Efficacy of pulsed magnetic therapy, high-intensity magnetic stimulation of the pelvic floor muscles and intrauterine plasma therapy to restore endometrial receptivity after intrauterine interventions: a randomized trial

Abstract

Surgical interventions on the pelvic organs lead to damage to the basal layer of the endometrium, which disrupts embryo implantation. Restoring endometrial receptivity helps improve fertility. Purpose of the study. Evaluation of the effectiveness of non-drug methods for restoring endometrial receptivity after intrauterine interventions in women of reproductive age. Material and methods. The prospective randomized study included 120 patients aged 18–45 years who had undergone intrauterine surgery and were planning pregnancy. The patients were divided into three equal groups: group 1 — 40 patients who received combined pulsed magnetic therapy and intrauterine plasma therapy of the endometrium; group 2 — 40 patients who underwent high-intensity magnetic stimulation of the pelvic floor muscles and intrauterine plasma therapy of the endometrium; group 3 — 40 patients who underwent pulsed magnetic therapy. Anamnesis data, as well as clinical, laboratory, and instrumental data of the patients were analyzed, an ultrasound assessment of endometrial thickness and blood flow velocity in the uterine arteries was performed, and the pregnancy rate was assessed 1, 2, and 3 months after treatment. Results. The probability of pregnancy in group 1 was significantly higher than in group 3 (p = 0.014), but it did not reach statistically significant differences from the first group. The treatment method in group 2 increased the likelihood of pregnancy most effectively (by 70 %) (risk ratio 2.37 (95 % confidence interval 1.10–5.11), p = 0.027). Taking vitamins increased the chance of getting pregnant by 72 %, absence of chronic diseases — by 81 %, younger age — by 49 %, and normal body mass index — by 48 %. Based on the data obtained, the predictors of a favorable treatment outcome and a high probability of pregnancy are as follows: endometrial thickness more than 7.5 mm after 1 month, more than 9.5 mm after 2 months, more than 10.5 mm after 3 months; blood flow velocity more than 11.5 mm/s after 2 months and more than 13.5 mm after 3 months. Conclusion. The highest probability of restoration of endometrial receptivity after intrauterine interventions and pregnancy occurs when using a rehabilitation complex, including the combined use of high-intensity magnetic stimulation of the pelvic floor muscles and intrauterine plasma therapy. Predictors of a favorable outcome of treatment and pregnancy are the thickness of the endometrium and the blood flow velocity in the uterine arteries during the course of therapy.