A.S. Benyan, I.V. Gilevich-Rodkina, L.S. Tselkovich, R.B. Balter, E.P. Shatunova, T.V. Ivanova, A.R. Ibragimova, OA. Ilchenko, G.I. Teleeva, O.V. Tyumina, A.Yu. Ryabov Prospects for restoring the endometrium function in women with hyperplasia of the uterine mucosa after an unsuccessful attempt of extracorporeal fertilization

Abstract

One of the causes of infertility is endometrial hyperplasia. The treatment of it is a prerequisite before the in vitro fertilization. The aim of the study was to develop measures to prevent the development of endometrial hyperplastic processes in patients who have undergone the in vitro fertilization. The paper discusses the results of hysteroscopic, immuno-histochemical, and histological examinations of the endometrium of 179 infertile women with hyperplasia of the uterine mucosa before the ovulation stimulation in the in vitro fertilization protocols and after the protocols. The results were compared with similar indicators of 119 fertile patients with endometrial hyperplastic processes. Significant differences in the expression of endometrial receptivity were obtained. Immunohistochemical analysis indicated a significant decrease in the level of α-2 microglobulin of fertility with preserved estrogen and progesterone receptions even with a normal histological result. Based on the results of the study, an algorithm for the rehabilitation of patients after unsuccessful attempts at in vitro fertilization is proposed. It consists of three stages and allows to restore normal morphological and functional indicators of the endometrium, which is important for the subsequent implementation of the reproductive function. With a personalized approach to hormone therapy, complete restoration of endometrial function in infertile patients is achieved in 64% of cases. It was found that with an adequate reaction of the body to the therapeutic effect, endometrial reception is restored regardless of the presence or absence of fertility. As a prognostic criterion for pregnancy, it is possible to use indicators of α-2 microglobulin of fertility in the menstrual blood and ultrasound parameters of the endometrium in various phases of the menstrual cycle.