Preparation of the endometrium in the programs of auxiliary reproductive technologies for sterility in women

Abstract

Background. The most important stage in the treatment of infertility is the introduction into clinical practice of the methods of in vitro fertilization (IVF), which made it possible to implement the function of childbirth in almost all forms of female infertility. The introduction of endoscopic technologies made it possible to significantly expand diagnostic possibilities and clarify the nature of intrauterine pathology when using assisted reproductive technologies. Purpose – of the research should be to increase the effectiveness of the treatment of female infertility when using assisted reproductive technologies and hysteroscopy by creating conditions in the endometrium for embryo implantation. Materials and Methods. A study was conducted in 42 patients with infertility aged 32 to 38 years. In all women, the morphological state of the endometrium was determined after diagnostic hysteroscopy. The patients were divided into 2 clinical groups. Group 1 included 28 women who were in a state of preparation for IVF after hysteroscopy with changes characteristic of endometrial pathology, which were found during ultrasound. The second group included 14 patients in whom, according to ultrasound, no structural changes of the endometrium were noted. These patients had a failed IVF attempt. In the next cycle, the women underwent a diagnostic hysteroscopy due to the lack of pregnancy after the first IVF attempt. Results. Group 1 patients (n = 28) with endometrial changes before IVF showed that the causes of pathology were: endometrial hyperplasia (53.6%); chronic endometritis (21.4%), endometriosis (25%). Therefore, before stimulation of superovulation, a hysteroscopy was performed to confirm the morphological diagnosis. In patients of the 2nd group (n = 14) after hysteroscopy and histological examination, pathological changes of the endometrium were found in all patients. Chronic endometritis occurred in 5 cases (35.7%), micropolyposis of the endometrium – in 6 (42.9%), endometriosis – 3 (21.4%). Clinical pregnancy occurred in 17 patients (60.7%) in the first group, in 9 (64.2%) in the second group. Conclusions. Hysteroscopy with morphological examination of the endometrium remains the main method of diagnosing intrauterine pathology. Diagnosis of infertility by hysteroscopy plays a very important role in the normalization of reproductive function during in vitro fertilization (IVF). After an unsuccessful IVF attempt, in the absence of pathological changes in the endometrium, a diagnostic hysteroscopy should be performed to rule out endometrial pathology.