Efficacy of proteolytic therapy in the comprehensive management of patients with second-degree intrauterine synechia

Introduction. The article discusses the possibilities of comprehensive management for patients with Asherman’s syndrome.

Objective: to describe the experience in comprehensive management of patients with Asherman’s syndrome using an enzymatic proteolytic agent – bovgyaluronidase azoximer.

Material and methods. A total of 43 patients with Asherman’s syndrome were examined. The examination methods included transvaginal ultrasound (TVUS), hysteroscopy, intrauterine dissection of synechia, endometrial histopathological examination, IL-6, IL-10, VEGF-A and TGFβ1 test in cervical mucus. The treatment included hysteroscopy, dissection of intrauterine synechia and use of Longidaza I.M. at a dose of 3000 IU once every three days for the course – 5 injections followed up by 1 supposidoitory (3000 ME) intravaginally once every two days for the course – 15 applications) on the top of already administered cyclic estrogen gestagen therapy.

Results. A statistically significant reduction of anti-inflammatory index (AII) and TGFβ1/VEGF-A ratio in cervical mucus up to the test results of healthy women of reproductive age (controls) was observed in assessing changes in the local immunological status in patients with Asherman’s syndrome under pressure of azoximer bovgioluronidase therapy after 6 months of observation. AII – 0.68 (0.02) c.u. Group 1 against 0.65 (0.03) c.u. (in control), p = 0.87 and TGFβ1/VEGF-A – 1.8 (0.3) c.u. against 1.4 (0.2) c.u. accordingly, p = 0.84.

Сonclusions. Analysis of clinical efficacy of azoximer bovgyaluronidase in the comprehensive management of 21 women with second-grade intrauterine synechia showed recovery of menstrual cycle in 18/21 (85.7%) patients, relief of menstrual pain in 11/21 (52.3%) patients. 6/21 (28.5%) patients with infertility and 2/21 (9.5%) patients with miscarriage obtained spontaneous pregnancy 12 months after the therapy. All pregnancies ended in term births.

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