Top

Published in:

01-12-2021 | Hysteroscopy | Original Article

Intrauterine infusion of platelet-rich plasma for severe Asherman syndrome: a cutting-edge approach

Authors: Elena Puente Gonzalo, Luis Alonso Pacheco, Auxiliadora Vega Jiménez, Salvatore Giovanni Vitale, Antonio Raffone, Antonio Simone Laganà

Published in: Updates in Surgery | Issue 6/2021

Abstract

Asherman syndrome (AS) consists of intrauterine adhesions development as a consequence of trauma, radiation, or infection in the endometrium. Clinical symptoms include menstrual alterations, infertility, and pregnancy complications, such as recurrent pregnancy loss or abnormal placentation. In this article, we performed a narrative review of the literature, searching electronic databases (i.e., Medline, Pubmed, and Google Scholar) to summarize the available pieces of evidence about epidemiology, pathophysiology, diagnosis, and treatment of AS. Hysteroscopy is essential for diagnosis and treatment, although adhesions may recur. Different postoperative therapies have been proposed to prevent recurrence and restore impaired endometrial function and promote endometrial regeneration, although these effects are usually temporary. We report a case of AS with adhesion recurrence and endometrial atrophy who was successfully treated with intrauterine autologous platelet–rich plasma (PRP) infusion. This therapy allowed endometrial tissue regeneration, leading to increased vascularity and endometrium thickness, and restoration of endometrial function that led to a successful pregnancy. Though there is limited experience supporting the use of PRP to improve endometrial function, it has been safely used in other fields of medicine; besides, it is easy to obtain, not expensive, and harmless being an autologous source. Future studies are encouraged to further assess this approach to treat AS.

Fritsch H (1894) Ein Fall von volligen schwund der Gebaumutterhohle nach Auskratzung. Zentralbl Gynaekol 18:1337–1342

Asherman JG (1950) Traumatic intra-uterine adhesions. J Obstet Gynaecol Br Emp 57(6):892–896. https://doi.org/10.1111/j.1471-0528.1950.tb06053.xCrossRefPubMed

Freytag D, Mettler L, Maass N, Gunther V, Alkatout I (2020) Uterine anomalies and endometriosis. Minerva Med 111(1):33–49. https://doi.org/10.23736/S0026-4806.19.06341-9CrossRefPubMed

Alkatout I, Meinhold-Heerlein I, Keckstein J, Mettler L (2018) Endometriosis: a concise practical guide to current diagnosis and treatment. J Turk Ger Gynecol Assoc 19(3):173–175. https://doi.org/10.4274/jtgga.2018.0026CrossRefPubMedPubMedCentral

Yu D, Wong YM, Cheong Y, Xia E, Li TC (2008) Asherman syndrome–one century later. Fertil Steril 89(4):759–779. https://doi.org/10.1016/j.fertnstert.2008.02.096CrossRefPubMed

March CM, Israel R, March AD (1978) Hysteroscopic management of intrauterine adhesions. Am J Obstet Gynecol 130(6):653–657. https://doi.org/10.1016/0002-9378(78)90322-8CrossRefPubMed

Al-Inany H (2001) Intrauterine adhesions. An update. Acta Obstet Gynecol Scand 80(11):986–993PubMed

Schenker JG, Margalioth EJ (1982) Intrauterine adhesions: an updated appraisal. Fertil Steril 37(5):593–610. https://doi.org/10.1016/s0015-0282(16)46268-0CrossRefPubMed

Eriksen J, Kaestel C (1960) The incidence of uterine atresia after post-partum curettage. A follow-up examination of 141 patients. Dan Med Bull 7:50–51PubMed

10.

Dmowski WP, Greenblatt RB (1969) Asherman’s syndrome and risk of placenta accreta. Obstet Gynecol 34(2):288–299PubMed

11.

Taskin O, Sadik S, Onoglu A, Gokdeniz R, Erturan E, Burak F, Wheeler JM (2000) Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am Assoc Gynecol Laparosc 7(3):351–354. https://doi.org/10.1016/s1074-3804(05)60478-1CrossRefPubMed

12.

Netter AP, Musset R, Lambert A, Salomon Y (1956) Traumatic uterine synechiae: a common cause of menstrual insufficiency, sterility, and abortion. Am J Obstet Gynecol 71(2):368–375. https://doi.org/10.1016/s0002-9378(16)37600-1CrossRefPubMed

13.

Krolikowski A, Janowski K, Larsen JV (1995) Asherman syndrome caused by schistosomiasis. Obstet Gynecol 85(5 Pt 2):898–899. https://doi.org/10.1016/0029-7844(94)00371-jCrossRefPubMed

14.

Shaffer W (1986) Role of uterine adhesions in the cause of multiple pregnancy losses. Clin Obstet Gynecol 29(4):912–924CrossRef

15.

Puente E, Alonso L, Laganà AS, Ghezzi F, Casarin J, Carugno J (2020) Chronic endometritis: old problem, novel insights and future challenges. Int J Fertil Steril 13(4):250–256. https://doi.org/10.22074/ijfs.2020.5779CrossRefPubMed

16.

Klein SM, Garcia CR (1973) Asherman’s syndrome: a critique and current review. Fertil Steril 24(9):722–735. https://doi.org/10.1016/s0015-0282(16)39918-6CrossRefPubMed

17.

Chen Y, Chang Y, Yao S (2013) Role of angiogenesis in endometrial repair of patients with severe intrauterine adhesion. Int J Clin Exp Pathol 6(7):1343–1350PubMedPubMedCentral

18.

Tao Z, Duan H (2012) Expression of adhesion-related cytokines in the uterine fluid after transcervical resection of adhesion. Zhonghua Fu Chan Ke Za Zhi 47(10):734–737PubMed

19.

Liu D, Ha C, Zhang X, Zhang Z, Liu P (2013) Molecular implication of ADAM-15 and -17 in intrauterine adhesions. Eur J Obstet Gynecol Reprod Biol 170(1):264–269. https://doi.org/10.1016/j.ejogrb.2013.06.036CrossRefPubMed

20.

Gargett CE, Schwab KE, Deane JA (2016) Endometrial stem/progenitor cells: the first 10 years. Hum Reprod Update 22(2):137–163. https://doi.org/10.1093/humupd/dmv051CrossRefPubMed

21.

Gargett CE, Ye L (2012) Endometrial reconstruction from stem cells. Fertil Steril 98(1):11–20. https://doi.org/10.1016/j.fertnstert.2012.05.004CrossRefPubMed

22.

Wamsteker K (1997) Intrauterine adhesions (synechiae). In: Brosens I, Wamsteker K (eds) Diagnostic imaging and endoscopy in gynecology: a practical guide. WB Saunders, London, pp 171–184

23.

Confino E, Friberg J, Giglia RV, Gleicher N (1985) Sonographic imaging of intrauterine adhesions. Obstet Gynecol 66(4):596–598PubMed

24.

Schlaff WD, Hurst BS (1995) Preoperative sonographic measurement of endometrial pattern predicts outcome of surgical repair in patients with severe Asherman’s syndrome. Fertil Steril 63(2):410–413. https://doi.org/10.1016/s0015-0282(16)57379-8CrossRefPubMed

25.

Salle B, Gaucherand P, de Saint HP, Rudigoz RC (1999) Transvaginal sonohysterographic evaluation of intrauterine adhesions. J Clin Ultrasound 27(3):131–134. https://doi.org/10.1002/(sici)1097-0096(199903/04)27:3<131:aid-jcu5>3.0.co;2-3CrossRefPubMed

26.

Sylvestre C, Child TJ, Tulandi T, Tan SL (2003) A prospective study to evaluate the efficacy of two- and three-dimensional sonohysterography in women with intrauterine lesions. Fertil Steril 79(5):1222–1225. https://doi.org/10.1016/s0015-0282(03)00154-7CrossRefPubMed

27.

Laganà AS, Ciancimino L, Mancuso A, Chiofalo B, Rizzo P, Triolo O (2014) 3D sonohysterography vs hysteroscopy: a cross-sectional study for the evaluation of endouterine diseases. Arch Gynecol Obstet 290(6):1173–1178. https://doi.org/10.1007/s00404-014-3366-6CrossRefPubMed

28.

Letterie GS, Haggerty MF (1994) Magnetic resonance imaging of intrauterine synechiae. Gynecol Obstet Invest 37(1):66–68. https://doi.org/10.1159/000292525CrossRefPubMed

29.

Bacelar AC, Wilcock D, Powell M, Worthington BS (1995) The value of MRI in the assessment of traumatic intra-uterine adhesions (Asherman’s syndrome). Clin Radiol 50(2):80–83. https://doi.org/10.1016/s0009-9260(05)82984-8CrossRefPubMed

30.

Chiofalo B, Palmara V, Vilos GA, Pacheco LA, Lasmar RB, Shawki O, Giacobbe V, Alibrandi A, Di Guardo F, Vitale SG (2019) Reproductive outcomes of infertile women undergoing “see and treat” office hysteroscopy: a retrospective observational study. Minim Invasive Ther Allied Technol. https://doi.org/10.1080/13645706.2019.1705352CrossRefPubMed

31.

Deans R, Abbott J (2010) Review of intrauterine adhesions. J Minim Invasive Gynecol 17(5):555–569. https://doi.org/10.1016/j.jmig.2010.04.016CrossRefPubMed

32.

Valle RF, Sciarra JJ (1988) Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol 158(6 Pt 1):1459–1470. https://doi.org/10.1016/0002-9378(88)90382-1CrossRefPubMed

33.

Society TA (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril 49(6):944–955. https://doi.org/10.1016/s0015-0282(16)59942-7CrossRef

34.

Nasr AL, Al-Inany HG, Thabet SM, Aboulghar M (2000) A clinicohysteroscopic scoring system of intrauterine adhesions. Gynecol Obstet Invest 50(3):178–181. https://doi.org/10.1159/000010305CrossRefPubMed

35.

Gitas G, Proppe L, Alkatout I, Rody A, Kotanidis C, Tsolakidis D, Baum S (2019) Accuracy of frozen section at early clinical stage of endometrioid endometrial cancer: a retrospective analysis in Germany. Arch Gynecol Obstet 300(1):169–174. https://doi.org/10.1007/s00404-019-05158-0CrossRefPubMed

36.

Te Linde RW, Rock JA, Thompson JD (1997) Te Linde’s operative gynecology, 8th edn. Lippincott-Raven, Philadelphia

37.

Capella-Allouc S (1999) Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility. Hum Reprod 14(5):1230–1233. https://doi.org/10.1093/humrep/14.5.1230CrossRefPubMed

38.

Vitale SG (2019) The biopsy snake grasper sec. VITALE: a new tool for office hysteroscopy. J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2019.12.014CrossRefPubMed

39.

Bakas P, Gregoriou O, Hassiakos D, Liapis A, Creatsas M, Konidaris S (2012) Hysteroscopic resection of uterine septum and reproductive outcome in women with unexplained infertility. Gynecol Obstet Invest 73(4):321–325. https://doi.org/10.1159/000335924CrossRefPubMed

40.

DeCherney A, Polan ML (1983) Hysteroscopic management of intrauterine lesions and intractable uterine bleeding. Obstet Gynecol 61(3):392–397PubMed

41.

Cararach M, Penella J, Ubeda A, Labastida R (1994) Hysteroscopic incision of the septate uterus: scissors versus resectoscope. Hum Reprod 9(1):87–89. https://doi.org/10.1093/oxfordjournals.humrep.a138326CrossRefPubMed

42.

Thomson AJ, Abbott JA, Kingston A, Lenart M, Vancaillie TG (2007) Fluoroscopically guided synechiolysis for patients with Asherman’s syndrome: menstrual and fertility outcomes. Fertil Steril 87(2):405–410. https://doi.org/10.1016/j.fertnstert.2006.06.035CrossRefPubMed

43.

Broome JD, Vancaillie TG (1999) Fluoroscopically guided hysteroscopic division of adhesions in severe Asherman syndrome. Obstet Gynecol 93(6):1041–1043. https://doi.org/10.1016/s0029-7844(99)00245-8CrossRefPubMed

44.

Bellingham FR (1996) Intrauterine adhesions: hysteroscopic lysis and adjunctive methods. Aust N Z J Obstet Gynaecol 36(2):171–174. https://doi.org/10.1111/j.1479-828x.1996.tb03279.xCrossRefPubMed

45.

Protopapas A, Shushan A, Magos A (1998) Myometrial scoring: a new technique for the management of severe Asherman’s syndrome. Fertil Steril 69(5):860–864. https://doi.org/10.1016/s0015-0282(98)00036-3CrossRefPubMed

46.

McComb PF, Wagner BL (1997) Simplified therapy for Asherman’s syndrome. Fertil Steril 68(6):1047–1050. https://doi.org/10.1016/s0015-0282(97)00413-5CrossRefPubMed

47.

Chen FP, Soong YK, Hui YL (1997) Successful treatment of severe uterine synechiae with transcervical resectoscopy combined with laminaria tent. Hum Reprod 12(5):943–947. https://doi.org/10.1093/humrep/12.5.943CrossRefPubMed

48.

Coccia ME, Becattini C, Bracco GL, Pampaloni F, Bargelli G, Scarselli G (2001) Pressure lavage under ultrasound guidance: a new approach for outpatient treatment of intrauterine adhesions. Fertil Steril 75(3):601–606. https://doi.org/10.1016/s0015-0282(00)01770-2CrossRefPubMed

49.

Alkatout I, Mettler L (2017) Hysterectomy a comprehensive surgical approach. J Turk Ger Gynecol Assoc 18(4):221–223. https://doi.org/10.4274/jtgga.2017.0097CrossRefPubMedPubMedCentral

50.

Alkatout I (2015) [Communicative and ethical aspects of physician-patient relationship in extreme situations]. Wien Med Wochenschr (1946) 165(23–24):491–498. https://doi.org/10.1007/s10354-015-0385-2CrossRef

51.

Feng ZC, Yang B, Shao J, Liu S (1999) Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions after induced abortions: clinical analysis of 365 cases. Gynaecol Endosc 8(2):95–98. https://doi.org/10.1046/j.1365-2508.1999.00245.xCrossRef

52.

Hanstede MM, van der Meij E, Goedemans L, Emanuel MH (2015) Results of centralized Asherman surgery, 2003–2013. Fertil Steril 104(6):1561–1568. https://doi.org/10.1016/j.fertnstert.2015.08.039CrossRefPubMed

53.

Xu W, Zhang Y, Yang Y, Zhang S, Lin X (2018) Effect of early second-look hysteroscopy on reproductive outcomes after hysteroscopic adhesiolysis in patients with intrauterine adhesion, a retrospective study in China. Int J Surg 50:49–54. https://doi.org/10.1016/j.ijsu.2017.11.040CrossRefPubMed

54.

Robinson JK, Colimon LMS, Isaacson KB (2008) Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman’s syndrome). Fertil Steril 90(2):409–414. https://doi.org/10.1016/j.fertnstert.2007.06.034CrossRefPubMed

55.

Pabuccu R, Onalan G, Kaya C, Selam B, Ceyhan T, Ornek T, Kuzudisli E (2008) Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopic adhesiolysis of intrauterine synechiae. Fertil Steril 90(5):1973–1977. https://doi.org/10.1016/j.fertnstert.2007.06.074CrossRefPubMed

56.

Vesce F, Jorizzo G, Bianciotto A, Gotti G (2000) Use of the copper intrauterine device in the management of secondary amenorrhea. Fertil Steril 73(1):162–165. https://doi.org/10.1016/s0015-0282(99)00475-6CrossRefPubMed

57.

March CM, Israel R (1981) Gestational outcome following hysteroscopic lysis of adhesions. Fertil Steril 36(4):455–459. https://doi.org/10.1016/s0015-0282(16)45792-4CrossRefPubMed

58.

Evans-Hoeker EA, Young SL (2014) Endometrial receptivity and intrauterine adhesive disease. Semin Reprod Med 32(5):392–401. https://doi.org/10.1055/s-0034-1376358CrossRefPubMed

59.

Orhue AA, Aziken ME, Igbefoh JO (2003) A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet 82(1):49–56. https://doi.org/10.1016/s0020-7292(03)00030-4CrossRefPubMed

60.

Lin X, Wei M, Li TC, Huang Q, Huang D, Zhou F, Zhang S (2013) A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study. Eur J Obstet Gynecol Reprod Biol 170(2):512–516. https://doi.org/10.1016/j.ejogrb.2013.07.018CrossRefPubMed

61.

Farhi J, Bar-Hava I, Homburg R, Dicker D, Ben-Rafael Z (1993) Induced regeneration of endometrium following curettage for abortion: a comparative study. Hum Reprod 8(7):1143–1144. https://doi.org/10.1093/oxfordjournals.humrep.a138208CrossRefPubMed

62.

Fedele L, Vercellini P, Viezzoli T, Ricciardiello O, Zamberletti D (1986) Intrauterine adhesions: current diagnostic and therapeutic trends. Acta Eur Fertil 17(1):31–37PubMed

63.

Zikopoulos KA, Kolibianakis EM, Platteau P, de Munck L, Tournaye H, Devroey P, Camus M (2004) Live delivery rates in subfertile women with Asherman’s syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system. Reprod Biomed Online 8(6):720–725. https://doi.org/10.1016/s1472-6483(10)61654-9CrossRefPubMed

64.

Yu D, Li TC, Xia E, Huang X, Liu Y, Peng X (2008) Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman’s syndrome. Fertil Steril 89(3):715–722. https://doi.org/10.1016/j.fertnstert.2007.03.070CrossRefPubMed

65.

Friedman A, DeFazio J, DeCherney A (1986) Severe obstetric complications after aggressive treatment of Asherman syndrome. Obstet Gynecol 67(6):864–867. https://doi.org/10.1097/00006250-198606000-00025CrossRefPubMed

66.

Queckborner S, Davies LC, von Grothusen C, Santamaria X, Simon C, Gemzell-Danielsson K (2019) Cellular therapies for the endometrium: an update. Acta Obstet Gynecol Scand 98(5):672–677. https://doi.org/10.1111/aogs.13598CrossRefPubMed

67.

Malhotra N, Bahadur A, Kalaivani M, Mittal S (2012) Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis. Arch Gynecol Obstet 286(2):525–530. https://doi.org/10.1007/s00404-012-2336-0CrossRefPubMed

68.

Tan J, Li P, Wang Q, Li Y, Li X, Zhao D, Xu X, Kong L (2016) Autologous menstrual blood-derived stromal cells transplantation for severe Asherman’s syndrome. Hum Reprod 31(12):2723–2729. https://doi.org/10.1093/humrep/dew235CrossRefPubMed

69.

Cao Y, Sun H, Zhu H, Zhu X, Tang X, Yan G, Wang J, Bai D, Wang J, Wang L, Zhou Q, Wang H, Dai C, Ding L, Xu B, Zhou Y, Hao J, Dai J, Hu Y (2018) Allogeneic cell therapy using umbilical cord MSCs on collagen scaffolds for patients with recurrent uterine adhesion: a phase I clinical trial. Stem cell Res Ther 9(1):192. https://doi.org/10.1186/s13287-018-0904-3CrossRefPubMedPubMedCentral

70.

Aghajanova L, Horcajadas JA, Esteban FJ, Giudice LC (2010) The bone marrow-derived human mesenchymal stem cell: potential progenitor of the endometrial stromal fibroblast. Biol Reprod 82(6):1076–1087. https://doi.org/10.1095/biolreprod.109.082867CrossRefPubMedPubMedCentral

71.

Alawadhi F, Du H, Cakmak H, Taylor HS (2014) Bone marrow-derived stem cell (BMDSC) transplantation improves fertility in a murine model of Asherman’s syndrome. PLoS ONE 9(5):e96662. https://doi.org/10.1371/journal.pone.0096662CrossRefPubMedPubMedCentral

72.

Santamaria X, Cabanillas S, Cervello I, Arbona C, Raga F, Ferro J, Palmero J, Remohi J, Pellicer A, Simon C (2016) Autologous cell therapy with CD133+ bone marrow-derived stem cells for refractory Asherman’s syndrome and endometrial atrophy: a pilot cohort study. Hum Reprod 31(5):1087–1096. https://doi.org/10.1093/humrep/dew042CrossRefPubMed

73.

von Bahr L, Batsis I, Moll G, Hagg M, Szakos A, Sundberg B, Uzunel M, Ringden O, Le Blanc K (2012) Analysis of tissues following mesenchymal stromal cell therapy in humans indicates limited long-term engraftment and no ectopic tissue formation. Stem Cells 30(7):1575–1578. https://doi.org/10.1002/stem.1118CrossRef

74.

Wysoczynski M, Khan A, Bolli R (2018) New paradigms in cell therapy: repeated dosing, intravenous delivery, immunomodulatory actions, and new cell types. Circ Res 123(2):138–158. https://doi.org/10.1161/CIRCRESAHA.118.313251CrossRefPubMed

75.

Marx RE (2001) Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 10(4):225–228. https://doi.org/10.1097/00008505-200110000-00002CrossRefPubMed

76.

Sampson S, Gerhardt M, Mandelbaum B (2008) Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 1(3–4):165–174. https://doi.org/10.1007/s12178-008-9032-5CrossRefPubMedPubMedCentral

77.

Anitua E, Orive G (2010) Short implants in maxillae and mandibles: a retrospective study with 1 to 8 years of follow-up. J Periodontol 81(6):819–826. https://doi.org/10.1902/jop.2010.090637CrossRefPubMed

78.

Reurink G, Verhaar JA, Tol JL (2014) More on platelet-rich plasma injections in acute muscle injury. N Engl J Med 371(13):1264–1265. https://doi.org/10.1056/NEJMc1409204CrossRefPubMed

79.

Le ADK, Enweze L, DeBaun MR, Dragoo JL (2019) Platelet-rich plasma. Clin Sports Med 38(1):17–44. https://doi.org/10.1016/j.csm.2018.08.001CrossRefPubMed

80.

Aghajanova L, Houshdaran S, Balayan S, Manvelyan E, Irwin JC, Huddleston HG, Giudice LC (2018) In vitro evidence that platelet-rich plasma stimulates cellular processes involved in endometrial regeneration. J Assist Reprod Genet 35(5):757–770. https://doi.org/10.1007/s10815-018-1130-8CrossRefPubMedPubMedCentral

81.

Chang Y, Li J, Chen Y, Wei L, Yang X, Shi Y, Liang X (2015) Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J Clin Exp Med 8(1):1286–1290PubMedPubMedCentral

82.

Tandulwadkar SR, Naralkar MV, Surana AD, Selvakarthick M, Kharat AH (2017) Autologous intrauterine platelet-rich plasma instillation for suboptimal endometrium in frozen embryo transfer cycles: a pilot study. J Hum Reprod Sci 10(3):208–212. https://doi.org/10.4103/jhrs.JHRS_28_17CrossRefPubMedPubMedCentral

83.

Molina A, Sanchez J, Sanchez W, Vielma V (2018) Platelet-rich plasma as an adjuvant in the endometrial preparation of patients with refractory endometrium. JBRA Assist Reprod 22(1):42–48. https://doi.org/10.5935/1518-0557.20180009CrossRefPubMedPubMedCentral

84.

Nazari L, Salehpour S, Hoseini S, Zadehmodarres S, Azargashb E (2019) Effects of autologous platelet-rich plasma on endometrial expansion in patients undergoing frozen-thawed embryo transfer: a double-blind RCT. Int J Reprod Biomed (Yazd) 17(6):443–448. https://doi.org/10.18502/ijrm.v17i6.4816CrossRef

85.

Sardana D, Upadhyay AJ, Deepika K, Pranesh GT, Rao KA (2014) Correlation of subendometrial-endometrial blood flow assessment by two-dimensional power Doppler with pregnancy outcome in frozen-thawed embryo transfer cycles. J Hum Reprod Sci 7(2):130–135. https://doi.org/10.4103/0974-1208.138872CrossRefPubMedPubMedCentral

Title: Intrauterine infusion of platelet-rich plasma for severe Asherman syndrome: a cutting-edge approach
Authors: Elena Puente Gonzalo
Luis Alonso Pacheco
Auxiliadora Vega Jiménez
Salvatore Giovanni Vitale
Antonio Raffone
Antonio Simone Laganà
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Hysteroscopy
Estradiol
Published in: Updates in Surgery / Issue 6/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-020-00828-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Intrauterine infusion of platelet-rich plasma for severe Asherman syndrome: a cutting-edge approach

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2021

Comparison of two different surgical strategies for breast cancer patients treated with mastectomy plus sentinel lymph node biopsy

Comparing and contrasting clinical consensus and guidelines for anal intraepithelial neoplasia in different geographical regions

Re-laparoscopy for the treatment of complications after laparoscopic appendectomy: is it possible to maintain the minimally invasive approach?

Sexual dysfunction following surgery for rectal cancer: a single-institution experience

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Early diagnosis of anastomotic leakage in colorectal surgery: prospective observational study of the utility of inflammatory markers and determination of pathological levels