Клініко-статистичний аналіз особливостей репродуктивного здоров’я жінок при повторних невдалих спробах застосування допоміжних репродуктивних технологій

Abstract

The objective: to conduct a clinical and statistical analysis of the characteristics of the somatic and reproductive history in women with repeated unsuccessful attempts of assisted reproductive technologies and to determine significant medical and social factors in the formation of chronic endometritis. Materials and methods. A clinical and statistical analysis of 177 outpatient cards was carried out: Group I – 127 women under the age of 45 with a history of two or more ineffective attempts at in vitro fertilization; Group II – there were 50 healthy women without reproductive disorders. The comprehensive examination included data from anamnesis, general clinical and gynecological examination, laboratory and instrumental methods according to the data of outpatient observation cards at the MC LLC «Isida – IVF». The diagnosis of chronic endometritis was verified by the data of the histological examination of the endometrium obtained by the pipel biopsy method on days 4 –9 of the menstrual cycle. Results. The incidence of inflammatory diseases of the uterine appendages in patients of group I was 47.2%, inflammatory diseases of the endometrium – 41.7%; р1.2<0.01. The incidence of acute endometritis among patients of group I was 6.3%; р1.2>0.05 and was due to the implementation of the infectious process after abortion. In the first group, sexually transmitted infections were noted in 67.7% of patients, р1.2>0.05; bacterial vaginosis was recorded 1.5 times more often – 28.4%; р1.2<0.05. In the first group, one-time artificial termination of pregnancy appeared in 15.0%, twice – in 15.7% (р1.2<0.05). Laparoscopies were previously performed in 59.8% of women, laparotomies – in 62.2%, while operations were repeated in 25.4% of women. Unilateral tubectomy for ectopic pregnancy was performed in 25.4% of women, bilateral in 12.7%. Removal of fallopian tubes due to sactosalpinxes in 25.4% of women, unilateral removal of appendages appeared in patients in 3.9% of cases. The most significant risk factors for the development of chronic endometritis in the studied groups are acute post-abortion endometritis VR (relative risk) = 1.439, p=0.029 and postoperative peritonitis, which was caused by complications of appendectomy – RR=1.430, p=0.084. We did not reveal a significant effect of inflammatory diseases of the uterine appendages on the implementation of chronic endometritis (RR=45.132, CI (6.151-31.167), p=0.001. Analysis of reproductive failures as a risk factor for the development of chronic endometritis in women of group I showed a significant relative risk: with a history of PR RR=1.44, p=0.039, with repeated artifactual abortions RR=1.5, p<0.001, SV RR=1.572, p=0.001. A higher relative risk of developing XE was observed during pregnancy – RR=1.597, p=0.001. Conclusions. Clinical and statistical analysis of the reproductive health of women with repeated unsuccessful attempts at ART has shown that these women have a high frequency of intrauterine interventions, a low frequency of using alternative and safe methods of abortion, and there is no system of health measures after reproductive failures. There is a significant increase in spontaneous abortion in the early stages and the absence of a decrease in premature birth. Preserving the reproductive health of women is an important medical and social problem, the solution of which depends on the joint efforts of state and public organizations and health authorities, as well as on the responsibility of the population for their health. The development and implementation of pregravid health improvement and pregnancy planning programs for women with repeated unsuccessful attempts at ART against the background of chronic endometritis should be a priority in the health care system. Keywords: assisted reproductive technologies, chronic endometritis, ineffective attempts at fertilization, reproductive health, pregnancy.