CONSEQUENCES OF THE ASSISTANT REPRODUCTIVE TECHNOLOGY PROGRAM IN WOMEN WITH HYPERPLASTIC PROCESSES OF ENDOMETRIUM
In women of reproductive age, reproductive dysfunction is associated with uterine factor, which ranges from 24% to 62% in the population, especially in the case of endocrine and metabolic disorders.
Literature sources show a significant decrease in fertility in such patients, 38.6% of women report infertility, 11.9% - recurrent miscarriage.
The aim was to study the effectiveness and consequences of in vitro fertilization programs in patients with infertility and hyperplastic processes of endometrium.
Materials and methods. A prospective cohort research included 75 patients with history of hyperplastic processes of endometrium and reduced reproductive potential (infertility and history of fetal loss syndrome) - the main group, as well as 40 women without uterine infertility and without menstrual irregularities (comparison group).
Results. In the main group, the average age of women was significantly higher and 1.4 times - the average body mass index against the data of the comparison group (p <0,05). The share of comorbidity of somatic pathology and proliferative processes of the reproductive system (fibroids, adenomyosis etc.) was significantly higher in the main group (p <0.05). Assessment of reproductive function and obstetric history allowed to establish a significantly higher number of pregnancies, miscarriages and intrauterine interventions in the main group (p <0,05). The results of indicators of hormonal homeostasis showed a tendency to reduce the level of antimullerian hormone, although it corresponded to the reference values, which can be explained by the older age group of patients in the main group and a high concentration of testosterone (p<0.05), that required a longer period of superovulation stimulation and a higher dose of gonadotropins, while chorionic gonadotropin was more often used as an ovulation trigger. Women of the main group had smaller number of mature oocytes, more oocytes with cytoplasmic and extracytoplasmic dysmorphism and low-quality blastocysts versus data in the comparison group. The incidence of biochemical and clinical pregnancies did not differ significantly between groups, whereas the proportion of spontaneous abortions was 6.4 times higher in the case of uterine infertility (history of endometrial hyperplasia and polyposis), which was accompanied by a lower percentage of live births in this category of patients compared to the comparison group (p <0.05).
Conclusions. The research found a reduced chance of prolonging clinical pregnancy and live birth in patients with history of hyperplastic processes of endometrium, as well as a decrease in the effectiveness of assisted reproductive technology programs due to the weaker response of the ovaries to superovulation stimulation. Patients with history of hyperplastic processes of endometrium had a higher BMI, a high proportion of uterine fibroids, adenomyosis and comorbidity of somatic pathology, which is naturally associated with age and pathogenesis of hyperplastic processes of the reproductive system. Patients of the main group were found to have higher androgenic rates and such following features of superovulation stimulation: appointment of combined drugs FSH / LH, high total doses of gonadotropins and chorionic gonadotropin as a trigger of ovulation, also an increase in the duration of superovulation stimulation with increasing BMI.
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