Hysteroscopy for infertile women: experience of using anti-adhesion barriers

Objective: To evaluate the effectiveness of the anti-adhesion intrauterine barrier Antiadhesin during hysteroscopic surgery in infertile patients.

Materials and methods: We examined and performed surgical treatment of 331 patients with infertility and intrauterine pathology, including patients with submucous uterine fibroids (n=100), with intrauterine septum (n=152) and intrauterine synechiae (n=79). Intrauterine barrier Antiadhesin was used in 114 cases after surgical interventions. Ultrasound assessment of the uterine cavity was carried out for the presence or absence of intrauterine synechiae after three months, and the patients were allowed to plan pregnancy. The patients included in the study were treated for infertility using the IVF/ICSI protocol with controlled ovarian stimulation and transfer of fresh embryos into the uterine cavity or cryoprotocol. The reproductive function was evaluated within 12 months after the operation.

Results: Antiadhesin was introduced in 27 cases after hysteroresectoscopy (type II myoma, with 4 or more nodes, the size of the nodes exceeding 3 cm), in 54 cases after dissection of the intrauterine septum, and in 33 cases after dissection of intrauterine synechiae of II–III degree. There were no complications after the use of anti-adhesive gel. The control ultrasound assessment which was performed three months after the operation revealed the presence of synechiae in 5 (18.5%) out of 27 patients after myomectomy, in 19 (35.2%) out of 54 patients after dissection of the intrauterine septum and in 14 (42%) out of 33 patients after dissection of intrauterine synechiae. The reproductive function restoration was evaluated within one year after the complex treatment with assisted reproductive techniques. Pregnancy was observed in 167 (50.4%) women.

Conclusion: Infertile patients especially those after ineffective IVF programs should undergo hysteroscopy during their examination, as intrauterine pathology can be timely diagnosed and eliminated, and effectiveness of infertility treatment can be improved. Currently, we have obtained the preliminary results on the safety and effectiveness of intrauterine use of the anti-adhesion barrier Antiadhesin. In order to accumulate a larger number of clinical observations and obtain data on the reproductive function restoration, it is necessary to conduct further studies.