Efficacy of intrauterine device in the treatment of intrauterine adhesions

Abstract

The primary purpose of this paper is to assess the efficacy of the use of the intrauterine device (IUD) as an adjunctive treatment modality, for intrauterine adhesions (IUAs). All eligible literatures were identified by electronic databases including PubMed, Scopus, and Web of Science. Additional relevant articles were identified from citations in these publications. There were 28 studies included for a systematic review. Of these, 5 studies were eligible for meta-analysis and 23 for qualitative assessment only. Twenty-eight studies related to the use of IUDs as ancillary treatment following adhesiolysis were identified. Of these studies, 25 studies at least one of the following methods were carried out as ancillary treatment: Foley catheter, hyaluronic acid gel, hormonal therapy, or amnion graft in addition to the IUD. There was one study that used IUD therapy as a single ancillary treatment. In 2 studies, no adjunctive therapy was used after adhesiolysis. There was a wide range of reported menstrual and fertility outcomes which were associated with the use of IUD combined with other ancillary treatments. At present, the IUD is beneficial in patients with IUA, regardless of stage of adhesions. However, IUD needs to be combined with other ancillary treatments to obtain maximal outcomes, in particular in patients with moderate to severe IUA.

Figure 1

Flow chart showing search results.

Figure 2

Summary of meta-analysis presenting odds ratio (OR) with 95% confidence interval (CI) for menstruation rates number (a), fertility rates number (b), and live birth rates number (c) of postoperative use of Lippes loop IUD with 3-month follow-up for the management of IUAs. IUAs: intrauterine adhesions and IUD: intrauterine device.

Figure 3

Types of IUD. (a) Lippes loop (patent number US3802425 A). Many investigators support the use of a Lippes loop of IUD. (b) T-shaped (patent number US4026281 A). IUDs are thought to have too small surface area to be truly effective in providing a physical barrier. (c) Uterine-shaped (patent number CN201220343083) IUD. The uterine-shaped IUD was originally manufactured in Chongqing, Sichuan. It is designed in the shape of the uterine cavity, consisting of a stainless steel coiled wire framework with copper added inside the coil wire, and releases anti-inflammatory agent. The uterine-shaped IUD is the most commonly used IUD in China. (d) Multiload Cu 375 (patent number EP2198815 A1). This IUD consists of a copper-bearing plastic shaft and two small flexible curved side arms. Some authors suggested that the copper-containing IUDs provoke an inflammatory reaction. (e) Recently, a new type of uterine-shaped IUDs was researched and manufactured in China with China patent number Zl 2008 2 0052366.3 and (f) another new product with a China patent number Zl 2012 20070407.8; this type of devices is only used for IUA.