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Reproductive performance after the application of hyaluronic acid gel after dilation and curettage in women who have experienced at least one previous curettage: long-term results of a multicenter prospective randomized trial.
Fertil Steril. 2018 12; 110(7):1231-1238.FS

Abstract

OBJECTIVE

To examine whether intrauterine application of auto-cross-linked hyaluronic acid (ACP) gel after dilation and curettage (D&C) improves reproductive performance.

DESIGN

Multicenter prospective randomized trial.

SETTING

One university and seven university-affiliated teaching hospitals.

PATIENT(S)

A total of 149 women who have experienced a miscarriage at <14 weeks of gestation, with at least one previous D&C for miscarriage or termination of pregnancy, were randomly assigned to either D&C plus ACP gel (intervention group) or D&C alone (control group). A hysteroscopy was performed 8-12 weeks after the procedure. Where intrauterine adhesions (IUAs) were found, adhesiolysis was executed.

INTERVENTION(S)

Participants received questionnaires 3, 6, and 12 months after the initial D&C procedure with questions regarding menstrual pattern, conception, and reproductive outcome.

MAIN OUTCOME MEASURE(S)

Reproductive outcomes during the 12 months after the D&C procedure.

RESULT(S)

Outcomes were available for 149 women: 77 in the intervention group and 72 in the control group. The conception rates were, respectively, 71% (46/64) and 59.7% (40/67). There was no significant difference in the miscarriage, ongoing pregnancy, and live birth rates. The median times to conception were 5.5 and 7.1 months, respectively.

CONCLUSION(S)

Reproductive performance was similar in both groups although there was a significant difference in the prevalence of IUAs. Given the favorable reproductive outcome in this underpowered study and the fact that adhesiolysis was executed, no solid conclusion can be drawn. Future studies are needed to evaluate the effect of ACP gel on fertility and reproductive outcomes.

CLINICAL TRIAL REGISTRATION NUMBER

NTR 3120.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Zaans Medical Center, Zaandam, The Netherlands; Department of Obstetrics and Gynecology, Free University Medical Center, Amsterdam, The Netherlands. Electronic address: hooker.a@zaansmc.nl.Department of Obstetrics and Gynecology, Free University Medical Center, Amsterdam, The Netherlands.Department of Epidemiology and Biostatistics, Free University Medical Center, Amsterdam, the Netherlands.Department of Obstetrics and Gynecology, Free University Medical Center, Amsterdam, The Netherlands.Department of Obstetrics and Gynecology, Free University Medical Center, Amsterdam, The Netherlands.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30503111

Citation

Hooker, Angelo B., et al. "Reproductive Performance After the Application of Hyaluronic Acid Gel After Dilation and Curettage in Women Who Have Experienced at Least One Previous Curettage: Long-term Results of a Multicenter Prospective Randomized Trial." Fertility and Sterility, vol. 110, no. 7, 2018, pp. 1231-1238.
Hooker AB, de Leeuw RA, van de Ven PM, et al. Reproductive performance after the application of hyaluronic acid gel after dilation and curettage in women who have experienced at least one previous curettage: long-term results of a multicenter prospective randomized trial. Fertil Steril. 2018;110(7):1231-1238.
Hooker, A. B., de Leeuw, R. A., van de Ven, P. M., Brölmann, H. A. M., & Huirne, J. A. F. (2018). Reproductive performance after the application of hyaluronic acid gel after dilation and curettage in women who have experienced at least one previous curettage: long-term results of a multicenter prospective randomized trial. Fertility and Sterility, 110(7), 1231-1238. https://doi.org/10.1016/j.fertnstert.2018.07.021
Hooker AB, et al. Reproductive Performance After the Application of Hyaluronic Acid Gel After Dilation and Curettage in Women Who Have Experienced at Least One Previous Curettage: Long-term Results of a Multicenter Prospective Randomized Trial. Fertil Steril. 2018;110(7):1231-1238. PubMed PMID: 30503111.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reproductive performance after the application of hyaluronic acid gel after dilation and curettage in women who have experienced at least one previous curettage: long-term results of a multicenter prospective randomized trial. AU - Hooker,Angelo B, AU - de Leeuw,Robert A, AU - van de Ven,Peter M, AU - Brölmann,Hans A M, AU - Huirne,Judith A F, PY - 2018/02/22/received PY - 2018/07/24/revised PY - 2018/07/25/accepted PY - 2018/12/4/entrez PY - 2018/12/7/pubmed PY - 2019/4/18/medline KW - Intrauterine adhesion KW - dilatation and curettage KW - hyaluronic acid KW - miscarriage KW - reproductive outcome SP - 1231 EP - 1238 JF - Fertility and sterility JO - Fertil Steril VL - 110 IS - 7 N2 - OBJECTIVE: To examine whether intrauterine application of auto-cross-linked hyaluronic acid (ACP) gel after dilation and curettage (D&C) improves reproductive performance. DESIGN: Multicenter prospective randomized trial. SETTING: One university and seven university-affiliated teaching hospitals. PATIENT(S): A total of 149 women who have experienced a miscarriage at <14 weeks of gestation, with at least one previous D&C for miscarriage or termination of pregnancy, were randomly assigned to either D&C plus ACP gel (intervention group) or D&C alone (control group). A hysteroscopy was performed 8-12 weeks after the procedure. Where intrauterine adhesions (IUAs) were found, adhesiolysis was executed. INTERVENTION(S): Participants received questionnaires 3, 6, and 12 months after the initial D&C procedure with questions regarding menstrual pattern, conception, and reproductive outcome. MAIN OUTCOME MEASURE(S): Reproductive outcomes during the 12 months after the D&C procedure. RESULT(S): Outcomes were available for 149 women: 77 in the intervention group and 72 in the control group. The conception rates were, respectively, 71% (46/64) and 59.7% (40/67). There was no significant difference in the miscarriage, ongoing pregnancy, and live birth rates. The median times to conception were 5.5 and 7.1 months, respectively. CONCLUSION(S): Reproductive performance was similar in both groups although there was a significant difference in the prevalence of IUAs. Given the favorable reproductive outcome in this underpowered study and the fact that adhesiolysis was executed, no solid conclusion can be drawn. Future studies are needed to evaluate the effect of ACP gel on fertility and reproductive outcomes. CLINICAL TRIAL REGISTRATION NUMBER: NTR 3120. SN - 1556-5653 UR - https://www.unboundmedicine.com/medline/citation/30503111/Reproductive_performance_after_the_application_of_hyaluronic_acid_gel_after_dilation_and_curettage_in_women_who_have_experienced_at_least_one_previous_curettage:_long_term_results_of_a_multicenter_prospective_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(18)30613-7 DB - PRIME DP - Unbound Medicine ER -