Treatment Outcomes of Individualized PDLLA-Copper Stents Versus Intrauterine Balloons in Moderate-to-Severe Intrauterine Adhesions After Hysteroscopic Adhesiolysis: A Propensity Score-Weighted Analysis

STUDY OBJECTIVE: To compare the efficacy of individualized poly-DL-lactic acid (PDLLA)- copper stents versus intrauterine balloons (Cook balloon) in improving reproductive outcomes and preventing adhesion recurrence following hysteroscopic adhesiolysis (HA). DESIGN: Retrospective cohort study. SETTING: A tertiary university hospital. PATIENTS: 399 consecutive women diagnosed with moderate-to-severe intrauterine adhesions (IUAs) who underwent HA with cold scissors and received an individualized PDLLA-copper stent (Stent group, n=139) or a COOK balloon (COOK group, n=260) from January 2019 to December 2022. INTERVENTIONS: All cases were reviewed. Inverse probability of treatment weighting (IPTW) was applied to mitigate selection bias and ensure comparability between the groups. MAIN RESULTS: Compared with the Cook Group, the Stent Group demonstrated a significantly higher clinical pregnancy rate (62.4% versus 48.6%; Hazard Ratio [HR] 1.59, 95% confidence interval [CI] 1.16-2.19), a lower miscarriage rate (14.3% vs 28.0%; Relative Risk [RR] 0.51, 95% CI 0.27-0.98), and a reduced adhesion recurrence rate (14.1% vs 32.6%; RR 0.43, 95% CI 0.23-0.82). The median time to pregnancy was also significantly shorter in the Stent Group (11 months vs 18 months; p = .003). However, no statistically significant difference in clinical pregnancy rate was observed between the two groups among patients with severe IUAs. Live birth rates did not differ significantly across the analyses. CONCLUSION: The individualized PDLLA‑copper stent represents a promising alternative approach for improving reproductive outcomes and reducing adhesion recurrence particularly in patients with moderate IUAs after HA with cold scissors.