Strategies to avoid recurrence of intrauterine adhesions after hysteroscopic adhesiolysis

Intrauterine adhesions (IUA) are fibrous bands of scar tissue within the uterine cavity resulting from trauma to the endometrium. Despite treatment with hysteroscopic lysis of IUA, recurrence rates are substantial, ranging from 3 to 25%. Practice patterns can differ widely regarding intraoperative and postoperative interventions. Our goal is to review current literature that explores strategies to decrease recurrence of IUA.

This literature review examines intraoperative recommendations regarding surgical technique for lysis of IUA, intrauterine placement of mechanical barriers like a balloon or an intrauterine device, and use of substances like hyaluronic acid, platelet-rich plasma, and amnion graft. Postoperative techniques including hormonal medications after lysis of IUA, medications that increase vascular flow to the uterus, and second-look hysteroscopy are also explored.

Various intraoperative and postoperative interventions show promise in reducing IUA reformation after hysteroscopic lysis of adhesions. What remains to be explored are implications of preventive therapy on pregnancy rate and live birth rate. Additionally, the optimal combination of therapy for preventing IUA recurrence has yet to be established. Further research is essential to determine the most effective strategies for preventing IUA reformation and optimizing long-term reproductive health.