Клінічне значення хронічного ендометриту у жінок зі зниженою відповіддю на стимуляцію яєчників у програмі екстракорпорального запліднення

Abstract

The objective: determination of the frequency of detection, risk factors, diagnostic criteria for chronic endometritis in poor responders patients in ART cycles with the study of the effectiveness of the proposed regimens for the treatment of this pathological condition. Materials and methods. A clinical study of the diagnosis of chronic endometritis in in poor responders patients have been conducted to develop individual approaches to overcoming infertility in a given cohort of women, taking into account not only the ovarian reserve, but also the endometrial status, assessed by clinical, instrumental and laboratory research methods, for achievement of successful implantation and ongoing pregnancy. The control group of women included 93 patients with infertility, a normal ovarian response to stimulation and lack of criteria for bad defendants. Results. As a result of a study conducted in poor responders patients, there is a significant percentage of the presence of chronic endometritis, which greatly complicates the overcoming of infertility. Risk factors for the occurrence of this pathological condition are genital tract infections, surgical intervention, intrauterine manipulations. Diagnostic criteria for chronic endometritis in women with infertility are micropolips, stomach edema, local and diffuse congestion of the endometrium during hysteroscopic examination and high expression of the imunohistochemical marker CD-138. Conclusion. The treatment protocol of the first line of chronic endometritis – docxicillin 100 mg 2 times a day 14 days, neomycin sulfate 35 000 MU, polymyxin B sulfate 35 000 MU, nystatin 100 000 MU for 1 suppositirium 1 time per day for 10 days and diclofenac 100 mg rectally for 5 days – is effective in 67.5% of cases . In patients who are resistant to previous antibiotic therapy, the second line treatment regimen is – сefotaxime 2.0 i /v 1 time per day, gentamycin 80 mg 3 times a day in / m, metronidazol 100 ml per day i / v, and diclofenac 100 mg rectally once daily for 7 days – the effectiveness of the treatment of chronic endometritis reached 79.1% of the cases. Key words: chronic endometritis, infertility, poor responders, ART.