Inflammatory cytokine signatures predict postoperative intrauterine adhesions after hysteroscopic fibroid resection: Evidence from a prospective cohort.

BACKGROUND

Intrauterine adhesions (IUAs), or Asherman's syndrome, are common complications of intrauterine surgery, such as hysteroscopic myomectomy, leading to menstrual disturbances and infertility. Postoperative inflammation is thought to drive adhesion formation, but the predictive value of specific inflammatory biomarkers remains unclear.

METHODS

We conducted a prospective observational study of 150 women aged 19-45 years undergoing hysteroscopic resection of submucosal fibroids. Serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels were measured preoperatively, 48 h postoperatively, and at 3 months. IUAs were evaluated at 12 weeks by second-look hysteroscopy and graded by the American Fertility Society criteria. Logistic regression and receiver operating characteristic analysis were performed.

RESULTS

Among 135 patients who completed follow-up, 40 (30.8%) developed IUAs (20 mild, 12 moderate, and eight severe). Postoperative (48-h) serum IL-6 and CRP levels increased significantly in patients who developed adhesions compared with those who did not (P < 0.01), while postoperative TNF-α differences were less pronounced. IL-6 showed the strongest correlation with adhesion severity (ρ = 0.53) and was an independent predictor of moderate-to-severe IUA risk (adjusted odds ratio [OR] = 1.25 per pg/mL, 95% confidence interval [CI] 1.10-1.42). CRP was also predictive (OR = 1.30 per mg/L, 95% CI 1.05-1.60). IL-6 had the best discriminative ability (area under the curve [AUC] = 0.80), outperforming CRP (AUC = 0.72) and TNF-α (AUC = 0.65).

CONCLUSION

Perioperative elevations in IL-6 and CRP are strongly associated with adhesion formation after hysteroscopic myomectomy. These markers might support risk-stratified postoperative surveillance in future multicenter studies.