ПРОБЛЕМА НЕВЫНАШИВАНИЯ БЕРЕМЕННОСТИ ПРИ АДЕНОМИОЗЕ: ПУТИ РЕШЕНИЯ

Abstract

The purpose of this study is to substantiate the possibility of successful therapy of miscarriage with adenomyosis based on the study of a clinical case (the patient has a history of 7 unsuccessful IVF attempts). The analysis of this clinical case revealed that despite the presence of clinical signs of endometriosis, in particular, adenomyosis, such as copious, prolonged, painful menstruation with menarche, the absence of pregnancy for 12 months, provided regular sexual activity without the use of contraception by a married couple, unsuccessful IVF attempts in the anamnesis, the diagnosis of adenomyosis was made untimely. Although one of the signs of this disease may be the absence of spontaneous spontaneous pregnancy, despite regular ovulation, patency of the fallopian tubes and a normal spermogram in the partner, as was the case in this case. It is necessary to pay attention to the possibility of this pathology as a cause of infertility in infertile women. At the same time, each unsuccessful IVF attempt can also increase the likelihood of miscarriage, according to research. The adenomyosis revealed in this case apparently caused infertility . The treatment prescribed according to the current clinical recommendations, using progestogens in a continuous mode, in particular, dienogest at a dosage of 2 mg, showed a good result. It is important to take into account that the timing of drug administration and the time of its withdrawal are strictly individual, based on clinical criteria. In this case, as a criterion for drug withdrawal, the achievement of uniformity of the endometrium during ultrasound of the pelvic organs was used, which served as confirmation of the effective suppression of foci of endometriosis in the myometrium. To achieve this result, it took 15 months of hormone therapy with dienogest. The subsequent course of pregnancy was favorable and ended with the birth of a healthy full-term baby. This could also indicate the readiness of both the myometrium and the endometrium for fetal gestation and the normal course of pregnancy. This clinical case demonstrates the effectiveness of using dienogest at a dosage of 2 mg, prescribed with an individual selection of the duration of the course of therapy, in patients with adenomyosis in order to restore reproductive function.