Pabuçcu Emre G, Kovanci Ertuğ, Şahin Özgür, Arslanoğlu Esra, Yıldız Yiğit, Pabuçcu Recai
Department of Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey.
Aspire Fertility, Houston, TX, USA.
JSLS. 2019 Jan-Mar;23(1). doi: 10.4293/JSLS.2018.00108.
To compare the efficacy of 3 different techniques for prevention of adhesion reformation after hysteroscopic adhesiolysis in patients with moderate-to-severe intrauterine adhesions. Short-term assisted reproductive outcomes were also compared.
Total of 72 cases were randomized to Lippes loop intrauterine device (IUD) only, IUD plus a new crosslinked hyaluronan (NCH) gel, or NCH gel only following hysteroscopic adhesiolysis. All cases received hormonal therapy and a second hysteroscopy was carried out. Endometrial thickness values were measured using transvaginal ultrasonography and American Fertility Society adhesion scores were noted during first and second hysteroscopy in all groups. Reproductive outcomes were also compared for those who received in vitro fertilization treatment.
Transvaginal ultrasonography revealed significantly better endometrial thickness in the IUD+NCH (7.5 mm) and NCH-only groups (6.5 mm) than the IUD-only group (5 mm) ( < .001). All groups revealed enhanced but comparable American Fertility Society adhesion scores on second-look hysteroscopy. A total of 37 patients received in vitro fertilization treatment after surgical management of adhesions. Ongoing pregnancy rates after in vitro fertilization were 27%, 40%, and 36% in IUD, IUD+NCH, and NCH groups, respectively. However, the difference between the groups did not reach statistically significant difference.
All interventions are of similar efficacy in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate to severe intrauterine adhesions. However, better endometrial thickness values were observed in those who received NCH gel either alone or in combination with IUD. Assisted reproductive outcomes of both groups were comparable for ongoing pregnancy rates.
比较3种不同技术预防中重度宫腔粘连患者宫腔镜粘连松解术后粘连复发的疗效。同时比较短期辅助生殖结局。
72例患者在宫腔镜粘连松解术后随机分为仅放置Lippes环宫内节育器（IUD）组、IUD联合新型交联透明质酸（NCH）凝胶组或仅使用NCH凝胶组。所有患者均接受激素治疗，并进行第二次宫腔镜检查。在所有组的首次和第二次宫腔镜检查时，使用经阴道超声测量子宫内膜厚度值，并记录美国生育协会粘连评分。还比较了接受体外受精治疗患者的生殖结局。
经阴道超声显示，IUD+NCH组（7.5 mm）和仅使用NCH凝胶组（6.5 mm）的子宫内膜厚度明显优于仅放置IUD组（5 mm）（P<0.001）。所有组在二次宫腔镜检查时美国生育协会粘连评分均有所改善，但具有可比性。共有37例患者在粘连手术治疗后接受了体外受精治疗。IUD组、IUD+NCH组和NCH凝胶组体外受精后的持续妊娠率分别为27%、40%和36%。然而，各组之间的差异未达到统计学显著性差异。
对于中重度宫腔粘连，所有干预措施在预防宫腔镜粘连松解术后粘连复发方面疗效相似。然而，单独或联合IUD使用NCH凝胶的患者子宫内膜厚度更佳。两组的辅助生殖结局在持续妊娠率方面具有可比性。
