Репродуктивные исходы женщин, страдающих аденомиоз-ассоциированным бесплодием

Abstract

Relevance. The identification of the relationship between adenomyosis and infertility, as well as the possible overcoming of the consequences, is one of the main tasks of reproduction. Despite the fact that adenomyosis is more often detected in women of late reproductive age, issues related to its effect on the frequency of pregnancy have not yet been studied. It is also worth noting that the average age of pregnancy among women in developed countries tends to late reproductive age, which is of greater interest for solving the problems of adenomyosis-associated infertility. In this article we present an analysis of the literature data on the effect of adenomyosis on fertility. Objective. Based on the analysis of scientific publications, to consider adenomyosis as a cause of infertility from a contraversion position and to describe the reproductive outcomes in this cohort of patients. Results. A search of literature, publications from Pubmed, Embase and Cochran databases for the last 5 years has been carried out. Molecular studies have provided a deep understanding of the pathogenesis of adenomyosis over the past few years, but there is a huge discrepancy between in vitro research and practice. Radical treatment: endometrial ablation and hysterectomy, used to relieve pain caused by adenomyosis, exclude pregnancy planning. Conclusion. Adenomyosis is a common gynecological disease with an unclear etiology that leads to impaired fertility. The presence of different approaches to the treatment of adenomyosis did not contribute to an increase in the effectiveness in achieving fertility. Since there is still the main problem – time. For example, how long should pregnancy be postponed after treatment and whether hormonal treatment improves the outcome of fertility after surgery, such questions still remain controversial and debatable. Despite numerous studies of the pathogenesis of fertility decline in adenomyosis, their results do not correlate with treatment. We also concluded that adenomyosis has an adverse effect on the clinical results of in vitro fertilization. This reduces the frequency of pregnancy and live birth and increases the frequency of miscarriages. Thus, it is very important to study new, more effective, safer and less invasive strategies for managing women with infertility due to adenomyosis.