Эндометриоз-ассоциированное бесплодие: патогенез и возможности гормональной терапии в подготовке к ЭКО

Abstract

Objective. Analytical review of the literature on endometriosis-associated infertility, its mechanisms and hormone therapy in preparation for in vitro fertilization (IVF). Endometriosis is considered the most common benign but potentially metastatic gynecological disease and occurs in approximately 10% of women of reproductive age, causing infertility in 40%. Patients with this disease often require the use of assisted reproductive technologies to increase the chances of pregnancy. However, endometriosis interferes with all aspects of the reproductive process and is associated with lower success rates than other indications for IVF. The mechanisms of infertility associated with endometriosis remain largely unknown. Several etiological factors of endometriosis-associated infertility are discussed, ranging from abnormal anatomy and fallopian tube obstruction due to pelvic adhesions to less studied factors such as proinflammatory cytokine responses leading to endometrial receptivity and impaired oocyte quality. Conclusion. To improve IVF outcomes in infertile patients with endometriosis, a long-term (3–6 months) hormone suppressive therapy before the cycle was suggested. Preliminary prescription of dienogest may improve clinical outcomes of pregnancy after IVF in patients with this disease. Dienogest has a favorable effect on both systemic and local inflammatory microenvironment, increases the number and quality of obtained oocytes, high-quality embryos and blastocysts, the rate of clinical pregnancy and live birth, which has been repeatedly shown in studies. Key words: endometriosis, IVF, IVF failure, dienogest, infertility