Application of a Hyaluronic Acid Gel after Intrauterine Surgery May Improve Spontaneous Fertility: A Randomized Controlled Trial in New Zealand White Rabbits

Stéphanie Huberlant (1) , Hervé Fernandez (2) , Pierre Vieille (1, 3) , Mohamed M. Khrouf (2) , Daniela Ulrich (1) , Renaud Detayrac (1, 3) , Vincent Letouzey (1, 4)

1 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
2 Hôpital Bicêtre
3 UM - Université de Montpellier
4 IBMM - Institut des Biomolécules Max Mousseron [Pôle Chimie Balard]

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. MATERIALS AND 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). CONCLUSION: 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.

Domaines: Médecine humaine et pathologie

Stéphanie Huberlant, Hervé Fernandez, Pierre Vieille, Mohamed M. Khrouf, Daniela Ulrich, et al.. Application of a Hyaluronic Acid Gel after Intrauterine Surgery May Improve Spontaneous Fertility: A Randomized Controlled Trial in New Zealand White Rabbits. PLoS ONE, 2015, 10 (5), pp.e0125610. ⟨10.1371/journal.pone.0125610⟩. ⟨hal-01915548⟩