Efficacy of Intrauterine Device in the Treatment of Intrauterine Adhesions

Table 1

Characteristics of included studies.

Source, year	Study type	Number of; patients; (mean age)	Classification	Adhesion stage	Surgical technique	IUD	HT	FC	Normal/improved; menses (%)	Conception rate; (%)	Live birth rate; (%)
Caspi and Perpinial, 1975 [30]	NR	80 (74 followed up); (NR)	NR	NR	Vaginal approach (long curved scissors)	Yes	Yes	No	NR	62/74 (83.7)	40/62 (64.5)
March and Israel, 1976 [31]	NR	10; (27.1)	NR	NR	Hysteroscopic miniature scissors	Yes	Yes	Yes	10/10 (100); normal	1/1 (100)	1/1 (100)
March and Israel, 1981 [37]	NR	38; (NR)	NR	Mild (); Moderate (); Severe ()	Hysteroscopy with miniature scissors	Yes (35)	Yes	Yes	NR	(87.2)	(87.2)
Ismajovich et al., 1985 [43]	NR	51; (NR)	NR	Mild (); Moderate ()	Hysteroscopic scissors, uterine dilator	Yes	No	No	46/51 (90); normal	46/51 (90)	40/46 (85)
Fedele et al., 1986 [40]	Retrospective	31; (NR)	NR	Mild (); Moderate (); Severe ()	Hysteroscopic scissors	Yes	Yes	No	21/31 (67.7); normal	13/27 (40.7)	13/27 (40.7)
Valle and Sciarra, 1988 [8]	Retrospective	187; (NR)	AFS	Mild (); Moderate (); Severe ()	Hysteroscopy and sharp dissection with hysteroscopic scissors (hysterosalpingography guided)	Yes (151)	Yes	No	134/151 (88.2); normal	143/187 (76.4)	114/143 (79.2)
Bellingham, 1996 [42]	NR	17 (16 followed up); (NR)	NR	NR	Hysteroscopic division under US guidance	Yes	Yes	No	11/13 (84.6); normal	8/10 (80)	8/10 (80)
Roge et al., 1997 [9]	Retrospective	54 (52 followed up) (NR)	AFS	Mild () Moderate (); Severe ()	Hysteroresectoscopy with resection electrode needle (under US guidance)	Yes	Yes	Yes	NR	34/52 (65.3)	24/34 (70.5)
Chen et al., 1997 [18]	NR	7; (31.14)	March	Severe	Hysteroresectoscopy with resection electrode needle	Yes	Yes	No	7/7 (100); normal	3/4 (75)	2/3 (66.6)
Feng et al., 1999 [13]	Retrospective cohort study	365; (33.8)	Sugimoto	NR	Hysteroscopy with microscissors and biopsy forceps	Yes	Yes	No	294/351 (83.7); normal	156/186 (83.8)	NR
Ozumba and Ezegwui, 2002 [32]	NR	50 (44 followed up)	NR	NR	Uterine sound and occasionally uterine dilators	Yes	Yes	No	34/44 (77.2); normal	4/44 (9)	NR
Orhue et al., 2003 [19]	NR	110; ()	NR	NR	Blind adhesiolysis under US guidance	Yes; (51)	Yes	Yes; (59)	32/51 (32.7); normal	14/51 (27.5)	6/14 (42.8)
Alborzi et al., 2003 [11]	Prospective	30; (30.4 up) (NR)	ASRM	Stage I (); Stage II (); Stage III ()	Hysteroscopy scissors (under vision of laparoscopy)	Yes	Yes	No	30/30 (100); normal	19/30 (63.3)	15/30 (50)
Zikopoulos et al., 2004 [16]	NR	46; (33.6)	AFS	Stage I (); Stage II (); Stage III ()	Resection using electrode needle (),; bipolar electrosurgery system ()	Yes	Yes	No	13/14 (92.85); normal	35/46 (76.1)	20/46 (43.5)
Efetie, 2006 [12]	Retrospective	71; ()	NR	NR	Hysteroscopy, uterine sound	Yes	Yes	Yes	34/71 (47.9); normal	8/71 (11.3)	NR
Fumino et al., 2007 [44]	NR	47; (32.8)	AFS	I (); II (); III ()	Pushing via tip of hysteroscopy () Ballooning at; hysterosalpingography (), transcervical resectoscope, and mechanical D&C (=13)	No	No	No	NR	20/47 (42.5)	NR
Shokeir et al., 2008 [41]	Retrospective	61; (31.5)	AFS	Stage II (); Stage III ()	Hysteroscopy with electrode needle	Yes; (40)	Yes	No	NR	10/40 (40)	2/10 (20)
Yasmin et al., 2007 [33]	Descriptive study	20 (19 followed up) (26.1)	NR	Mild (); Moderate (); Severe ()	Blunt and resectoscopic dissection	Yes	Yes	Yes	18/19 (94.7); normal	2/19 (10.5)	1/2 (50)
Yu et al., 2008 [7]	Retrospective	85; (31.1)	ESH; ESGE	Mild (); Moderate (); Severe; ()	Hysteroscopy using electrode needle or loop	Yes	Yes	No	46/62 (74.2); improved	39/85 (45.88)	25/39 (64.1)
Pabuccu et al., 2008 [28]	Prospective, randomized trial	71; (group 1: ); (group 2: )	AFS	Stage III	Sharp hysteroscopic division under US guidance	Yes	Yes	No	NR	Group 1: 17/36; (47.2); Group 2: 11/35; (31.4)	Group 1: 10/36; (27.7); Group 2: 7/35; (20)
Roy et al., 2010 [29]	Retrospective	96 (89 followed up); (28.4)	ESH,; ESGE	I (); III (); IV ()	Hysteroscopic monopolar with Collin’s knife	Yes	Yes	No	53/75 (70.67); improved	36/89 (44.4)	31/36 (86.1)
Salma et al., 2011 [34]	NR	60 (59 followed up); (29.3)	AFS	Severe	Hysteroscopy using scissors or electrode needle under direct vision	Yes	Yes	Yes	56/59 (94.9); normal	NR	NR
Myers and Hurst, 2012 [35]	Retrospective	12; (34.41)	AFS	Severe	Hysteroscopy scissors	Yes	Yes	Yes	12/12 (100); normal	6/8 (75)	4/6 (66.6)
Fernandez et al., 2012 [45]	Retrospective	23 (22 followed up); ()	ESHRE; AFS	IV, severe	Hysteroscopy and bipolar electrosurgery system	No	No	No	1/24 (4.3%) (after; 2 surgical; procedures)	9/22 (40.9)	6/22 (27.2)
Mohamed et al., 2012 [39]	Retrospective	363 (130 followed up); ()	ESGE	Grade I (); Grade II (); Grade III (); Grade IV ()	Hysteroscopy with unipolar and bipolar electrosurgery	Yes	Yes	Yes	3/4 (75%); normal	40 (31.5%)	36/40 (90)
Yamamoto and Takeuchi, 2013 [36]	Retrospective	27; ()	AFS	Mild (); Moderate (); Severe ()	Hysteroscopic loop monopolar knife, Hegar’s dilators (under US guidance)	Yes	Yes	No	27/27 (100) improved	14/27 (52.9 )	3/27 (11)
Lin et al., 2013 [27]	Retrospective cohort study	107; ()	AFS	Mild (); Moderate (); Severe ()	Hysteroscopic scissors	Yes (28)	Yes	Yes	18/28 (64.2); 8/28 (28.5); improved	NR	NR
Şendağ et al., 2013 [38]	NR	24; (30.5)	ESH	Grade 1 (); Grade 2 (); Grade 3 (); Grade 4 ()	Hysteroscopy with sharp scissors	Yes (11)	Yes	Yes	24/24 (100); normal	4/14 (28.5)	3/4 (75)

HT = hormonal therapy; IUD = intrauterine device; FC = Foley catheter; NR = not reported. “Yes” = studies that used IUD; “No” = studies that didn’t used IUD.