{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:02:59Z","timestamp":1790841779374,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Restoration of the uterine cavity after hysteroscopic adhesiolysis should be evaluated as a combined anatomical and functional endpoint. Anatomical normalization is a necessary prerequisite for implantation, but functional recovery of the endometrium (re\u2010epithelialization, glandular regeneration, vascularization, and hormone responsiveness) is equally critical for reproductive success. Contemporary data show that pregnancy and live birth rates correlate closely with the degree of postoperative cavity restoration, underscoring the prognostic relevance of anatomical repair, while established adjuncts and emerging regenerative therapies are designed to target the biological processes that govern functional endometrial recovery rather than cavity patency alone. In this narrative review, we appraise the current standard of care and the adjuncts proposed to improve it, including postoperative estrogen, mechanical barriers, anti\u2010adhesion gels, platelet\u2010rich plasma, mesenchymal stem cells, exosomes, and bioactive scaffolds. We argue that these interventions should be judged by their ability to achieve durable anatomical restoration coupled with functional endometrial recovery, particularly in moderate\u2010to\u2010severe disease, with reproductive outcomes serving as the ultimate validation. Although biologically plausible and supported by encouraging surrogate and preclinical data, these adjuncts have not yet demonstrated a reproducible improvement in live birth across adequately powered, independently validated trials. We provide a clinically meaningful framework for interpreting current evidence and for guiding future trial design in women with intrauterine adhesions.<\/jats:p>","DOI":"10.1002\/ijgo.71372","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:45:31Z","timestamp":1790840731000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intrauterine adhesions: Adjunctive strategies beyond hysteroscopic lysis and reconstruction"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9633-9911","authenticated-orcid":false,"given":"Ece","family":"Aksakal","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology and Assisted Reproduction American Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7021-4600","authenticated-orcid":false,"given":"Irem","family":"Usta","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology and Assisted Reproduction American Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinem","family":"Ertas","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology and Assisted Reproduction American Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore Giovanni","family":"Vitale","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit, Gaspare Rodolico \u2010 San Marco university Hospital, Department of General Surgery and Medical Surgical Specialties University of Catania  Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1452-1718","authenticated-orcid":false,"given":"Bulent","family":"Urman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmt045"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15262"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.09.015"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dey237"},{"key":"e_1_2_10_6_1","first-page":"588","article-title":"The epidemiology, clinical burden, and prevention of intrauterine adhesions related to surgically induced endometrial trauma: a systematic literature review and selective meta\u2010analyses","volume":"31","author":"Munro MG","year":"2025","journal-title":"Hum Reprod Update"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13287-021-02620-2"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJN.S527637"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41073-019-0064-8"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10397-017-1007-3"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2024.01.022"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-022-05164-2"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13010073"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2024.05.026"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2022.04.004"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2017.07.011"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-024-07460-y"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2025.08.035"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2021.102276"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2024.10.013"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2025.1619778"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew042"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2019.05.012"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11427-023-2403-7"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/stcltm\/szaf011"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13287-018-0904-3"}],"container-title":["International Journal of Gynecology &amp; 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