Abstract
OBJECTIVE: To investigate the long-term effects of hysteroscopic adhesiolysis on postoperative pregnancy rates and fertility outcomes in patients with intrauterine adhesions (IUA). METHODS: A retrospective analysis was conducted on 105 patients with IUA treated at Baoji Maternal and Child Health Hospital from June 2022 to December 2023. All patients underwent hysteroscopic adhesiolysis. Based on the adjunctive treatment, patients were divided into two groups: the observation group (n=55), which received adhesiolysis plus balloon uterine stent placement, and the control group (n=50), which received adhesiolysis alone. We compared clinical efficacy, changes in endometrial thickness, menstrual volume, and serum estrogen levels, including estrogen receptor (ER) and progesterone receptor (PR) levels, between the two groups. Additionally, we recorded and compared the 3-month postoperative recurrence rate of IUA, pregnancy rates and outcomes, and complications. The predictive value of ER and PR levels for postoperative pregnancy was also analyzed. We then compared the general data of patients who became pregnant after surgery with those who did not, and used multivariate logistic regression to analyze the factors influencing postoperative non-pregnancy. RESULTS: The overall treatment efficacy was significantly higher in the observation group than in the control group (P<0.05). The observation group showed significantly greater improvements in endometrial thickness, menstrual volume, and serum estrogen levels compared to the control group (all P<0.05). The recurrence rate of adhesions during follow-up was significantly lower in the observation group than in the control group (P<0.05). The postoperative pregnancy rates and fertility outcomes were also significantly better in the observation group (both P<0.05). The sensitivity and specificity of ER levels in predicting postoperative pregnancy were 78.05% and 70.31%, respectively, with an AUC of 0.788. For PR levels, the sensitivity was 75.61%, specificity was 71.88%, and AUC was 0.834. Multivariate regression analysis indicated that age, adhesion severity, adhesion recurrence, and the use of a balloon uterine stent were independent risk factors affecting postoperative pregnancy in patients with IUA (P<0.05). CONCLUSION: The combination of adhesiolysis and intrauterine balloon stent placement in patients with moderate to severe intrauterine adhesions significantly IUA increases endometrial thickness and volume, promotes menstrual recovery, prevents re-adhesion, and improves pregnancy outcomes. This approach is recommended for clinical application.