- University Medical Center Utrecht, Department of Reproductive Medicine and Gynecology, Utrecht, The Netherlands
| | - Mark Hans Emanuel
- University Medical Center Utrecht, Department of Reproductive Medicine and Gynecology, Utrecht, The Netherlands
| |
Collapse
|
46
|
Jegaden M, Capmas P, Debras E, Neveu ME, Pourcelot AG, Fernandez H. [Treatment of synechiae related to infertility]. ACTA ACUST UNITED AC 2021; 49:930-935. [PMID: 34051425 DOI: 10.1016/j.gofs.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 11/28/2022]
Abstract
Synechiae are intrauterine adhesions that affect the fertility of women. They are most often of post-traumatic origin. The management of pregnancy abortions in the first trimester and post-delivery retention are the main contributing factors. Synechiae is responsible for cycle disorders and repeated pregnancy loss. Hysteroscopy is the reference method for its diagnosis and treatment. The surgical objective is the restoration of a normal sized cavity and a functional endometrium to allow fertilization and implantation. The use of small diameter (5mm) hysteroscopes and no energy or bipolar energy instruments are recommended. Echo guidance facilitates the treatment of severe synechiae and limits the risk of intraoperative perforation. The main risk of treatment is recurrence, particularly in severe cases where multiple operating times are sometimes necessary. An office hysteroscopy at 6 weeks is recommended to identify and treat these recurrences. Different physical, molecular or cellular methods are studied as primary and secondary prevention of postoperative synechiae. The objective of this review is to provide an update on the treatment of synechiae in the context of infertility.
Collapse
Affiliation(s)
- M Jegaden
- AP-HP, GHU-Sud, CHU Bicêtre, Service Gynécologie Obstétrique, 78, rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - P Capmas
- AP-HP, GHU-Sud, CHU Bicêtre, Service Gynécologie Obstétrique, 78, rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; Faculté de Médecine Paris-Sud Saclay, 63, rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France
| | - E Debras
- AP-HP, GHU-Sud, CHU Bicêtre, Service Gynécologie Obstétrique, 78, rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; Faculté de Médecine Paris-Sud Saclay, 63, rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France
| | - M-E Neveu
- AP-HP, GHU-Sud, CHU Bicêtre, Service Gynécologie Obstétrique, 78, rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - A-G Pourcelot
- AP-HP, GHU-Sud, CHU Bicêtre, Service Gynécologie Obstétrique, 78, rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - H Fernandez
- AP-HP, GHU-Sud, CHU Bicêtre, Service Gynécologie Obstétrique, 78, rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; Faculté de Médecine Paris-Sud Saclay, 63, rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France.
| |
Collapse
|
47
|
Keyhanvar N, Zarghami N, Bleisinger N, Hajipour H, Fattahi A, Nouri M, Dittrich R. Cell-based endometrial regeneration: current status and future perspectives. Cell Tissue Res 2021; 384:241-254. [PMID: 33650018 DOI: 10.1007/s00441-021-03419-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/18/2021] [Indexed: 02/08/2023]
Abstract
Endometrial-related disorders including Asherman's syndrome, thin endometrium, pelvic organ prolapse, and cesarean scar pregnancies can be accompanied by different symptoms such as amenorrhea, infertility, abnormal placental implantation and recurrent miscarriage. Different methods have been introduced to overcome these problems such as surgery and hormonal therapy but none of them has shown promising outcomes. On the other hand, the development of novel regenerative therapeutic strategies has opened new avenues for the treatment of endometrial-related deficiencies. In this regard, different types of scaffolds, acellular matrices and also cell therapy with adult or stem cells have been investigated for the treatment of endometrial-related deficiencies. In this paper, we review the current status of cell-based endometrium regeneration using scaffold dependent and scaffold-free methods and future perspectives in this field. Moreover, we discuss the endometrial diseases that can be candidates for cell-based treatments. Also, the cells with the potential for endometrial regeneration are explained.
Collapse
Affiliation(s)
- Neda Keyhanvar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nathalie Bleisinger
- University Hospital Erlangen, OB/GYN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hamed Hajipour
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Nouri
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ralf Dittrich
- University Hospital Erlangen, OB/GYN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
48
|
Yang L, Wang L, Chen Y, Guo X, Miao C, Zhao Y, Li L, Zhang Q. Cold scissors versus electrosurgery for hysteroscopic adhesiolysis: A meta-analysis. Medicine (Baltimore) 2021; 100:e25676. [PMID: 33907137 PMCID: PMC8084071 DOI: 10.1097/md.0000000000025676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/07/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Intrauterine adhesion seriously affects reproductive health in women. Hysteroscopic adhesiolysis using cold scissors or electrosurgery is the main treatment, although there is no consensus on the preferable method. This review aimed to compare the efficacy and safety of these methods for treating moderate to severe intrauterine adhesion. METHODS PubMed, EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure were searched on April 30, 2020. Randomized controlled trials and observational studies that were published in all languages (must contain English abstracts) and compared hysteroscopic cold scissors with electrosurgery for the treatment of intrauterine adhesion were included. Mean differences, odds ratios, and 95% confidence intervals (CIs) were reported. Bias was evaluated using the Cochrane Risk of Bias assessment tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Data were analyzed using RevMan software (Review Manager version 5.3, The Cochrane Collaboration, 2014). Two researchers independently extracted data and assessed the quality of the included studies. If a consensus was not reached, a third researcher was consulted. RESULTS Nine studies (n = 761; 6 randomized controlled trials and 3 retrospective studies) were included. The intrauterine adhesion recurrence rate with second look hysteroscopy was significantly lower (odds ratio = 0.30, 95% CI = 0.16-0.56; P = .0002) with hysteroscopic cold scissors than with electrosurgery. The total operation time was significantly shorter (mean difference = -7.78, 95% confidence interval = -8.50 to -7.07; P < .00001), intraoperative blood loss was significantly lower (mean difference = -9.88, 95% CI = -11.25 to -8.51; P < .00001), and the menstrual flow rate was significantly higher (odds ratio = 4.36, 95% confidence interval = 2.56-7.43; P < .00001) with hysteroscopic cold scissors than with electrosurgery. There were no significant differences in the pregnancy rate. One complication (1 perforation case, hysteroscopic cold scissors group) was reported. CONCLUSIONS Hysteroscopic cold scissors is more efficient in preventing intrauterine adhesion recurrence, increasing the menstrual flow, reducing intraoperative blood loss, and shortening the operation time.
Collapse
Affiliation(s)
- Liuqing Yang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Ling Wang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
- The First Clinical College of Zhejiang Chinese Medical University
| | - Yun Chen
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Xiaoshi Guo
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Chenyun Miao
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Ying Zhao
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Lu Li
- College of Pharmaceutical Sciences, Zhejiang University, Xihu District, Hangzhou, Zhejiang, PR China
| | - Qin Zhang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| |
Collapse
|
49
|
Wu C, Dong Y, Li Y, Liu H. The efficacy of amniotic membrane-mediated sequential double-barrier therapy for the treatment of postoperative intrauterine adhesions. Medicine (Baltimore) 2021; 100:e25416. [PMID: 33847639 PMCID: PMC8051972 DOI: 10.1097/md.0000000000025416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/10/2021] [Indexed: 01/04/2023] Open
Abstract
To study the efficacy of using amniotic membrane, balloon and intrauterine device (IUD) as barrier therapy to prevent re-adhesion after hysteroscopic adhesiolysis.A total of 45 patients diagnosed with intrauterine adhesions in Changzhou Maternal and Child Health Hospital from June 2014 to December 2017 were included in this retrospective case control study. According to different postoperative isolation barrier methods, the patients were divided into group A (Foley balloon + fresh amniotic membrane Day1 + IUD Day7) (22 cases) and group B (Foley balloon Day1 + IUD Day7) (23 cases). Three months after the surgery, the second hysteroscopy was performed to observe the condition of the uterine cavity and the improvement of menstruation, and to monitor the thickness of the endometrium.The efficacy of hysteroscopic procedure in group A was significantly higher than that of group B (P < .05). After 3 months of treatment, the improvement rate of menstruation was significantly higher in group A than in group B (P < .05). Endometrial thickness in both group A and B was significantly increased compared with that before the surgery (P < .05). The postoperative endometrium of group A was significantly thicker than that of group B (P < .05).Amniotic membrane-mediated sequential double-barrier method is clinically feasible for preventing recurrent intrauterine adhesions.
Collapse
|
50
|
Genovese F, Di Guardo F, Monteleone MM, D'Urso V, Colaleo FM, Leanza V, Palumbo M. Hysteroscopy as An Investigational Operative Procedure in Primary and Secondary Infertility: A Systematic Review. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2021; 15:80-87. [PMID: 33687159 PMCID: PMC8052803 DOI: 10.22074/ijfs.2020.134704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
Background The aim of this study is to review current indications to diagnostic and/or operative hysteroscopy in
primary and secondary infertility, as well as to determine its efficacy in improving fertility. Materials and Methods We gathered available evidence about the role of hysteroscopy in the management of vari-
ous infertility conditions. Literature from 2000 to 2020 that pertained to this topic were retrieved and appropriately
selected.
Results Hysteroscopy does not appear as a first line diagnostic procedure for every clinical scenario. However, its di-
agnostic sensitivity and specificity in assessing intrauterine pathology is superior to all other non-invasive techniques,
such as saline infusion/gel instillation sonography (SIS/GIS), transvaginal sonography (TVS) and hysterosalpingog-
raphy (HSG). Hysteroscopy allows not only a satisfactory evaluation of the uterine cavity but also, the eventual treat-
ment of endocavitary pathologies that may affect fertility both in spontaneous and assisted reproductive technology
(ART) cycles. Conclusion Hysteroscopy, due to its diagnostic and therapeutic potential, should be regarded as a necessary step in
infertility management. However, in case of suspected uterine malformation, hysteroscopy should be integrated with
other tests [three-dimensional (3D) ultrasound or magnetic resonance imaging (MRI)] for diagnostic confirmation.
Collapse
Affiliation(s)
- Fortunato Genovese
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Viale Carlo Azeglio Ciampi, Catania, Italy
| | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Viale Carlo Azeglio Ciampi, Catania, Italy.
| | - Morena Maria Monteleone
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Viale Carlo Azeglio Ciampi, Catania, Italy
| | - Valentina D'Urso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Viale Carlo Azeglio Ciampi, Catania, Italy
| | - Francesco Maria Colaleo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Viale Carlo Azeglio Ciampi, Catania, Italy
| | - Vito Leanza
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Viale Carlo Azeglio Ciampi, Catania, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Viale Carlo Azeglio Ciampi, Catania, Italy
| |
Collapse
|