Репродуктивний потенціал жінок із матковим фактором безплідності

Abstract

Intrauterine pathology, its diagnosis and treatment remain the most urgent problem of operative gynecology and reproduction, which is associated with a significant percentage of uterine submucosa, adhesions (senechias) in the uterus, endometrial hyperplasia and polyposis. The objective: on the basis of a detailed analysis of anamnestic data of women with an intrauterine factor of infertility, identify a high-risk group, which requires a deeper study of the hormonal features and the state of the endometrium. Materials and methods. 105 case histories of women of all ages with endometrial pathology – endometrial polyp, endometrial hyperplasia, intrauterine synechia, which were treated in the departments of infertile marriage, family planning and gynecological department, were selected for an observational cross-sectional retrospective study by continuous sampling. Special instrumental research methods were used in the work: ultrasound, hysterosalpingography, hysteroscopy, pathomorphological studies of remote preparations. Results. Clinical symptoms of intrauterine pathology in patients with long-term infertility treatment are represented by menstrual disorders, such as hypomenorrhea, amenorrhea, chronic pelvic pain, and obliteration of the cervical canal. In addition, the characteristic complications of pregnancy, manifested by miscarriage, threatened termination, abnormal placentation, which significantly reduces the reproductive potential and quality of life. Сonclusions. Among patients with intrauterine pathology, as the leading cause of infertility, it is advisable to select a separate group of high risk of miscarriage, and this affiliation depends on the multiplicity of intrauterine interventions, the age of the woman, the infectious profile and a combination of leading factors. The method of stratification analysis proved that instrumental interventions in the history of five times increase the chances of unsuccessful attempts of assisted reproductive technology programs (OR=5.92; 95% CI: 2.18–14.32; p<0.05), besides a significant factor is a high infectious index and inflammatory disease of the uterus, seven times increases the risk of reproductive failure (OR=7,36; 95% CI: 3.72–16.16; p<0.005), surgery on the pelvic organs and the uterus doubled, and the accompanying dyshormonal disorders and ovarian dysfunction five times (OR=5.84; 95% CI: 1.19–12.26; p<0.002). Key words: uterine infertility factor, endometrial hyperplasia, polyposis, uterine senechia, reproductive failure.