Auto-Cross-Linked Hyaluronic Acid Gel for Prevention of Intrauterine Adhesions after Hysteroscopic Adhesiolysis: A Randomized Controlled Trial

Study Objective: To investigate auto-cross-linked hyaluronic acid gel for the prevention of intrauterine adhesion (IUA) recurrence after hysteroscopic adhesiolysis. Design: A single-center, double-blinded randomized controlled trial. Setting: A tertiary university hospital. Patients: Two hundred seventy-two patients with moderate-to-severe (American Fertility Society [AFS] score >= 5) IUAs underwent hysteroscopic adhesiolysis. Interventions: The patients were randomized to receive standard care along with auto-cross-linked hyaluronic acid gel after surgery (treatment group) or standard care only (control group). All patients had second-look hysteroscopy at 4 weeks and hormonal therapy for 2 cycles after surgery. Measurements and Main Results: Two hundred sixty patients were eligible and randomized; 245 patients successfully completed the study (n = 122 in treatment group, and n = 123 in control group). The primary outcome measure was IUA recurrence at second-look hysteroscopy. The secondary outcome measures included an improvement in the AFS score and menstrual pattern. There was no significant difference with regard to IUA recurrence (31.1% vs 39.8%) or median AFS score at second-look hysteroscopy (2, interquartile range [2- 4] vs 2, interquartile range [2- 4]) or improvement in the menstrual pattern at 3-month follow-up (87.7% vs 76.4%), in the treatment and control groups, respectively. Conclusion: The application of auto-cross-linked hyaluronic acid gel did not seem to improve IUA recurrence after hysteroscopic adhesiolysis. (C) 2020 AAGL. All rights reserved.

Automated summary

The study investigated the use of auto-cross-linked hyaluronic acid gel for preventing intrauterine adhesion recurrence after hysteroscopic adhesiolysis. However, the application of this gel did not seem to improve the recurrence of intrauterine adhesions based on the study results.