title: Application of a hyaluronic acid gel after intrauterine surgery may improve spontaneous fertility: a randomized controlled trial in New Zealand White rabbits.
abstract: OBJECTIVE
  Intrauterine adhesions (IUAs) are the most common complication after hysteroscopy in patients of reproductive age. Intra-abdominal anti-adhesion gel reduces the incidence of adhesions, but effects on fertility after uterine surgery are not known. The objective of our work was to evaluate the effect of intrauterine anti-adhesion gel on spontaneous fertility after repeated intrauterine surgery with induced experimental synechiae in the rabbit model.
  
  
  METHODS
  Twenty New Zealand White rabbits underwent a double uterine curettage 10 days apart and were randomized into two groups. Each rabbit served as its own control: one uterine tube was the treatment group (A), the second uterine tube was the control group (B) to avoid bias through other causes of infertility. Group A received a post curettage intrauterine instillation of anti-adhesion gel whereas group B, the control group, underwent curettage without instillation of the gel. After a recovery period, the rabbits were mated. An abdominal ultrasound performed 21 days after mating allowed us to diagnose pregnancy and quantify the number of viable fetuses.
  
  
  RESULTS
  There was a significant difference in total fetuses in favor of group A, with an average of 3.7 (range, 0-9) total fetuses per tube against 2.1 (0-7) in group B (p = .04). The number of viable fetuses shows a trend in favor of group A, with an average of 3.4 (0-7) viable fetuses per tube against 1.9 (0-6) viable fetuses per tube in group B (p = .05).
  
  
  CONCLUSIONS
  The use of immediate postoperative anti-adhesion gel improved fertility in an animal model after intrauterine surgery likely to cause uterine synechiae. This experimental model will permit comparison of different anti-adhesion solutions, including assessment of their tolerance and potential mucosal toxicity on embryonic development.
authors.affiliation: Department of Obstetrics and Gynaecology, Nimes University Hospital, Nîmes, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Huberlant
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital de Bicêtre- Assistance Publique- Hopîtaux de Paris, Le Kremlin-Bicêtre, Paris, France.
authors.forename: Herve
authors.initials: H
authors.lastname: Fernandez
authors.affiliation: Department of Obstetrics and Gynaecology, Nimes University Hospital, Nîmes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Vieille
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital de Bicêtre- Assistance Publique- Hopîtaux de Paris, Le Kremlin-Bicêtre, Paris, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khrouf
authors.affiliation: Department of Obstetrics and Gynaecology, Nimes University Hospital, Nîmes, France.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ulrich
authors.affiliation: Department of Obstetrics and Gynaecology, Nimes University Hospital, Nîmes, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: deTayrac
authors.affiliation: Department of Obstetrics and Gynaecology, Nimes University Hospital, Nîmes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Letouzey
mesh_terms: D000818:Animals; D005260:Female; D005298:Fertility; D005782:Gels; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D023421:Models, Animal; D011247:Pregnancy; D011817:Rabbits; D000267:Tissue Adhesions / Q000517:prevention & control; D014599:Uterus / Q000601:surgery*; D014945:Wound Healing
chemical_list: D005782:Gels; D006820:Hyaluronic Acid