Тактика підготовки ендометрію пацієнток у проґрамі допоміжних репродуктивних технолоґій для підвищення ефективності лікування

Abstract

Aim. To develop a strategy of improvement of the effectiveness of infertility treatment by preparing endometrium in ART program. Materials and Method. The study was conducted from 01.01.2015 to 31.12.2016 in the Communal Institution "Regional Medical Centre of Human Reproduction" of Zaporizhzhya Regional Council. It involved 112 patients with 1-2 previous unsuccessful fertilization attempts in ART programs. The diagnostic stage included general examination approaches: extended range of ultrasound exploration; diagnostic hysteroscopy or the Pipelle  endometrial biopsy; PCR diagnosis and detection of antisperm antibodies; and additional tests: Hyaluronan binding assay, identification of antibodies to Zonapellucida oocyte and the degree of the sperm DNA fragmentation. Taking into account the identified pathologies, 92 of the 112 patients were divided into four subgroups: I. 23 - with signs of chronic endometritis and cervical antisperm antibodies; II. 12 - with abnormalities of the steroid receptors' expression; III.27 - with endometrium pathology; IV. 30 - with a combination of inflammatory and hyperplastic processes in the endometrium. Twenty patients without any pathology of endometrium were included into the fifth, control group. At the stage of preparation to ART programs, courses of curative plasmapheresis (CP) and ozone therapy were prescribed to all patients. Depending on the indications, additional treatments were administered: HRT, GM-CSF, hCG, and Nicergoline administration. Results and Discussion. By applying an individualized approach, we have developed algorithms for preliminary treatment of endometrium in ART program for each of the selected groups of patients, in addition to CP and ozone therapy: I - complex specific treatment, and also: in case of inflammatory markers' detection - combined oral contraceptives (COCs), and in the presence of ACA - condom therapy; II - COCs or a cycle of HRT, irrigation by HCG, intrauterine administration of G-CSF and drugs improving rheological properties of the blood; III - metabolic and cyclic hormone therapy, irrigation by HCG and intrauterine administration of G-CSF; IV - etiopathogenetic therapy: pharmacological, hormonal therapy, and surgical treatment. According to the results of the clinical work on the comprehensive preparation of endometrium for fertilization in ART programs, clinical pregnancy occurred in: 19 patients (67%) in Group I; 3 patients (25%) in Group ІІ; 10 patients (45%) in Group ІІІ; 19 patients (63 %) in Group IV; and 8 patients (40%) of Group V (control). Conclusions. The implementation of modern techniques and technologies based on the developed strategy of conducting the preparatory stage of the ART program and the optimization of the embryological stage increases the effectiveness of the IVF / ICSI / ET cycles by 15.7% and allows achieving the incidence of clinical pregnancy of 52.7%.