Комплексна реабілітаційна терапія генітального ендометріозу у жінок з ендометріоз-асоційованою безплідністю

Abstract

The most relevant and least investigated questions are the relationships between genital endometriosis and disorders of the fertile function. It is precisely the lack of a clear algorithm for early detection of genital endometriosis and the choice of adequate treatment to further develop these issues, both for improving the quality of life in this category of women and for improving reproductive capacity. The objective: to increase the effectiveness of rehabilitation therapy in patients with genital endometriosis and defection of fertility based on evaluation of individual factors and immunological mechanisms of interaction and optimizing ways to overcome these negative influences. Materials and methods. To achieve this goal, 68 patients with endometriosis associated infertility were examined, which assessed the nature of the hormonal imbalance, violations of individual immune defense units in relation to the level fluctuations of individual tumor markers. In order to evaluate the effectiveness of the proposed program, a group of patients with endometriosis associated infertility was divided into two groups: the main group (38 women) and the comparison group (30 patients). The features of the proposed treatment program were the use after surgical manipulation of complex therapy with the use of progestogens (didrogesterone in contraceptive mode) and the antiproliferative complex: indole-3-carbinol and epigallocatechin-3-galate. Results. Characteristic features of adenomyosis are an increase in this category of patients with levels of LH (2.67 times) and FSH (1.98 times), mainly in the II phase of the menstrual cycle, as well as an increase in estradiol levels, especially in the follicular phase of the menstrual cycle (2, 13 times). In patients with internal endometriosis, in 30.9% of cases (according to ultrasound scan) and in 41.1% of cases (according to histological examination), there are manifestations of hyperplastic processes of endometrium. Increasing the serum CA-125 level (according to our data, 3.1-fold) in women with external genital endometriosis is an effective diagnostic marker to confirm the presence of this pathology. Conclusions. Thus, it should be noted that the proposed rehabilitation therapy for genital endometriosis in the postoperative period is effective in the treatment of pain syndrome and increasing fertility for endometriosis-associated infertility. Key words: genital endometriosis, infertility, hormonal imbalance, tumor markers, rehabilitation therapy.