Оцінка впливу гінекологічної патології на шанси живонародження серед жінок із повторними невдачами імплантації

Abstract

Aim - to study the prognostic impact of the presence of gynecological pathology on live birth in women with multiple negative implantation attempts in the context of the proposed methods of examination and treatment, such as preimplantation genetic diagnosis of embryos and individualization of the endometrial preparation protocol, taking into account the results of the assessment of the implantation window. Materials and methods. The prospective cohort study included 93 women with infertility treated by in vitro fertilization (IVF). Patients had repeated failed implantation attempts and were divided into three groups: the Group 1 - patients who were treated with genetically untested embryos according to a standard fixed stimulation protocol, the Group 2 - patients who were treated with euploid embryos after preimplantation genetic screening according to a standard fixed protocol; the Group 3 - patients treated with euploid embryos after preimplantation genetic screening and determination of the implantation window with subsequent modification of the stimulation protocol, according to the results of the endometrial examination. The implantation window was determined by three-time aspiration biopsy of the endometrium during the luteal phase of the menstrual cycle. The samples were analyzed by scanning electron microscopy. Based on the results, the endometrial preparation protocol was individualized for the next IVF attempt. Preimplantation diagnostics of embryos was performed using the next generation method. Statistical analysis was performed using IBM SPSS V25.0 for Windows software. Results. According to the results obtained, the presence of genital pathology reduced the chance of live birth by 30% in patients with repeated failed implantation attempts. Pathologies such as endometriosis, including endometrioid ovarian cysts, benign breast disease and Asherman syndrome have a negative effect on the chance of live birth among patients who have undergone infertility treatment with IVF. Conclusions. The presence of gynecologic pathology reduces the chances of live birth in patients with repeated failed implantation attempts undergoing IVF treatment. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent was obtained from the patients. No conflict of interests was declared by the authors.