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Yang J, Zheng X, Pan J, Chen Y, Chen C, Huang Z. Advancing intrauterine adhesion severity prediction: Integrative machine learning approach with hysteroscopic cold knife system, clinical characteristics and hematological parameters. Comput Biol Med 2024; 177:108599. [PMID: 38796878 DOI: 10.1016/j.compbiomed.2024.108599] [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: 03/11/2024] [Revised: 04/19/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
Intrauterine Adhesion (IUA) constitute a significant determinant impacting female fertility, potentially leading to infertility, miscarriage, menstrual irregularities, and placental complications. The precise assessment of the severity of IUA is pivotal for the customization of personalized treatment plans, aimed at enhancing the success rate of treatments and mitigating reproductive health risks. This study proposes bTLSMA-SVM-FS, a novel feature selection machine learning model that integrates an enhanced slime mould algorithm (SMA), termed TLSMA, with support vector machines (SVM), aiming to develop a predictive model for assessing the severity of IUA. Initially, a series of optimization comparative experiments were conducted on the TLSMA using the CEC 2017 benchmark functions. By comparing it with eleven meta-heuristic algorithms as well as eleven SOTA algorithms, the experimental outcomes corroborated the superior performance of the TLSMA. Subsequently, the developed bTLSMA-SVM-FS model was employed to conduct a thorough analysis of the clinical features of 107 IUA patients from Wenzhou People's Hospital, comprising 61 cases of moderate IUA and 46 cases of severe IUA. The evaluation results of the model demonstrated exceptional performance in predicting the severity of IUA, achieving an accuracy of 86.700 % and a specificity of 87.609 %. Moreover, the model successfully identified critical factors influencing the prediction of IUA severity, including the preoperative Chinese IUA score, production times, thrombin time, preoperative endometrial thickness, and menstruation. The identification of these key factors not only further validated the efficacy of the proposed model but also provided vital scientific evidence for a deeper understanding of the pathogenesis of IUA and the enhancement of targeted treatment strategies.
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Affiliation(s)
- Jie Yang
- Department of Obstetrics and Gynecology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, 325000, China.
| | - Xiaodong Zheng
- Department of Obstetrics and Gynecology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, 325000, China.
| | - Jiajia Pan
- Department of Obstetrics and Gynecology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, 325000, China.
| | - Yumei Chen
- Department of Obstetrics and Gynecology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, 325000, China.
| | - Cong Chen
- Department of Obstetrics and Gynecology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, 325000, China.
| | - Zhiqiong Huang
- Department of Obstetrics and Gynecology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, 325000, China.
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Cao Y, Qi J, Wang J, Chen L, Wang Y, Long Y, Li B, Lai J, Yao Y, Meng Y, Yu X, Chen X, Ng LG, Li X, Lu Y, Cheng X, Cui W, Sun Y. Injectable "Homing-Like" Bioactive Short-Fibers for Endometrial Repair and Efficient Live Births. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2306507. [PMID: 38504456 PMCID: PMC11132084 DOI: 10.1002/advs.202306507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/14/2023] [Indexed: 03/21/2024]
Abstract
The prevalence of infertility caused by endometrial defects is steadily increasing, posing a significant challenge to women's reproductive health. In this study, injectable "homing-like" bioactive decellularized extracellular matrix short-fibers (DEFs) of porcine skin origin are innovatively designed for endometrial and fertility restoration. The DEFs can effectively bind to endometrial cells through noncovalent dipole interactions and release bioactive growth factors in situ. In vitro, the DEFs effectively attracted endometrial cells through the "homing-like" effect, enabling cell adhesion, spreading, and proliferation on their surface. Furthermore, the DEFs effectively facilitated the proliferation and angiogenesis of human primary endometrial stromal cells (HESCs) and human umbilical vein endothelial cells (HUVECs), and inhibited fibrosis of pretreated HESCs. In vivo, the DEFs significantly accelerated endometrial restoration, angiogenesis, and receptivity. Notably, the deposition of endometrial collagen decreased from 41.19 ± 2.16% to 14.15 ± 1.70% with DEFs treatment. Most importantly, in endometrium-injured rats, the use of DEFs increased the live birth rate from 30% to an impressive 90%, and the number and development of live births close to normal rats. The injectable "homing-like" bioactive DEFs system can achieve efficient live births and intrauterine injection of DEFs provides a new promising clinical strategy for endometrial factor infertility.
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Affiliation(s)
- Yumeng Cao
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Jia Qi
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Juan Wang
- Department of OrthopaedicsShanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Liang Chen
- Department of OrthopaedicsShanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Yuan Wang
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Yijing Long
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Boyu Li
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Junliang Lai
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Yejie Yao
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Yiwen Meng
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Xiaohua Yu
- Hangzhou Phil Stone Biotech Co., Ltd.HangzhouZhejiang311215P. R. China
| | - Xiao‐Dong Chen
- Department of Comprehensive DentistryUniversity of Texas Health Science Center at San AntonioSan AntonioTX78229USA
- Research ServiceSouth Texas Veterans Health Care SystemAudie Murphy VA Medical CenterSan AntonioTX78229USA
| | - Lai Guan Ng
- Shanghai Immune Therapy InstituteShanghai Jiao Tong University School of Medicine affiliated Renji HospitalShanghai200127P. R. China
| | - Xinyu Li
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Yao Lu
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Xiaoyue Cheng
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
| | - Wenguo Cui
- Department of OrthopaedicsShanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Yun Sun
- Department of Reproductive Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai200135P. R. China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsShanghai200135P. R. China
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Ding H, Zhang H, Qiao R, Sun N, Ji Y, Pang W, Li W, Zhang Q. Comparing the efficacy and pregnancy outcome of intrauterine balloon and intrauterine contraceptive device in the prevention of adhesion reformation after hysteroscopic adhesiolysis in infertile women: a prospective, randomized, controlled trial study. Reprod Biol Endocrinol 2024; 22:49. [PMID: 38654308 PMCID: PMC11036652 DOI: 10.1186/s12958-024-01222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
STUDY OBJECTIVE To evaluate the efficacy and pregnancy outcomes of intrauterine balloon and intrauterine contraceptive devices in the prevention of adhesion reformation following hysteroscopic adhesiolysis in infertile women with moderate to severe intrauterine adhesion. DESIGN A prospective, randomized, controlled trial study. SETTING A tertiary university hospital. PATIENTS A total of 130 patients with moderate (American Fertility Society [AFS] score of 5-8) and severe (AFS score of 9-12) intrauterine adhesions were recruited. INTERVENTIONS 86 patients were evenly allocated to group treated with an IUD for 1 month and group treated with an IUD for 2 months. 44 patients were allocated to group treated with a Foley catheter balloon.(IUD: Yuangong IUD). MEASUREMENTS AND MAIN RESULTS The primary outcome measures were the AFS score, endometrial thickness, and pregnancy outcome. After hysteroscopy, the AFS score was significantly decreased(P<0.05), whereas endometrial thickness was significantly increased across the three groups(P<0.001). Notably, the decline in the AFS score in the balloon group was greater than that in the IUD-1-month group and IUD-2-month group(P<0.01), with no significant difference between the IUD groups(P = 0.298). Lastly, In addition, the extent of the increase in endometrial thickness(P = 0.502) and the pregnancy outcomes(P = 0.803) in the three groups were not significantly different. CONCLUSION Inserting a balloon or placing an IUD for one or two months can effectively lower the risk of adhesion recurrence and restore the shape of the uterine cavity. While the therapeutic effect of the balloon was superior to that of the IUD, no significant differences were observed in the one-month and two-month IUD groups. TRIAL REGISTRATION This research was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/enIndex.aspx ); Clinical trial registry identification number: ChiCTR-IOR-17,011,943 ( http://www.chictr.org.cn/showprojen.aspx?proj=17979 ). Date of trial registration: July 11, 2017.
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Affiliation(s)
- HaiXia Ding
- Center for Reproductive Medicine & Fertility Preservation Program, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Honghong Zhang
- Reproductive Medicine Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, People's Republic of China
| | - Rui Qiao
- Center for Reproductive Medicine & Fertility Preservation Program, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Ningxia Sun
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, Shanghai, People's Republic of China
| | - Yixuan Ji
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, Shanghai, People's Republic of China
| | - Wenjuan Pang
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, Shanghai, People's Republic of China
| | - Wen Li
- Center for Reproductive Medicine & Fertility Preservation Program, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Qing Zhang
- Center for Reproductive Medicine & Fertility Preservation Program, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
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Fan J, Xie J, Liao Y, Lai B, Zhou G, Lian W, Xiong J. Human umbilical cord-derived mesenchymal stem cells and auto-crosslinked hyaluronic acid gel complex for treatment of intrauterine adhesion. Aging (Albany NY) 2024; 16:6273-6289. [PMID: 38568100 PMCID: PMC11042966 DOI: 10.18632/aging.205704] [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: 10/24/2023] [Accepted: 03/09/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE The purpose of this study was to explore the therapeutic characteristics of mesenchymal stem cells generated from human umbilical cord (hUC-MSCs) when utilized in conjunction with auto-crosslinked hyaluronic acid gel (HA-gel) for the management of intrauterine adhesion (IUA). The goal was to see how this novel therapy could enhance healing and improve outcomes for IUA patients. METHODS In this study, models of intrauterine adhesion (IUA) were established in Sprague-Dawley (SD) rats, which were then organized and divided into hUC-MSCs groups. The groups involved: hUC-MSCs/HA-gel group, control group, and HA-gel group. Following treatment, the researchers examined the uterine cavities and performed detailed analyses of the endometrial tissues to determine the effectiveness of the interventions. RESULTS The results indicated that in comparison with to the control group, both HA-gel, hUC-MSCs, and hUC-MSCs/HA-gel groups showed partial repair of IUA. However, in a more notable fashion transplantation of hUC-MSCs/HA-gel complex demonstrated significant dual repair effects. Significant outcomes were observed in the group treated with hUC-MSCs and HA-gel, they showed thicker endometrial layers, less fibrotic tissue, and a higher number of endometrial glands. This treatment strategy also resulted in a significant improvement in fertility restoration, indicating a profound therapeutic effect. CONCLUSIONS The findings of this study suggest that both HA-gel, hUC-MSCs, and hUC-MSCs/HA-gel complexes have the potential for partial repair of IUA and fertility restoration caused by endometrium mechanical injury. Nonetheless, the transplantation of the hUC-MSCs/HA-gel complex displayed exceptional dual healing effects, combining effective anti-adhesive properties with endometrial regeneration stimuli.
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Affiliation(s)
- Jiaying Fan
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jingying Xie
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Yunsheng Liao
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Baoyu Lai
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Guixin Zhou
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Wenqin Lian
- Department of Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jian Xiong
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
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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).
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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
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Motan T, Cockwell H, Elliott J, Antaki R. Guideline No. 446: Hysteroscopic Surgery in Fertility Therapy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102400. [PMID: 38320665 DOI: 10.1016/j.jogc.2024.102400] [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] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To evaluate the indications, benefits, and risks of hysteroscopy in the management of patients with infertility and provide guidance to gynaecologists who manage common conditions in these patients. TARGET POPULATION Patients with infertility (inability to conceive after 12 months of unprotected intercourse) undergoing investigation and treatment. BENEFITS, HARMS, AND COSTS Hysteroscopic surgery can be used to diagnose the etiology of infertility and improve fertility treatment outcomes. All surgery has risks and associated complications. Hysteroscopic surgery may not always improve fertility outcomes. All procedures have costs, which are borne either by the patient or their health insurance provider. EVIDENCE We searched English-language articles from January 2010 to May 2021 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library (see Appendix B for MeSH search terms). VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations). INTENDED AUDIENCE Gynaecologists who manage common conditions in patients with infertility. TWEETABLE ABSTRACT When offering hysteroscopic surgery to patients with infertility, ensure it improves the live birth rate. SUMMARY STATEMENTS RECOMMENDATIONS.
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Motan T, Cockwell H, Elliott J, Antaki R. Directive clinique n o446 : Chirurgie hystéroscopique dans les traitements de fertilité. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102399. [PMID: 38325735 DOI: 10.1016/j.jogc.2024.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
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Moore O, Tzur T, Vaknin Z, Rabbi ML, Smorgick N. Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions? Arch Gynecol Obstet 2024; 309:205-210. [PMID: 37782418 DOI: 10.1007/s00404-023-07238-8] [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: 10/19/2022] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To describe the feasibility of hysteroscopy-assisted suction curettage for early pregnancy loss and to investigate whether it reduces the rates of retained products of conception (RPOC) and intrauterine adhesions (IUA). DESIGN Prospective single-arm cohort study. SETTING University-affiliated Department of Obstetrics and Gynecology. PATIENTS Women admitted for surgical evacuation of early pregnancy loss were invited to participate in the study. INTERVENTION Vaginal misoprostol was administered for cervical ripening preoperatively. Under general anesthesia, a diagnostic hysteroscopy was performed to identify the pregnancy's implantation wall, followed by ultrasound-guided suction and curettage directed to the implantation wall, and then diagnostic hysteroscopy to verify complete uterine cavity emptying. Postoperative IUA were evaluated by follow-up office hysteroscopy. MAIN OUTCOME MEASURE Identification of the pregnancy's implantation wall on hysteroscopy, and intra-, and postoperative complications associated with the procedure. The evaluation of postoperative IUA was limited due to the COVID-19 pandemic-related restrictions on elective procedures. RESULTS Forty patients were included in the study group. Their mean age was 34.0 ± 6.6 years, and their mean gestational age was 8.9 ± 1.6 weeks. The implantation wall was clearly visualized on hysteroscopy in 33 out of 40 cases (82.5%). The mean operative time was 17.2 ± 8.8 min, and no intraoperative complications occurred. Suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed in 4 cases, and the histologic examination confirmed the presence of RPOC in three of them. Follow-up office hysteroscopy was performed in nine women: mild IUA was diagnosed in one case and a normal cavity was confirmed in eight cases. A new pregnancy was reported at the time of follow-up in 15 cases, while 12 women declined to attend the follow-up hysteroscopy and four were lost to follow-up. CONCLUSIONS Hysteroscopy-assisted suction curettage for early pregnancy loss is a safe, short, and inexpensive procedure, which allows the identification of the pregnancy's wall in most cases and may reduce the rates of RPOC.
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Affiliation(s)
- Omer Moore
- Department of Obstetrics and Gynecology, The Yitzhak Shamir (Formerly Assaf Harofeh) Medical Center, Zerifin, Israel.
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, 70300, Zeriffin, Beer Yaakov, Israel.
| | - Tamar Tzur
- Department of Obstetrics and Gynecology, The Yitzhak Shamir (Formerly Assaf Harofeh) Medical Center, Zerifin, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Vaknin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir (Formerly Assaf Harofeh) Medical Center, Zerifin, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Landau Rabbi
- Department of Obstetrics and Gynecology, The Yitzhak Shamir (Formerly Assaf Harofeh) Medical Center, Zerifin, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Smorgick
- Department of Obstetrics and Gynecology, The Yitzhak Shamir (Formerly Assaf Harofeh) Medical Center, Zerifin, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Uterine fibroids significantly impact women's reproductive health, influencing fertility potential and pregnancy outcomes. Their growth, often facilitated by hormonal influences like estrogen and progesterone, can cause considerable disruptions in the uterus, leading to symptoms and complications that impact the quality of life and reproductive prospects of women.This article provides an exhaustive discussion of uterine fibroids, including pathophysiology, their impact on endometrial function, receptivity, fertility, and pregnancy outcomes, and the management of infertility in patients with uterine fibroids. It underlines the critical role of uterine fibroids in women's reproductive health, emphasizing the importance of effective diagnosis and treatment to promote fertility and improve pregnancy outcomes.
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Affiliation(s)
- Samar Alkhrait
- Department of OBGYN, University of Chicago Medicine, OBGYN/N101, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Iana Malasevskaia
- Private Clinic of Obstetrics and Gynecology, Asbahi Street, Sana'a, Republic of Yemen
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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.
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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
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11
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Zhao LM, Da LC, Wang R, Wang L, Jiang YL, Zhang XZ, Li YX, Lei XX, Song YT, Zou CY, Huang LP, Zhang WQ, Zhang QY, Li QJ, Nie R, Zhang Y, Liang Y, Li-Ling J, Xie HQ. Promotion of uterine reconstruction by a tissue-engineered uterus with biomimetic structure and extracellular matrix microenvironment. SCIENCE ADVANCES 2023; 9:eadi6488. [PMID: 37967178 PMCID: PMC10651121 DOI: 10.1126/sciadv.adi6488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023]
Abstract
The recurrence rate for severe intrauterine adhesions is as high as 60%, and there is still lack of effective prevention and treatment. Inspired by the nature of uterus, we have developed a bilayer scaffold (ECM-SPS) with biomimetic heterogeneous features and extracellular matrix (ECM) microenvironment of the uterus. As proved by subtotal uterine reconstruction experiments, the mechanical and antiadhesion properties of the bilayer scaffold could meet the requirement for uterine repair. With the modification with tissue-specific cell-derived ECM, the ECM-SPS had the ECM microenvironment signatures of both the endometrium and myometrium and exhibited the property of inducing stem cell-directed differentiation. Furthermore, the ECM-SPS has recruited more endogenous stem cells to promote endometrial regeneration at the initial stage of repair, which was accompanied by more smooth muscle regeneration and a higher pregnancy rate. The reconstructed uterus could also sustain normal pregnancy and live birth. The ECM-SPS may thereby provide a potential treatment for women with severe intrauterine adhesions.
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Affiliation(s)
- Long-mei Zhao
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Frontier Medical Center, Tianfu Jincheng Laboratory, Chengdu, Sichuan 610212, China
| | - Lin-cui Da
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Reproductive Center of Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Rui Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Long Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan-lin Jiang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiu-zhen Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ya-xing Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiong-xin Lei
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yu-ting Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Chen-yu Zou
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Li-ping Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wen-qian Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qing-yi Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qian-jin Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Rong Nie
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Zhang
- Research Core Facility of West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Liang
- Research Core Facility of West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jesse Li-Ling
- Center of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hui-qi Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Frontier Medical Center, Tianfu Jincheng Laboratory, Chengdu, Sichuan 610212, China
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12
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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: 0] [Impact Index Per Article: 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.
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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.
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13
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Yao S, Zhou Z, Wang L, Lv H, Liu D, Zhu Q, Zhang X, Zhao G, Hu Y. Targeting endometrial inflammation in intrauterine adhesion ameliorates endometrial fibrosis by priming MSCs to secrete C1INH. iScience 2023; 26:107201. [PMID: 37456855 PMCID: PMC10344943 DOI: 10.1016/j.isci.2023.107201] [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: 03/01/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Intrauterine adhesion (IUA) is a common cause of uterine infertility and its histopathologic characteristic is endometrial fibrosis. A shortage of stem cells in the endometrial basalis has been recognized as a common cause of IUA development because approximately 90% of patients suffer from IUA after endometrial injury. In this study, we provide evidence that persistent inflammation is the main contributor to endometrial fibrosis in IUA patients. We further found that treating an IUA-like mouse model with ITI-hUC-MSCs (hUC-MSCs reprogrammed by IL-1β, TNF-α and IFN-γ) significantly decreased endometrial inflammation and fibrosis. Mechanistically, high levels of complement 1 inhibitor (C1INH) secreted by ITI-hUC-MSCs prevented inflammation from inducing profibrotic CD301+ macrophage polarization by downregulating the JAK-STAT signaling pathway. In conclusion, persistent inflammation in the endometria of IUA patients provides macrophage polarization with a profibrotic niche to promote endometrial fibrosis, and the powerful immunomodulatory effects of ITI-hUC-MSCs improve the immune microenvironment of endometrial regeneration.
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Affiliation(s)
- Simin Yao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhenhua Zhou
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Limin Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Haining Lv
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Dan Liu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qi Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiwen Zhang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Guangfeng Zhao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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14
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Jegaden M, Bleas C, Debras E, Couet D, Pourcelot AG, Capmas P, Fernandez H. Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes. J Minim Invasive Gynecol 2023; 30:494-501. [PMID: 36813132 DOI: 10.1016/j.jmig.2023.02.012] [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: 01/22/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
STUDY OBJECTIVE To study the severity of intrauterine adhesions (IUA) after uterine arterial embolization and to evaluate fertility, pregnancy, and obstetrical outcomes after hysteroscopic treatment. DESIGN Retrospective cohort. SETTING French University Hospital. PATIENTS Thirty-three patients under the age of 40 years who were treated by uterine artery embolization with nonabsorbable microparticles between 2010 and 2020 for symptomatic fibroids or adenomyosis, or postpartum hemorrhage. INTERVENTIONS All patients had a diagnosis of IUA after embolization. All patients desired future fertility. IUA was treated with operative hysteroscopy. MEASUREMENTS AND MAIN RESULTS Severity of IUA, number of operative hysteroscopies performed to obtain a normal cavity shape, pregnancy rate, and obstetrical outcomes. Of our 33 patients, 81.8% had severe IUA (state IV et V according to the European Society of Gynecological Endoscopy or state III according to the American fertility society classification). To restore fertility potential, an average of 3.4 operative hysteroscopies had to be performed [CI 95% (2.56-4.16)]. We reported a very low rate of pregnancy (8/33, 24%). Obstetrical outcomes reported are 50% of premature birth and 62.5% of delivery hemorrhage partly due to 37.5% of placenta accreta. We also reported 2 neonatal deaths. CONCLUSION IUA after uterine embolization is severe, and more difficult to treat than other synechiae, probably related to endometrial necrosis. Pregnancy and obstetrical outcomes have shown a low pregnancy rate, an increased risk of preterm delivery, a high risk of placental disorders, and very severe postpartum hemorrhage. Those results have to alert gynecologists and radiologists to the use of uterine arterial embolization in women who desire future fertility.
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Affiliation(s)
- Margaux Jegaden
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France.
| | - Cécile Bleas
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Elodie Debras
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France
| | - Déborah Couet
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Anne-Gaëlle Pourcelot
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors)
| | - Perrine Capmas
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP (Drs. Capmas, Fernandez), Villejuif, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, 8 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France (all authors); Faculty of medicine, University Paris-Saclay (Drs. Jegaden, Debras, Capmas, Fernandez), 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP (Drs. Capmas, Fernandez), Villejuif, France
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15
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Zhu Y, Wang T, Bao MJ, Qu XH, Li ZM. Effect of stem cell conditional medium-loading adhesive hydrogel on TGF-β1-induced endometrial stromal cell fibrosis. Front Bioeng Biotechnol 2023; 11:1168136. [PMID: 37214295 PMCID: PMC10192850 DOI: 10.3389/fbioe.2023.1168136] [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: 02/17/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction: Uterine adhesion (IUA) is a severe complication that results from uterine operations or uterine infections. Hysteroscopy is considered the gold standard for the diagnosis and treatment of uterine adhesions. Yet, this invasive procedure leads to re-adhesions after hysteroscopic treatment. Hydrogels loading functional additives (e.g., placental mesenchymal stem cells (PC-MSCs)) that can act as physical barriers and promote endometrium regeneration are a good solution. However, traditional hydrogels lack tissue adhesion which makes them unstable under a rapid turnover of the uterus, and PC-MSCs have biosafety risks when used as functional additives. Methods: In this study, we coupled an adhesive hydrogel with a PC-MSCs conditioned medium (CM) to form a hybrid of gel and functional additives (CM/Gel-MA). Results and Discussion: Our experiments show that CM/Gel-MA enhances the activity of endometrial stromal cells (ESCs), promotes cell proliferation, and reduces the expression of α-SMA, collagen I, CTGF, E-cadherin, and IL-6, which helps to reduce the inflammatory response and inhibit fibrosis. We conclude that CM/Gel-MA can more potentially prevent IUA by combining the physical barriers from adhesive hydrogel and functional promotion from CM.
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Affiliation(s)
- Yuan Zhu
- JXHC Key Laboratory of Fertility Preservation, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
- Department of Reproductive Health, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Ting Wang
- Department of Reproductive Health, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Ming-Jie Bao
- Department of Reproductive Health, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Xiao-Hui Qu
- Pathology Department, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Zeng-Ming Li
- JXHC Key Laboratory of Fertility Preservation, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
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16
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Research progress of stem cell therapy for endometrial injury. Mater Today Bio 2022; 16:100389. [PMID: 36033375 PMCID: PMC9403503 DOI: 10.1016/j.mtbio.2022.100389] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Endometrial damage is an important factor leading to infertility and traditional conventional treatments have limited efficacy. As an emerging technology in recent years, stem cell therapy has provided new hope for the treatment of this disease. By comparing the advantages of stem cells from different sources, it is believed that menstrual blood endometrial stem cells have a good application prospect as a new source of stem cells. However, the clinical utility of stem cells is still limited by issues such as colonization rates, long-term efficacy, tumor formation, and storage and transportation. This paper summarizes the mechanism by which stem cells repair endometrial damage and clarifies the material basis of their effects from four aspects: replacement of damaged sites, paracrine effects, interaction with growth factors, and other new targets. According to the pathological characteristics and treatment requirements of intrauterine adhesion (IUA), the research work to solve the above problems from the aspects of functional bioscaffold preparation and multi-functional platform construction is also summarized. From the perspective of scaffold materials and component functions, this review will provide a reference for comprehensively optimizing the clinical application of stem cells.
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Zhang L, Feng L. Application of hysteroscopy in female fertility preservation. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1472-1478. [PMID: 36481624 PMCID: PMC10930613 DOI: 10.11817/j.issn.1672-7347.2022.220237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Indexed: 12/13/2022]
Abstract
Under the background of the trend in late marriage and the relaxation of family planning policy, the reproductive behavior of women has changed and the proportion of elderly pregnant women has increased progressively year by year. Thus the female fertility preservation is particularly important. As the cradle of life, uterine malformation and uterine cavity diseases may have adverse effects on embryo implantation and development. Several common intrauterine diseases, such as uterine submucosal fibroids, endometrial polyps, intrauterine adhesions, uterine malformation, cesarean scar diverticulum, and embryo residues, may affect female fertility. Hysteroscopy is the gold standard for the diagnosis and treatment for intrauterine diseases. With the progress in science and technology, the refinement of hysteroscopy instruments and the promotion of transvaginal endoscopic technology, hysteroscopy will yield brilliant results in female fertility preservation. The knowledge and training related to hysteroscopy should be continuously promoted and popularized, so that it can be mastered by more clinicians and applied in clinical practice to benefit more female patients.
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Affiliation(s)
- Luping Zhang
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
| | - Limin Feng
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
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18
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Sun D, Zhao X, Huang H, Zhang A, Cheng W, Yang Y, Xu D. In vitro fertilization and embryo transfer may improve live birth rate for patients with intrauterine adhesions after hysteroscopic adhesiolysis. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1559-1567. [PMID: 36481634 PMCID: PMC10930628 DOI: 10.11817/j.issn.1672-7347.2022.220546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The prevalence of intrauterine adhesion (IUA) increased gradually, which seriously affected female reproductive health and fertility. This study aims to analyze the clinical features of pre-, intra-, and post hysteroscopic adhesiolysis (HA) and to identify the main risk factors for non-live birth and other factors affecting pregnancy outcome in patients with IUA. METHODS A total of 486 IUA patients with reproductive needs, who underwent HA in the third Xiangya Hospital of Central South University from January 2017 to May 2018, were retrospectively included. The follow-up period was 2-3 years after operation. Univariate analysis and multivariate logistic regression analysis were used to explore the relationship between clinical features and live birth rate in patients with IUA. Pre-operative clinical indicators included age, gravidity, parity, abortion, IUA recurrence, menstrual patterns, and disease course. Intraoperative clinical features assessed in the last operation were uterine cavity length, IUA appearance, IUA area, number of visible uterine cornua, number of visible tubal ostia, and American Fertility Society (AFS) scores. The relationship between clinical indicators and postoperative live birth rate was investigated by univariate analysis and multivariate logistic regression analysis. Pregnancy pattern was the main variable. RESULTS Among the 486 IUA patients included in this study, there were 256 (52.67%) live births and 230 (47.33%) non-live births. Univariate analysis and multivariate logistic regression showed that the live birth rate of in vitro fertilization and embryo transfer (IVF-ET) after HA was higher than that of spontaneous pregnancy (OR=0.557, 95% CI 0.361 to 0.861, P=0.008). When the bilaterally fallopian tube ostia were invisible in the last operation (OR=0.322, 95% CI 0.104 to 0.997, P=0.049), patients were more likely to have live birth. The older the patient was, the lower the live birth rate was (OR=1.081, 95% CI 1.034 to 1.131, P<0.001). The live birth rate would be low when the last AFS score was moderate (OR=2.973, 95% CI to 1.541 to 5.738, P<0.010). CONCLUSIONS Based on the outcome of the first pregnancy after HA, IUA patients' pregnancy patterns, age, number of visible tubal ostia, and AFS scores noted by a second-look hysteroscopy, are the factors influencing the prognosis for the live birth rate in IUA patients. IVF-ET may improve live birth rate for patients with IUA after HA.
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Affiliation(s)
- Dan Sun
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, 410013.
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Guangxi Medical University, Nanning 530021.
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, 410013.
| | - Huan Huang
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, 410013
| | - Aiqian Zhang
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, 410013
| | - Wenwei Cheng
- Department of Medical Administration, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yimin Yang
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, 410013.
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, 410013.
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19
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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: 6] [Impact Index Per Article: 3.0] [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.
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Zhao X, Sun D, Zhang A, Huang H, Zhu X, Yi S, Xu D. Uterine Cavity Parameters Evaluated by Hysteroscopy can Predict the Live Birth Rate For Intrauterine Adhesion Patients. Front Med (Lausanne) 2022; 9:926754. [PMID: 35783613 PMCID: PMC9249163 DOI: 10.3389/fmed.2022.926754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
We aim to establish an objective and accurate prediction model by evaluating the uterine cavity and correlate these key factors with the live birth rate after hysteroscopic adhesiolysis (HA). A total of 457 intrauterine adhesions (IUA) patients were retrospectively enrolled in this study. The participants underwent HA and second-look hysteroscopy at the Third Xiangya Hospital of Central South University. Pregnancy outcomes, including spontaneous live births and no live births (miscarriages and infertility), were followed. Clinical parameters, containing the number of visible uterine horns and tubal ostia, the length of the uterine cavity, among others, were measured and analyzed to determine the dominant variables in an attempt to establish the live birth rate, prediction models. Women in the no live birth group were older than that in the live birth group (P = 0.0002, OR = 0.895, 95% CI: 0.844–0.949) and were more likely to be 2 gravidity (P = 0.0136, OR = 2.558, 95% CI: 1.213–5.394). Uterine cavity length in pre-HA hysteroscopy was longer in the live birth group (P = 0.0018, OR = 1.735, 95% CI: 1.227–2.453), and adhesion scores in pre-HA hysteroscopy were more frequently above 6 (P = 0.0252, OR = 0.286, 95% CI: 0.096–0.856) in the no live birth group. During the second-look, hysteroscopy, visible bilateral fallopian tube ostia were more frequently observed in the live birth group (P = 0.0339, OR = 11.76, 95% CI: 1.207–114.611), and adhesion scores were 4–6 (P < 0.0001, OR = 0.032, 95% CI: 0.007–0.146) and above 6 (P < 0.0001, OR = 0.012, 95% CI: 0.002–0.073) in the no live birth group. The areas under the curves (AUCs) of the pre-HA and second-look hysteroscopy prediction models were 0.7552 and 0.8484, respectively. We established an objective and accurate method for evaluating the uterine cavity by hysteroscopy, and second-look hysteroscopy is more valuable than the fist hysteroscopy in predicting the live birth rate following HA. Visible bilateral fallopian tube ostia or adhesion scores were <4 in the second-look hysteroscopy might predict live birth after surgery.
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Guo Y, Shi X, Song D, Liu Y, Huang X, Xiao Y, Yang L, Xia E, Li TC. The efficacy of auto-cross-linked hyaluronic acid gel in addition to estradiol and intrauterine balloon in the prevention of adhesion reformation after hysteroscopic adhesiolysis. Reprod Biomed Online 2022; 45:501-507. [DOI: 10.1016/j.rbmo.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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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.
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Sun D, Mao X, Zhang A, Gao B, Huang H, Burjoo A, Xu D, Zhao X. Pregnancy Patterns Impact Live Birth Rate for Patients With Intrauterine Adhesions After Hysteroscopic Adhesiolysis: A Retrospective Cohort Study. Front Physiol 2022; 13:822845. [PMID: 35360249 PMCID: PMC8963734 DOI: 10.3389/fphys.2022.822845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The pregnancy patterns and other factors of live birth for patients with intrauterine adhesions (IUAs) were identified by analyzing the clinical features of pre-, intra-, and post-hysteroscopic adhesiolysis (HA). Design A total of 742 patients with IUAs who wanted to become pregnant underwent HA from January 2017 to May 2018 at the Third Xiangya Hospital of Central South University. The patient follow-up period was 2 years post-HA. A logistic regression was performed to analyze the clinical characteristics associated with a live birth for patients with IUAs. Pre-operative clinical indicators included age, gravidity, parity, abortion, IUA recurrence, menstrual patterns, disease course. Intraoperative clinical features assessed in the last operation were uterine cavity length, IUA appearance, IUA area, number of visible uterine cornua, number of visible tubal ostia, AFS scores. Pregnancy patterns were post-hysteroscopic adhesiolysis features. Results Among the 742 IUA patients, 348 (46.9%) had a live birth and 394 (53.1%) did not. A bivariate and binary logistic regression analysis showed that IUA patients’ pregnancy patterns, age, number of visible tubal ostia noted by a second-look hysteroscopy, and American Fertility Society (AFS) scores were significantly related to the live birth rate (P < 0.05). Conclusions Pregnancy patterns, age, number of visible tubal ostia, and AFS scores were significantly related to the live birth rate and may be considered potential predictors of the live birth rate in IUA patients. The indications of assisted reproductive technology (ART) might be a better choice for patients with recurrent IUAs.
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Affiliation(s)
- Dan Sun
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xuetao Mao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Aiqian Zhang
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Bingsi Gao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Huan Huang
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Arvind Burjoo
- Department of Obstetrics and Gynaecology, Bruno Cheong Hospital, Central Flacq, Mauritius
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Xingping Zhao,
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Laganà AS, Garzon S, Dababou S, Uccella S, Medvediev M, Pokrovenko D, Babunashvili EL, Buyanova SN, Schukina NA, Shcherbatykh Kaschchuk MG, Kosmas I, Licchelli M, Panese G, Tinelli A. Prevalence of intrauterine adhesions after myomectomy: a prospective multicenter observational study. Gynecol Obstet Invest 2022; 87:62-69. [PMID: 35168241 DOI: 10.1159/000522583] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate intrauterine adhesion formation after laparoscopic and laparotomic myomectomy. DESIGN Prospective, multicenter, observational study (ClinicalTrials.gov ID: NCT04030273). METHODS We included patients after laparotomic and laparoscopic myomectomy. All patients underwent post-surgical diagnostic hysteroscopy, after three months. The intrauterine adhesion rate and associated factors were investigated. RESULTS Between January 2020 and December 2020, 38 and 24 consecutive patients underwent laparoscopic and laparotomic myomectomy, respectively. All diagnostic hysteroscopies were performed in the office setting without complications. Intrauterine adhesions were identified in 19.4% of women (95% CI of 9 - 29%). Factors univariately associated (p <0.2) with the presence of intrauterine adhesions after myomectomy were previous uterine surgery, the surgical approach (laparoscopic or laparotomic), the number of removed fibroids, the type and diameter of the largest myoma, and the opening of the uterine cavity. In the multivariable analysis, only the opening of the uterine cavity (OR 51.99; 95% CI, 4.53 - 596.28) and the laparotomic approach (OR, 16.19; 95% CI, 1.66 - 158.35) were independently associated with the identification of intrauterine adhesions after myomectomy. LIMITATIONS One of the main limitations of our study is that we used uterine manipulator only in laparoscopic group; in addition, we did not perform a pre-operative hysteroscopy to evaluate the rate of intrauterine adhesions potentially present even before the myomectomy. CONCLUSIONS The prevalence of intrauterine adhesions after three months from surgery was significantly associated with the opening of the uterine cavity and the laparotomic approach.
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Affiliation(s)
- Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy,
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Susan Dababou
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Mykhailo Medvediev
- Department of Obstetrics and Gynecology, Dnipropetrovsk Medical Academy of the Health Ministry of Ukraine, Dnipro, Ukraine
| | - Darya Pokrovenko
- Department of Obstetrics and Gynecology, Dnipropetrovsk Medical Academy of the Health Ministry of Ukraine, Dnipro, Ukraine
| | - Evgenia Leonidovna Babunashvili
- Moscow Regional Institute of Obstetrics and Gynecology, Moscow State Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
| | - Svetlana Nikolaevna Buyanova
- Moscow Regional Institute of Obstetrics and Gynecology, Moscow State Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
| | - Natalya Alekseevna Schukina
- Moscow Regional Institute of Obstetrics and Gynecology, Moscow State Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
| | | | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Hatzikosta, University of Ioannina, Ioannina, Greece
| | - Martina Licchelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Italy
| | - Gaetano Panese
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Italy
- Division of Experimental Endoscopic Surgery, Imaging, Technology, and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Russian Federation
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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.
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Tempest N, Hill CJ, Maclean A, Marston K, Powell SG, Al-Lamee H, Hapangama DK. Novel microarchitecture of human endometrial glands: implications in endometrial regeneration and pathologies. Hum Reprod Update 2021; 28:153-171. [PMID: 34875046 PMCID: PMC8888994 DOI: 10.1093/humupd/dmab039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Human endometrium remains a poorly understood tissue of the female reproductive tract. The superficial endometrial functionalis, the site of embryo implantation, is repeatedly shed with menstruation, and the stem cell-rich deeper basalis is postulated to be responsible for the regeneration of the functionalis. Two recent manuscripts have demonstrated the 3D architecture of endometrial glands. These manuscripts have challenged and replaced the prevailing concept that these glands end in blind pouches in the basalis layer that contain stem cells in crypts, as in the intestinal mucosa, providing a new paradigm for endometrial glandular anatomy. This necessitates re-evaluation of the available evidence on human endometrial regeneration in both health and disease in the context of this previously unknown endometrial glandular arrangement. OBJECTIVE AND RATIONALE The aim of this review is to determine if the recently discovered glandular arrangement provides plausible explanations for previously unanswered questions related to human endometrial biology. Specifically, it will focus on re-appraising the theories related to endometrial regeneration, location of stem/progenitor cells and endometrial pathologies in the context of this recently unravelled endometrial glandular organization. SEARCH METHODS An extensive literature search was conducted from inception to April 2021 using multiple databases, including PubMed/Web of Science/EMBASE/Scopus, to select studies using keywords applied to endometrial glandular anatomy and regeneration, and the references included in selected publications were also screened. All relevant publications were included. OUTCOMES The human endometrial glands have a unique and complex architecture; branched basalis glands proceed in a horizontal course adjacent to the myometrium, as opposed to the non-branching, vertically coiled functionalis glands, which run parallel to each other as is observed in intestinal crypts. This complex network of mycelium-like, interconnected basalis glands is demonstrated to contain endometrial epithelial stem cells giving rise to single, non-branching functionalis glands. Several previous studies that have tried to confirm the existence of epithelial stem cells have used methodologies that prevent sampling of the stem cell-rich basalis. More recent findings have provided insight into the efficient regeneration of the human endometrium, which is preferentially evolved in humans and menstruating upper-order primates. WIDER IMPLICATIONS The unique physiological organization of the human endometrial glandular element, its relevance to stem cell activity and scarless endometrial regeneration will inform reproductive biologists and clinicians to direct their future research to determine disease-specific alterations in glandular anatomy in a variety of endometrial pathological conditions.
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Affiliation(s)
- Nicola Tempest
- Department of Women's and Children's Health, Centre for Women's Health Research, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK.,Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK.,Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Christopher J Hill
- Department of Women's and Children's Health, Centre for Women's Health Research, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
| | - Alison Maclean
- Department of Women's and Children's Health, Centre for Women's Health Research, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK.,Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
| | - Kathleen Marston
- Department of Women's and Children's Health, Centre for Women's Health Research, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
| | - Simon G Powell
- Department of Women's and Children's Health, Centre for Women's Health Research, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
| | - Hannan Al-Lamee
- Department of Women's and Children's Health, Centre for Women's Health Research, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK.,Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK.,Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Dharani K Hapangama
- Department of Women's and Children's Health, Centre for Women's Health Research, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK.,Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
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Ma J, Zhan H, Li W, Zhang L, Yun F, Wu R, Lin J, Li Y. Recent trends in therapeutic strategies for repairing endometrial tissue in intrauterine adhesion. Biomater Res 2021; 25:40. [PMID: 34819167 PMCID: PMC8611984 DOI: 10.1186/s40824-021-00242-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/31/2021] [Indexed: 12/25/2022] Open
Abstract
Intrauterine adhesion (IUA) is a common gynaecological disease that develops from infection or trauma. IUA disease may seriously affect the physical and mental health of women of childbearing age, which may lead to symptoms such as hypomenorrhea or infertility. Presently, hysteroscopic transcervical resection of adhesion (TCRA) is the principal therapy for IUAs, although its function in preventing the recurrence of adhesion and preserving fertility is limited. Pharmaceuticals such as hormones and vasoactive agents and the placement of nondegradable stents are the most common postoperative adjuvant therapy methods. However, the repair of injured endometrium is relatively restricted due to the different anatomical structures of the endometrium. Recently, the treatment outcome of IUAs has improved with the advancement of hysteroscopic techniques. In particular, the application of bioactive scaffolds combined with tissue engineering technology has proven to have high therapeutic potential or endometrial repair in IUA treatment. Herein, this review has summarized past therapeutic strategies, including postoperative adjuvant therapy, cell or therapeutic molecular delivery therapy methods and bioactive scaffold-based tissue engineering methods. Therefore, this review presented the recent therapeutic strategies for repairing endometrium treatment and pointed out the issues of clinical concern to provide alternative methods for the management of IUAs.
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Affiliation(s)
- Junyan Ma
- Zhejiang Provincial Key Laboratory for Precision Diagnosis & Treatment of Major Gynecological Diseases, Hangzhou, 310006, Zhejiang Province, China
| | - Hong Zhan
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Wen Li
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Liqi Zhang
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Feng Yun
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Ruijin Wu
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China.
| | - Jun Lin
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China.
| | - Yangyang Li
- Zhejiang Provincial Key Laboratory for Precision Diagnosis & Treatment of Major Gynecological Diseases, Hangzhou, 310006, Zhejiang Province, China.
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Stem cell-based therapy for ameliorating intrauterine adhesion and endometrium injury. Stem Cell Res Ther 2021; 12:556. [PMID: 34717746 PMCID: PMC8557001 DOI: 10.1186/s13287-021-02620-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023] Open
Abstract
Intrauterine adhesion refers to endometrial repair disorders which are usually caused by uterine injury and may lead to a series of complications such as abnormal menstrual bleeding, recurrent abortion and secondary infertility. At present, therapeutic approaches to intrauterine adhesion are limited due to the lack of effective methods to promote regeneration following severe endometrial injury. Therefore, to develop new methods to prevent endometrial injury and intrauterine adhesion has become an urgent need. For severely damaged endometrium, the loss of stem cells in the endometrium may affect its regeneration. This article aimed to discuss the characteristics of various stem cells and their applications for uterine tissue regeneration.
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Effectiveness of Hyaluronic Acid Gel and Intrauterine Devices in Prevention of Intrauterine Adhesions after Hysteroscopic Adhesiolysis in Infertile Women. J Minim Invasive Gynecol 2021; 29:284-290. [PMID: 34433103 DOI: 10.1016/j.jmig.2021.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To compare the recurrence rate, post-treatment American Fertility Society (AFS) score, ongoing pregnancy rate, and endometrial thickness of 3 secondary prevention therapies in preventing recurrent intrauterine adhesions (IUAs) and increasing pregnancy rates in infertile women after hysteroscopic adhesiolysis. DESIGN A retrospective study. SETTING A private fertility hospital. PATIENTS A total of 200 consecutive infertile women, with the desire to have a baby and were diagnosed as having IUAs detected by hysterosalpingogram, who underwent hysteroscopic adhesiolysis for IUAs from January, 2018 to May, 2020. INTERVENTIONS Women who underwent hysteroscopic adhesiolysis received hormone therapy, and one of the 3 secondary preventions: hyaluronic acid (HA) gel alone, intrauterine devices (IUDs) alone, or HA gel + IUD. MEASUREMENTS AND MAIN RESULTS Of the 200 women included in the final analysis, 121 received HA alone, 59 were treated with IUD alone, and 20 received HA gel + IUD combination. The mean post-treatment AFS score for IUAs was significantly lower in the HA gel + IUD group than the HA alone or the IUD alone groups (adjusted p = .01 and p = .02, respectively). Multivariable analysis revealed a significantly lower recurrence rate in the women after treatment with HA gel + IUD than HA alone (adjusted odds ratio, 0.19; 95% credible interval [CreI], 0.03-0.88). Women treated with HA gel + IUD also had reduced post-treatment AFS scores compared with HA alone (β coefficients, -0.83; 95% CreI, -1.64 to -0.01). For ongoing pregnancy rates after in vitro fertilization, the adjusted odds ratio for HA gel + IUD vs HA alone was 2.03 (95% CreI, 0.44-11.00) and for IUD alone vs HA alone was 1.13 (95% CreI, 0.41-3.29), indicating nonsignificant differences. There were no differences observed in endometrial thickness on the day of embryo transfer among the 3 groups. CONCLUSION The investigation of the primary outcome in reducing the recurrence rate IUA after treatment demonstrated that a combination of HA gel + IUD provides greater prevention of recurrent IUAs and may decrease post-treatment AFS scores for infertile women undergoing hysteroscopic adhesiolysis. However, for the secondary outcome of increasing pregnancy rates, there was no improvement in the ongoing pregnancy rates after in vitro fertilization.
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Zhao X, Gao B, Yang X, Zhang A, Jamail G, Li Y, Xu D. The density of endometrial glandular openings: a novel variable to predict the live birth rate in patients with intrauterine adhesions following hysteroscopic adhesiolysis. Hum Reprod 2021; 36:965-975. [PMID: 33486509 PMCID: PMC7970727 DOI: 10.1093/humrep/deaa377] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/20/2020] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION Can the density of endometrial glandular openings (DEGO) be a reliable and simple new variable in the prediction of live birth after hysteroscopic adhesiolysis? SUMMARY ANSWER The DEGO grade at follow-up hysteroscopy outperforms American Fertility Society (AFS) score in predicting the live birth rate after hysteroscopic adhesiolysis for patients with intrauterine adhesions (IUAs). WHAT IS KNOWN ALREADY Several methods, such as endometrial thickness and AFS score, have been proposed for predicting the live birth rate in patients with IUAs who undergo hysteroscopic adhesiolysis. STUDY DESIGN, SIZE, DURATION A test cohort of 457 patients with IUAs who underwent hysteroscopic adhesiolysis and had satisfactory follow-up hysteroscopy videos were retrospectively enrolled between January 2016 and January 2017. A validation cohort comprising 285 IUA patients was prospectively enrolled from March 2018 to August 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS An automated counting software tested the follow-up hysteroscopy videos to calculate the DEGO grade of all the 742 patients with IUAs after hysteroscopic adhesiolysis. The AFS score for each patient was also calculated at the same follow-up hysteroscopy. Logistic regression analysis was performed to develop prediction models to predict the live birth rate following hysteroscopic adhesiolysis. The performance of each of these prediction models was compared by calculating the AUC. MAIN RESULTS AND THE ROLE OF CHANCE In the test cohort (n = 457), 231 patients had a live birth, but 226 patients failed. In the validation cohort (n = 285), 117 patients had a live birth, while 168 patients did not. The logistic regression analysis revealed that both the DEGO grade and AFS score at follow-up hysteroscopy were closely correlated with the live birth rate in patients with IUAs (P = 0). The AUCs of AFS score and DEGO grade in the test cohort were 0.7112 and 0.8498, respectively (P < 0.0001). The AUCs of AFS score and DEGO grade in the prospective external validation cohort were 0.6937 and 0.8248, respectively (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION Further well-designed prospective clinical studies with a multicentric larger sample size should be needed to confirm the feasibility and efficacy of DEGO. WIDER IMPLICATIONS OF THE FINDINGS The DEGO grade is an accurate predictor factor of live birth rate in patients with IUAs following hysteroscopic adhesiolysis and can represent in the future an important and promising tool for assessing obstetric outcomes in IUAs. STUDY FUNDING/COMPETING INTEREST(S) This study is supported by National Key Research and Development Program of China (Grant No. 2018YFC1004800), Natural Science Foundation of China (Grant No. 81671492), Natural Science Foundation of Hunan (Grant No. 2020JJ5859). B.G. is supported by Chinese Scholarship Council (File number. 201806370178). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A
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Affiliation(s)
- Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Bingsi Gao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Xuan Yang
- Central South University Xiangya School of Medicine, Changsha, Hunan, 410013, China
| | - Aiqian Zhang
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Grace Jamail
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Yueran Li
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, 410013, China
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Hooker AB, Mansvelder FJ, Elbers RG, Frijmersum Z. Reproductive outcomes in women with mild intrauterine adhesions; a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2021; 35:6933-6941. [PMID: 34044740 DOI: 10.1080/14767058.2021.1931103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Moderate to severe intrauterine adhesions (IUAs) may greatly impact fertility, predisposing to pregnancy and obstetric complications. The impact of mild IUAs on reproductive performance remains unclear. A systematic review and meta-analysis was performed to examine the long-term reproductive outcomes in women with hysteroscopic identified and treated mild IUAs mild intrauterine adhesions (IUAs). METHODS An electronic literature search was conducted using MEDLINE and EMBASE from inception to June 2019. All prospective cohort, cross-sectional studies or randomized controlled trials Clinical trials in which reproductive outcomes of women with mild IUAs, were reported were included. RESULTS Five studies, reporting on reproductive outcomes of 229 women with hysteroscopic identified and treated mild IUAs, were included. The pregnancy rate was 62.3% (142 of 228; 95% CI: 0.55-0.72, I2 25%, p = .21) and in 86.6% (123 of 142) a live birth was encountered (95% CI: 0.71-0.97) with 83.1% (108 out of 130) term deliveries (95% CI: 0.53-0.95). A miscarriage was reported in 10% (13 of 130; 95% CI: 0.02-0.26). Due to the lack of a control group, reproductive outcomes were compared to a general population. Pregnancy and live birth rates were significantly lower in women with identified and treated mild IUAs, 90% versus 62.3% and respectively 99.5% versus 86.6%. The miscarriage rate was similar. Data on obstetric and neonatal outcomes are lacking. CONCLUSIONS Women with hysteroscopic identified and treated mild IUAs seem to have lower pregnancy and live birth rate compared to the general population. Future studies consisting of a large cohort of women with hysteroscopic identified and treated IUAs with structural follow-up and a control group are needed to confirm our findings.
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Affiliation(s)
- Angelo B Hooker
- Department of Obstetrics and Gynecology, Zaans Medical Center, Zaandam, The Netherlands.,Department of Obstetrics and Gynecology, Amsterdam UMC, location VU University Medical Center, Amsterdam, The Netherlands
| | - Floor J Mansvelder
- Clinical Epidemiology, Biostatistics and Bioinformatics, Master Evidence Based Practice in Health Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roy G Elbers
- Clinical Epidemiology, Biostatistics and Bioinformatics, Master Evidence Based Practice in Health Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Zayel Frijmersum
- Department of Obstetrics and Gynecology, Amsterdam UMC, location VU University Medical Center, Amsterdam, The Netherlands
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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.
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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.
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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.
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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
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Qiu T, Liu L, Zhou H, Sheng H, He Y, Liu M, Cai H. Analysis of endometrial microbiota in intrauterine adhesion by high-throughput sequencing. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:195. [PMID: 33708822 PMCID: PMC7940878 DOI: 10.21037/atm-20-2813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Intrauterine adhesions (IUA) arise from scar tissue formation between the endometrial surfaces in response to mechanical or infectious injuries. However, the potential role of endometrial microbiota in IUA remains unclear. We aimed to explore the composition of endometrial microbiota and its potential role in IUA. Methods We retrospectively enrolled 46 patients diagnosed with IUA and 21 infertility patients without intrauterine lesions, as control subjects. All cases were diagnosed with hysteroscopy and endometrial tissues were taken from the intrauterine cavity using a hysteroscopic cutting ring without electricity study. After endometrial samples were collected, DNA was extracted and amplified for barcoded Illumina high-throughput next-generation sequencing targeted to the 16S rRNA V4 region for microbiota. Microbiota data were compared between two groups using α-diversity, β-diversity and Nonmetric Multidimensional Scaling based on Weighted Unifrac distance. Results At the phyla level, the dominant bacteria included Proteobacteria, Firmicutes, Bacteroidetes and Actinobacteria. Proteobacteria accounted for more than 64.48%. At the genus level, the proportions of Klebsiella, Shewanella, and Lactobacillus were higher in patients with IUA than in non- IUA participants (20.67% and 8.77%, P=0.006, 13.37% and 4.53%, P=0.175, 12.74% and 6.95%, P=0.882; respectively). The proportion of Acinetobacter was significantly lower in patients with IUA than in non- IUA participants (P=0.005). Conclusions Endometrial microbiota differ between patients with IUA and infertility patients without intrauterine lesions, and the potential variation of endometrial microbiota might cause IUA.
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Affiliation(s)
- Tianmei Qiu
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Liu
- Department of Obstetrics and Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongwei Zhou
- State Key Laboratory of Organ Failure Research, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Huafang Sheng
- State Key Laboratory of Organ Failure Research, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuanli He
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mubiao Liu
- Department of Obstetrics and Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huihua Cai
- Department of Gynecology, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, China
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Cao M, Pan Y, Zhang Q, You D, Feng S, Liu Z. Predictive value of live birth rate based on different intrauterine adhesion evaluation systems following TCRA. Reprod Biol Endocrinol 2021; 19:13. [PMID: 33482838 PMCID: PMC7821669 DOI: 10.1186/s12958-021-00697-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/08/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the predictive value of five different intrauterine adhesion (IUA) evaluation systems for live birth rate following transcervical resection of adhesion (TCRA). METHOD This retrospective study included 128 women with IUA who desired for spontaneous conception after TCRA. All the patients were retrospectively scored by the American Fertility Society (AFS) classification, European Society of Gynecological Endoscopy (ESGE) classification, March's classification (March), Nasr classification (Nasr) and Chinese IUA diagnosis classification criteria (Chinese). The predictive value of these evaluation systems was determined by receiver operating characteristic (ROC) curves and area under a ROC curve (AUC). RESULTS The correlation coefficients of AFS, ESGE, March, Nasr and Chinese classification and the live birth rate were 0.313, 0.313, 0.288, 0.380, and 0.336, respectively. Among women with hypomenorrhea and amenorrhea, as well as women with no infertility, the severities determined by all five evaluation systems were correlated with live birth rate (P < 0.001). All five scoring systems were efficient to predict live birth rate. Among them, Nasr classification showed the highest AUC (0.748) with the best predictive value. Multivariate logistic regression analyses showed that Nasr classification had the highest OR (OR, 6.523; 95% CI, 2.612, 18.263). And, Nasr's classification system also showed highest sensitivity (81.8%) and negative predictive value (96.7%) when divide the system into mild IUA vs. moderate and severe IUA. CONCLUSION AFS, ESGE, March, Nasr and Chinese classification were demonstrated to be capable of predicting live birth following TCRA although the predictive capacities might be limited, and Nasr classification showed the highest predictive value of live birth.
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Affiliation(s)
- Mingzhu Cao
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingying Pan
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qingyan Zhang
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Danming You
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shuying Feng
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
| | - Zhi Liu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Hooker AB, de Leeuw RA, Twisk JWR, Brölmann HAM, Huirne JAF. Reproductive performance of women with and without intrauterine adhesions following recurrent dilatation and curettage for miscarriage: long-term follow-up of a randomized controlled trial. Hum Reprod 2021; 36:70-81. [PMID: 33320197 PMCID: PMC7801791 DOI: 10.1093/humrep/deaa289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/04/2020] [Indexed: 01/22/2023] Open
Abstract
STUDY QUESTION Are the long-term reproductive outcomes following recurrent dilatation and curettage (D&C) for miscarriage in women with identified and treated intrauterine adhesions (IUAs) comparable to women without IUAs. SUMMARY ANSWER Reproductive outcomes in women with identified and treated IUAs following recurrent D&C for miscarriage are impaired compared to women without IUAs; fewer ongoing pregnancies and live births are achieved with a prolonged time to a live birth. WHAT IS KNOWN ALREADY The Prevention of Adhesions Post Abortion (PAPA) study showed that application of auto-crosslinked hyaluronic acid (ACP) gel, an absorbable barrier in women undergoing recurrent D&C for miscarriage resulted in a lower rate of IUAs, 13% versus 31% (relative risk 0.43, 95% CI 0.22 to 0.83), lower mean adhesion score and significant less moderate to severe IUAs. It is unclear what the impact is of IUAs on long-term reproductive performance. STUDY DESIGN, SIZE, DURATION This was a follow-up of the PAPA study, a multicenter randomized controlled trial evaluating the application of ACP gel in women undergoing recurrent D&C for miscarriage. All included women received a diagnostic hysteroscopy 8-12 weeks after randomization to evaluate the uterine cavity and for adhesiolysis if IUAs were present. Here, we present the reproductive outcomes in women with identified and treated IUAs versus women without IUAs, 46 months after randomization. PARTICIPANTS/MATERIALS, SETTING, METHODS Between December 2011 and July 2015, 152 women with a first-trimester miscarriage with at least one previous D&C, were randomized for D&C alone or D&C with immediate intrauterine application of ACP gel. Participants were approached at least 30 months after randomization to evaluate reproductive performance, obstetric and neonatal outcomes and cycle characteristics. Additionally, the medical files of all participants were reviewed. Main outcome was ongoing pregnancy. Outcomes of subsequent pregnancies, time to conception and time to live birth were also recorded. MAIN RESULTS AND THE ROLE OF CHANCE In women pursuing a pregnancy, 14/24 (58%) ongoing pregnancies were recorded in women with identified and treated IUAs versus 80/89 (90%) ongoing pregnancies in women without IUAs odds ratio (OR) 0.18 (95% CI 0.06 to 0.50, P-value <0.001). Documented live birth was also lower in women with IUAs; 13/24 (54%) with versus 75/89 (84%) without IUAs, OR 0.22 (95% CI: 0.08 to-0.59, P-value 0.004). The median time to conception was 7 months in women with identified and treated IUAs versus 5 months in women without IUAs (hazard ratio (HR) 0.84 (95% CI 0.54 to 1.33)) and time to conception leading to a live birth 15 months versus 5.0 months (HR 0.54 (95% CI: 0.30 to 0.97)). In women with identified and treated IUAs, premature deliveries were recorded in 3/16 (19%) versus 4/88 (5%) in women without IUAs, P-value 0.01. Complications were recorded in respectively 12/16 (75%) versus 26/88 (30%), P-value 0.001. No differences were recorded in mean birth weight between the groups. LIMITATIONS, REASONS FOR CAUTION In the original PAPA study, randomization was applied for ACP gel application. Comparing women with and without IUAs is not in line with the randomization and therefore confounding of the results cannot be excluded. IUAs, if visible during routine hysteroscopy after randomization were removed as part of the study protocol; the influence of IUAs on reproductive outcome may therefore be underestimated. Women undergoing a recurrent D&C for miscarriage were included, a specific group likely to generate clinically significant adhesions. The findings should therefore not be generalized to all women undergoing D&C for miscarriage. WIDER IMPLICATIONS OF THE FINDINGS As IUAs have an impact on reproductive performance, even after hysteroscopic adhesiolysis, primary prevention is essential. Expectative and medical management should therefore be considered as serious alternatives for D&C in women with a miscarriage. In case D&C is necessary, application of ACP gel should be considered. STUDY FUNDING/COMPETING INTEREST(S) The original PAPA study (NTR 3120) was an investigator initiated study that was funded by the Foundation for scientific investigation in Obstetrics and Gynaecology of the Saint Lucas Andreas Hospital (currently renamed OLVG Oost), SWOGA. The syringes containing ACP gel were received from Anika Therapeutics, the manufacturer of Hyalobarrier® Gel Endo. The current follow-up study was also an investigator-initiated study without funding. The funder and sponsor had no role in the design of this follow-up study, data collection, data analysis, data interpretation, trial design, patient recruitment, writing of the report or any aspect pertinent to the study. ABH, RAL, JAFH and JWRT have no conflict to declare. HAMB reports being a member of safety board research Womed. TRIAL REGISTRATION NUMBER Netherlands Trial Register NTR 3120.
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Affiliation(s)
- Angelo B Hooker
- Department of Obstetrics and Gynecology, Zaans Medical Center, Zaandam, the Netherlands
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Robert A de Leeuw
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, the Netherlands
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Lin Y, Dong S, Zhao W, Hu KL, Liu J, Wang S, Tu M, Du B, Zhang D. Application of Hydrogel-Based Delivery System in Endometrial Repair. ACS APPLIED BIO MATERIALS 2020; 3:7278-7290. [PMID: 35019471 DOI: 10.1021/acsabm.0c00971] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A receptive endometrium with proper thickness is essential for successful embryo implantation. However, endometrial injury caused by intrauterine procedures often leads to pathophysiological changes in its environment, resulting in subsequent female infertility. Among diverse treatment methods of endometrial injury, hydrogels are a class of hydrophilic three-dimensional polymeric network with biocompatibility as well as the capability of absorbing water and encapsulation, which have potential applications as a promising intrauterine controlled-release delivery system. This review summarizes recent advances in the approaches of endometrial repair and further focuses on the application of a hydrogel-based delivery system in endometrial repair, including its preparation, therapeutic loading considerations, clinical applications, as well as working mechanisms.
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Affiliation(s)
- Yifeng Lin
- Key Laboratory of Re/productive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Shunni Dong
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science & Engineering, Zhejiang University, Hangzhou, Zhejiang 310027, PR China
| | - Wei Zhao
- Key Laboratory of Women Reproductive Health of Zhejiang Province, and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Kai-Lun Hu
- Key Laboratory of Re/productive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Juan Liu
- Key Laboratory of Re/productive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Siwen Wang
- Key Laboratory of Re/productive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Mixue Tu
- Key Laboratory of Re/productive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
| | - Binyang Du
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science & Engineering, Zhejiang University, Hangzhou, Zhejiang 310027, PR China
| | - Dan Zhang
- Key Laboratory of Re/productive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China.,Key Laboratory of Women Reproductive Health of Zhejiang Province, and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, PR China
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Reproductive Outcomes of In Vitro Fertilization-Intracytoplasmic Sperm Injection after Transcervical Resection of Adhesions: A Retrospective Cohort Study. J Minim Invasive Gynecol 2020; 28:1367-1374. [PMID: 33188921 DOI: 10.1016/j.jmig.2020.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To investigate pregnancy and obstetric outcomes of patients with intrauterine adhesions (IUAs) after treatment with in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) and fresh embryo transplantation after transcervical resection of adhesions (TCRA). DESIGN Retrospective cohort study. SETTING University-based reproductive medical center. PATIENTS A total of 535 patients with IUAs and with a history of TCRA and 1605 matched patients without a history of IUAs underwent IVF-ICSI and received fresh embryo transfers. INTERVENTIONS Between January 2014 and December 2018, all patients underwent IVF-ICSI treatment and received fresh embryo transfers. MEASUREMENTS AND MAIN RESULTS The patients in the TCRA group were matched with the control group according to strict criteria. Pregnancy and obstetric outcomes were compared. There were no significant differences in clinical pregnancies, ectopic pregnancies, live births, preterm births, and obstetric outcomes between the 2 groups (p >.05). However, the TCRA group had a higher risk of miscarriage than the control group (p = .048). CONCLUSION TCRA improved the reproductive outcomes of patients with IUAs, but the risk of miscarriage was higher than that in the general population. To avoid miscarriage, careful monitoring is critical for pregnant patients with a history of TCRA who undergo embryo transfers during IVF treatment.
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Huberlant S, Leprince S, Allegre L, Warembourg S, Leteuff I, Taillades H, Garric X, de Tayrac R, Letouzey V. In Vivo Evaluation of the Efficacy and Safety of a Novel Degradable Polymeric Film for the Prevention of Intrauterine Adhesions. J Minim Invasive Gynecol 2020; 28:1384-1390. [PMID: 33152532 DOI: 10.1016/j.jmig.2020.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To study the safety of a degradable polymeric film (DPF) and its efficacy on reducing the risk of intrauterine-adhesion (IUA) formation in a rat model. DESIGN A series of case-control studies relying on random allocation, where feasible. SETTING University and good practice animal laboratories. ANIMALS The animal models comprised female and male Oncins France Strain A and female Wistar rats. INTERVENTION(S) AND MEASUREMENTS The Oncins France Strain A rats were used for in vivo evaluation of the impact of the DPF on endometrial thickness and its effect on fertility. For in vivo evaluation of the biologic response, 40 Wistar rats were randomly allocated to intervention and control groups, with matched sampling time after surgery. Finally, for the in vivo evaluation of the DPF's efficacy on IUA prevention, a total of 24 Wistar rats were divided into 3 groups: 1 treated with the DPF, 1 treated with hyaluronic acid gel, and a sham group. MAIN RESULTS The DPF did not have a significant impact on endometrial thickness, and there were no significant differences in the number of conceived or prematurely terminated pregnancies, confirming its noninferiority to no treatment. The DPF did not induce irritation at 5 days and 28 days. Finally, the DPF significantly reduced the likelihood of complete IUA formation compared with hyaluronic acid gel- and sham-implanted animals, where only 27% of the animals had their uterine cavity obliterated compared with 80% and 100%, respectively. CONCLUSION The DPF is a safe film that is effective in preventing IUA formation after intrauterine curettage in rats.
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Affiliation(s)
- Stéphanie Huberlant
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France.
| | - Salome Leprince
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Lucie Allegre
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Sophie Warembourg
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Isabelle Leteuff
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Hubert Taillades
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Xavier Garric
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Renaud de Tayrac
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Vincent Letouzey
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
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Sharma JB, Dharmendra S, Jain S, Sharma SK, Singh UB, Soneja M, Sinha S, Vanamail P. Evaluation of Gene Xpert as compared to conventional methods in diagnosis of Female Genital Tuberculosis. Eur J Obstet Gynecol Reprod Biol 2020; 255:247-252. [PMID: 33256922 DOI: 10.1016/j.ejogrb.2020.09.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022]
Abstract
To evaluate Gene Xpert for diagnosis of Female Genital Tuberculosis (FGTB) as compared to conventional methods. STUDY DESIGN It was a prospective study conducted over 167 cases of infertile female genital tuberculosis (FGTB) diagnosed on composite reference standard (CRS) (smear for AFB, histopathological evidence of epithelioid granuloma or definite or possible findings of tuberculosis on laparoscopy). All women underwent endometrial biopsy for AFB microscopy, culture, gene Xpert, PCR and histopathology) and laparoscopy and hysteroscopy for diagnosis and prognostication of disease. The results of Gene Xpert were compared with conventional methods in detection of FGTB. All patients were treated with 6 months course of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) (RHZE for 2 months, RHE for 4 months) using directly observed treatment short course strategy. RESULTS Mean age, parity, body mass index and history of contact was 28.3 years, 0.28, 22.9 Kg/m2 and 38.92% respectively. Primary infertility was seen in 87.42% cases with mean duration of 2.42 years. Menstrual dysfunctions, abdominal or pelvic pain and lump were seen in 38.92%, 14.37% and 10.77% cases. Abnormal vaginal discharge and adnexal mass were seen in 28.14% and 13.17 % cases. On diagnostic laparoscopy, definite findings of tuberculosis (beaded tubes, tuebrcles and caseous nodules) were seen in 96 (57.48%) women while probable findings of tuberculosis (pelvic or abdominal adhesions, hydrosaplinx, tubo-ovarian mass, pyosalpinx) were seen in 81 (48.50%) women. On laboratory investigations, positive AFB on microscopy or culture was seen in 2.99% casess, PCR was positive in 47.90% gene Xpert was positive in 18.56% cases while epitheloid granuloma was seen on histopathology in 16 (9.58%) cases. Gene Xpert had sensitivity of 35.63%, specificity of 100%, positive predictive value of 100% and negative predictive value of 58.82% and diagnostic accuracy of 66.47% in the present study. CONCLUSION Gene Xpert is a very useful test to rule in tuberculosis whereas when it is negative it is not a good test to rule out tuberculosis.
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Affiliation(s)
- Jai B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sona Dharmendra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Shefali Jain
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - P Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Lee DY, Lee SR, Kim SK, Joo JK, Lee WS, Shin JH, Cho S, Park JC, Kim SH. A New Thermo-Responsive Hyaluronic Acid Sol-Gel to Prevent Intrauterine Adhesions after Hysteroscopic Surgery: A Randomized, Non-Inferiority Trial. Yonsei Med J 2020; 61:868-874. [PMID: 32975061 PMCID: PMC7515784 DOI: 10.3349/ymj.2020.61.10.868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the efficacy and safety of a newly developed thermo-responsive sol-gel, ABT13107, for reducing the formation of intrauterine adhesions (IUAs) after hysteroscopic surgery. MATERIALS AND METHODS In this multicenter, prospective, randomized trial (Canadian Task Force classification I), 192 women scheduled to undergo a hysteroscopic surgery at one of the eight university hospitals in South Korea were randomized into the ABT13107 group or the comparator (Hyalobarrier®) group in a 1:1 ratio. During hysteroscopic surgery, ABT13107 or Hyalobarrier® was injected to sufficiently cover the entire intrauterine cavity. RESULTS The patients returned to their respective sites for safety assessments at postoperative weeks 1 and 4 and for efficacy assessments at postoperative week 4. The post-surgery incidence of IUAs was 23.4% in the ABT13107 group and 25.8% in the comparator group; this difference met the criteria for ABT13107 to be considered as not inferior to the comparator. No differences were found in the extent of adhesions, types of adhesions, or the cumulative American Fertility Society score between the two treatment groups. Most adverse events were mild in severity, and no serious adverse events occurred. CONCLUSION ABT13107, a new anti-adhesive barrier containing hyaluronic acid, was not inferior to the highly viscous hyaluronic acid anti-adhesive barrier, Hyalurobarrier® in IUA formation after hysteroscopic surgery (Clinical trial registration No. NCT04007211).
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Affiliation(s)
- Dong Yun Lee
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sa Ra Lee
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics & Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Kil Joo
- Department of Obstetrics & Gynecology, Pusan National University School of Medicine, Busan, Korea
| | - Woo Shun Lee
- Department of Dermatology, Medytox Inc., Seoul, Korea
| | - Jung Ho Shin
- Department of Obstetrics & Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - SiHyun Cho
- Department of Obstetrics & Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Cheol Park
- Department of Obstetrics & Gynecology, Keimyung University School of Medicine, Daegu, Korea.
| | - Sung Hoon Kim
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Doroftei B, Dabuleanu AM, Ilie OD, Maftei R, Anton E, Simionescu G, Matei T, Armeanu T. Mini-Review of the New Therapeutic Possibilities in Asherman Syndrome-Where Are We after One Hundred and Twenty-Six Years? Diagnostics (Basel) 2020; 10:diagnostics10090706. [PMID: 32957624 PMCID: PMC7554703 DOI: 10.3390/diagnostics10090706] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023] Open
Abstract
Asherman syndrome is a multifaceted condition describing the partial or complete removal of the uterine cavity and/or cervical canal. It is a highly debatable topic because of its pronounced influence on both reproductive outcomes and gynaecologic symptoms. The latest reports demonstrated that trauma to the endometrium is the main cause of intrauterine adhesion formation. Left untreated, such adhesions gradually lead to a range of repercussions ranging from mild to severe. Considering the lack of non-invasive approaches, the advent of hysteroscopy has revolutionized the entire field, being otherwise considered the most efficient tool offering new directions and amplifying the chances of treating the Asherman syndrome.
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Affiliation(s)
- Bogdan Doroftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ana-Maria Dabuleanu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Research, Faculty of Biology, Alexandru Ioan Cuza University, Carol I Avenue, No. 20A, 700505 Iasi, Romania
- Correspondence:
| | - Radu Maftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Emil Anton
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Gabriela Simionescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (A.-M.D.); (R.M.); (E.A); (G.S.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Theodor Matei
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Theodora Armeanu
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, No. 34, 700038 Iasi, Romania; (T.M.); (T.A.)
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
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An update on stem cell therapy for Asherman syndrome. J Assist Reprod Genet 2020; 37:1511-1529. [PMID: 32445154 DOI: 10.1007/s10815-020-01801-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
The current treatment for Asherman syndrome is limited and not very effective. The aim of this review is to summarize the most recent evidence for stem cells in the treatment of Asherman syndrome. The advent of stem cell therapy has propagated experimentation on mice and humans as a novel treatment. The consensus is that the regenerative capacity of stem cells has demonstrated improved outcomes in terms of fertility and fibrosis in both mice and humans with Asherman syndrome. Stem cells have effects on tissue repair by homing to the injured site, recruiting other cells by secreting chemokines, modulating the immune system, differentiating into other types of cells, proliferating into daughter cells, and potentially having antimicrobial activity. The studies reviewed examine different origins and administration modalities of stem cells. In preclinical models, therapeutic systemic injection of stem cells is more effective than direct intrauterine injection in regenerating the endometrium. In conjunction, bone marrow-derived stem cells have a stronger effect on uterine regeneration than uterine-derived stem cells, likely due to their broader differentiation potency. Clinical trials have demonstrated the initial safety and effectiveness profiles of menstrual, bone marrow, umbilical cord, and adipose tissue-derived stem cells in resumption of menstruation, fertility outcomes, and endometrial regeneration.
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Huang XW, Lin MM, Zhao HQ, Powell M, Wang YQ, Zheng RR, Ellis LB, Xia WT, Lin F. A prospective randomized controlled trial comparing two different treatments of intrauterine adhesions. Reprod Biomed Online 2020; 40:835-841. [PMID: 32376313 DOI: 10.1016/j.rbmo.2020.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/04/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
RESEARCH QUESTION Intrauterine adhesions (IUA) are primarily caused by trauma to the endometrium, and hysteroscopy is presently the main treatment for IUA. However, high rates of post-operative adhesion re-formation remain a problem. In this study, the combination of an intrauterine device (IUD) with a Foley catheter and the balloon uterine stent were investigated to evaluate their efficacy in preventing adhesion re-formation and the subsequent reproductive outcomes in patients with moderate to severe adhesions. DESIGN A prospective randomized controlled study was conducted in a university-affiliated hospital. A total of 171 women with Asherman's syndrome were initially recruited between August 2016 and December 2017 and were randomized to undergo either balloon uterine stent insertion or placement of a contraceptive IUD plus a Foley catheter after hysteroscopic adhesiolysis. Reduction of adhesion scores, incidence of adhesion re-formation, changes in menstrual flow and reproductive outcomes were analysed. RESULTS A total of 118 participants were eligible for analysis. The American Fertility Society (AFS) scores were not significantly different between groups before hysteroscopic adhesiolysis. At the second-look hysteroscopy, the AFS scores and adhesion recurrence rates were significantly higher in the balloon uterine stent group compared with the combination group (P < 0.01 and P = 0.024, respectively). There were no statistically significant differences in pregnancy and live birth rates between the two groups. CONCLUSIONS The combination of an IUD and a Foley balloon catheter had better efficacy in preventing adhesion re-formation than the balloon uterine stent alone; however, it did not produce better reproductive outcomes.
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Affiliation(s)
- Xiao-Wan Huang
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, PR China
| | - Meng-Meng Lin
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, PR China
| | - Hong-Qin Zhao
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, PR China
| | - Martin Powell
- Nottingham University Affiliated Hospital, Nottingham Treatment Centre, Nottingham NG7 2FT, UK
| | - Yuan-Qiu Wang
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, PR China
| | - Ru-Ru Zheng
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, PR China
| | | | - Wei-Ting Xia
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, PR China.
| | - Feng Lin
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang Wenzhou 325000, PR China.
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Di Guardo F, Della Corte L, Vilos GA, Carugno J, Török P, Giampaolino P, Manchanda R, Vitale SG. Evaluation and treatment of infertile women with Asherman syndrome: an updated review focusing on the role of hysteroscopy. Reprod Biomed Online 2020; 41:55-61. [PMID: 32444259 DOI: 10.1016/j.rbmo.2020.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022]
Abstract
Asherman syndrome is a rare acquired clinical condition resulting in the obliteration of the uterine cavity causedby the presence of partial or complete fibrous intrauterine adhesions involving at least two-thirds of the uterine cavity potentially obstructing the internal cervical orifice. Common reported symptoms of the disease are alterations of the menstrual pattern with decreased menstrual bleeding leading up to amenorrhoea and infertility. Hysteroscopy is currently considered the gold standard diagnostic and therapeutic approach for patients with intrauterine adhesions. An integrated approach, including preoperative, intraoperative and postoperative therapeutic measures, however, are warranted owing to the complexity of the syndrome. This review aims to summarize the most recent evidence on the recommended preoperative, intraoperative and postoperative procedures to restore the uterine cavity and a functional endometrium, as well as on the concomitant use of adjuvant therapies to achieve optimal fertility outcomes.
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Affiliation(s)
- Federica Di Guardo
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - George Angelos Vilos
- The Fertility Clinic, London Health Sciences Centre, Department of Obstetrics and Gynecology, Western University, 800 Commissioners Road, London, Ontario N6A 4G5, Canada
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Science Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynaecology, University of Debrecen, 4032 Debrecen, Nagyerdei krt. 94, Hungary
| | - Pierluigi Giampaolino
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Rahul Manchanda
- Department of Gynae Endoscopy, Manchanda's Endoscopic Centre, Pushawati Singhania Research Institute, Press Enclave Marg, Sheikh Sarai II, Near Saket Court, New Delhi - 110017, India
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania 95123, Italy.
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Zhao X, Zhang A, Gao B, Burjoo A, Huang H, Xu D. Cold scissors ploughing technique in hysteroscopic adhesiolysis: a comparative study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:50. [PMID: 32175344 DOI: 10.21037/atm.2019.11.136] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Intrauterine adhesions (IUAs) can be dissected using hysteroscopic scissors (cold scissors) or other methods, but there is no consensus on which hysteroscopic method is preferable. There is also no consensus on the method of how to deal with the scar tissue on the surface of the intrauterine cavity. Methods From January 2016 to October 2017, 179 patients who had HA met the enrollment criteria (see the text below), and their data were analyzed retrospectively. In addition, all patients were divided into three groups according to the surgical techniques used. The groups were the ploughing group (PG) (using cold scissors to dissect the adhesion and cut the scar tissue using a ploughing technique) (n=81), the traditional group (TG) (using cold scissors to dissect the adhesion, but not deal with the scar tissue) (n=42), and the electrosurgical group (EG) (using a resectoscope to dissect the adhesion with an energy L-hook electrode, and not deal with the scar tissue) (n=56). Safety (surgical complications), feasibility (surgical technique replacement rate), and postoperative efficacy (reduction of AFS score, pregnancy, and live birth rate), were each evaluated between groups. Results No statistically significant differences between the groups were observed in basic preoperative information (P>0.05), while there were significant differences between PG and TG, as well as PG and EG in postoperative AFS scores (PG vs. TG: P=0.007; PG vs. EG: P<0.001) and pregnancy outcome (PG vs. TG: P=0.039; PG vs. EG: P<0.001). No patients had surgical complications such as uterine perforations, moderate or severe fluid overload, heavy uterine bleeding, nor any surgical technique replacements (for example, transfer to use a resectoscope). Conclusions Cold scissors ploughing technique in HA is effective, feasible, and safe, and thus worthy of further study.
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Affiliation(s)
- Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Aiqian Zhang
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Bingsi Gao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Arvind Burjoo
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Huan Huang
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha 410013, China
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Zhang H, Zhang Q, Zhang J, Sheng F, Wu S, Yang F, Li W. Urinary bladder matrix scaffolds improve endometrial regeneration in a rat model of intrauterine adhesions. Biomater Sci 2019; 8:988-996. [PMID: 31868868 DOI: 10.1039/c9bm00651f] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intrauterine adhesions caused by damage to the basal layer of the endometrium have a serious impact on women's fertility. Currently, there is no effective treatment to promote the regeneration of the endometrium. Urinary bladder matrix (UBM) is a derivative extracellular matrix biomaterial that has a complete basement membrane and provides a basis for the body to achieve complete self-functional repair. In this study, UBM was transplanted into the uterine horns of intrauterine adhesions in Sprague-Dawley rats to test whether UBM could improve endometrial regeneration in rats with intrauterine adhesions. Thicker endometria, increased numbers of glands, fewer fibrotic areas and increased proliferation of cells and blood vessels were found in the UBM group compared to the injury group. Transplantation of UBM reduced the mRNA levels of proinflammatory cytokines (tumor necrosis factor α) and increased those of anti-inflammatory cytokines (basic fibroblast growth factor) compared to the injury group. In the UBM group, the mRNA expression of endometrial receptivity factors (leukemia inhibitory factor and integrin αVβ3) was higher than that in the injury group, but it was lower than that in the normal group and the sham-operated group. More embryos were seen in the UBM group than in the injury group, although the UBM group had fewer embryos than the normal and sham-operated groups. Therefore, UBM may contribute to endometrial regeneration and may improve endometrial receptivity and fertility.
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Affiliation(s)
- Honghong Zhang
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Shanghai 200003, China.
| | - Qing Zhang
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Shanghai 200003, China.
| | - Jian Zhang
- Department of General Surgery, Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Shanghai 200003, China
| | - Fei Sheng
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Shanghai 200003, China.
| | - Shuang Wu
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Shanghai 200003, China.
| | - Fu Yang
- Department of Medical Genetics, Second Military Medical University, Shanghai 200433, China.
| | - Wen Li
- Reproductive Medicine Center, Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Shanghai 200003, China.
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Kou L, Jiang X, Xiao S, Zhao YZ, Yao Q, Chen R. Therapeutic options and drug delivery strategies for the prevention of intrauterine adhesions. J Control Release 2019; 318:25-37. [PMID: 31830539 DOI: 10.1016/j.jconrel.2019.12.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022]
Abstract
Intrauterine adhesions (IUAs) are bands of fibrous tissue that form in the endometrial cavity and associated with the increased risk of abnormal menstruation, recurrent pregnancy loss, secondary infertility, and pregnancy complications. Physical barriers, including intrauterine device and hydrogel, were clinical available to prevent the post-operational IUAs. But physically separation of the injured endometrium relies on the own limited healing power and often ends with recurrence. In recent years, the mechanisms driving IUAs treatment has validated the application of hormones, and further stem cell therapy has also led to the development of novel therapeutic agents with promising efficacy in pre-clinical and initial clinical studies. Still, it is challenging to delivery the therpaeutic factors to the injured uterus. Herein, in this review, we discuss the traditional intervention methods for the prevention of IUAs, as well as novel therapeutics and delivery strategies that will most likely change the treatment paradigms for better clinical outcomes. The combination strategy that using physical barriers as the delivery carriers for therapeutics might provide new alternatives for the prevention of IUAs.
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Affiliation(s)
- Longfa Kou
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Xue Jiang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Shuyi Xiao
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Ying-Zheng Zhao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Qing Yao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China.
| | - Ruijie Chen
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China.
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Jiang P, Tang X, Wang H, Dai C, Su J, Zhu H, Song M, Liu J, Nan Z, Ru T, Li Y, Wang J, Yang J, Chen B, Dai J, Hu Y. Collagen-binding basic fibroblast growth factor improves functional remodeling of scarred endometrium in uterine infertile women: a pilot study. SCIENCE CHINA-LIFE SCIENCES 2019; 62:1617-1629. [PMID: 31515729 DOI: 10.1007/s11427-018-9520-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/05/2019] [Indexed: 12/26/2022]
Abstract
Intrauterine adhesion (IUA) is a common cause of uterine infertility and one of the most severe clinical features is endometrial fibrosis namely endometrial scarring for which there are few cures currently. Blocked angiogenesis is the main pathological change in the scarred endometrium. The fibroblast growth factor 2 (bFGF), a member of FGF family, is usually applied to promote healing of refractory ulcer and contributes to angiogenesis of tissues. In this study, the sustained-release system of bFGF 100 µg was administrated around scarred endometrium guiding by ultrasound every 4 weeks in 18 patients (2-4 times). Results showed that after treatment, the menstrual blood volume, endometrial thickness and the scarred endometrial area were improved. Histological study showed blood vessel density increased obviously. Three patients (3/18) achieved pregnancy over 20 gestational weeks. Therefore, administrating the bFGF surrounding scarred endometrium may provide a new therapeutic approach for the patients with endometrial fibrosis.
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Affiliation(s)
- Peipei Jiang
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xiaoqiu Tang
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Chenyan Dai
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jing Su
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Hui Zhu
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Minmin Song
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jingyu Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Ziqing Nan
- Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical Collage, Nanjing, 210008, China
| | - Tong Ru
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yaling Li
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jingmei Wang
- Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jun Yang
- Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Bing Chen
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China
| | - Jianwu Dai
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Yali Hu
- Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Saridogan E. Role of general gynaecologists in the prevention of infertility. Best Pract Res Clin Obstet Gynaecol 2019; 59:132-136. [PMID: 30837119 DOI: 10.1016/j.bpobgyn.2019.01.014] [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: 12/07/2018] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 11/25/2022]
Abstract
Gynaecologists are frequently involved in the management of conditions that may result in reduced fertility or treatments they administer can lead to infertility. Sexually transmitted infections and pelvic inflammatory disease are the most common cause of tubal damage. Gynaecologists can play an important role in the identification and early treatment of these diseases. Pelvic surgery for conditions such as leiomyoma, ovarian cysts and endometriosis can lead to pelvic adhesions and iatrogenic infertility. By avoiding unnecessary operations by careful assessment of women with these conditions and by identifying those who can be managed without surgery, the future risk of infertility can be avoided. When surgery is clinically indicated, primary prevention of pelvic adhesions would be of paramount importance. A reliable surgical technique and the use of anti-adhesion agents may reduce the development of pelvic adhesions. Ovarian surgery for endometriomas and other benign cysts should be performed in the hands of experienced surgeons or in 'centres of clinical expertise', and maximum efforts should be made to preserve normal ovarian tissue as much as possible.
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Affiliation(s)
- Ertan Saridogan
- Consultant in Reproductive Medicine and Minimal Access Surgery, University College London Hospitals, UK.
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