A prospective randomized controlled trial comparing two different treatments of intrauterine adhesions. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Huang, Xiao-Wan; Lin, Meng-Meng; Zhao, Hong-Qin; Powell, Martin; Wang, Yuan-Qiu; Zheng, Ru-Ru; Ellis, Laura Burney; Xia, Wei-Ting; Lin, Feng
• Is Part Of: Reproductive biomedicine online. Volume 40:Issue 6(2020)
• Page Start: 835
• Page End: 841
• Publication Date: 2020-06
• Subjects: Asherman's syndrome -- Balloon uterine stent -- Foley balloon catheter -- Hysteroscopic adhesiolysis -- Intrauterine contraceptive device; Human reproductive technology -- Periodicals; Human embryo -- Periodicals; Reproduction -- Periodicals; 616.692
• DOI: 10.1016/j.rbmo.2020.02.013
• Languages: English
• ISSNs: 1472-6483

Abstract

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.