Abstract
Objective: optimization of pregravid (pre-pregnancy) preparation in patients with tubal-peritoneal infertility factor and marked delay in endometrial development after unsuccessful assisted reproductive technology (ART) treatment by the use of endometrium injection scratching technology with autoplasma.Material and methods. Study included 40 cases of unsuccessful treatment attempts for tubal-peritoneal factor infertility with severe delay of endometrial development and 10 patients with tubal-peritoneal factor infertility with normal endometrium with one or more unsuccessful ART attempts on history and the existence of cryopreserved embryos of satisfactory quality from previous cycles of assisted reproductive technology. The average age was 39.5 ± 3.1 years. Patients were divided into groups: I – 21 patients who underwent endometrial injection scratching and hormonе replacement therapy (HRT) with a standard (4/6 mg) dose of estradiol; II – 19 patients who were prescribed HRT with a standard (4/6 mg) dose of estradiol; control – 10 patients with normal endometrium who underwent cryo-ET with standard (4/6 mg) dose of estradiol.Clinical results were evaluated and compared in terms of pregnancy rate per embryo transfer and pregnancy loss rate in the first trimester. The correspondence of the morphofunctional structure of the endometrium was evaluated by ultrasound, cytologically, Doppler measurements, histologically, immunohistochemically and via selective electron microscopy. Endometrium was 8.9 ± 1.1 mm during the period of progesterone prescription in the cryoembryo transfer cycle. All participants were transferred day 5 embryos. Results. In the cryo-ET program autoplasma injection scratching in patients with marked delay of endometrial development after the first seven days of monotherapy with a starting dose of estradiol was accompanied by a significant improvement in clinical outcomes in terms of pregnancy rate (25%) and definite decrease of early reproductive losses (25%).Conclusions. After pre-pregnancy preparation according to our method, it is quite sufficient to perform HRT with a standard dose of estradiol (4/6 mg/day) before starting progesterone irrespective of the endometrial development degree. Meanwhile, injection scratching is advisable to be prescribed in cases of marked delay in the endometrium development and it should be combined with physiotherapy methods.
Highlights
The proportion of patients with repeated failed in vitro fertilization attempts is approximately 30% of all patients treated using these techniques
Comparative analysis of the endometrial morphofunctional state in women with severe endometrial developmental delay and unsuccessful attempts at treatment in the assisted reproductive technology (ART) program and the control group it was found that the probable features of the endometrium in infertile women were the areas of pinopods absence in 47.50% of cases, small size of pinopods – in 77.50% (p
Algorithm for examination of patients with unsuccessful attempts of treatment with ART in the anamnesis should include during pre-gravid preparation complex examination in the cycle preceding the treatment cycle, and examination of histological and immunohistochemical criteria for endometrial development delay and the presence of endometrial pinopods by performing selective electron microscopy, echography and Doppler in the appearance of signs of delayed endometrial development on the day 7 in the program of ART treatment
Summary
The proportion of patients with repeated failed in vitro fertilization attempts is approximately 30% of all patients treated using these techniques. There is no consensus on the regimens of hormonal correction, the duration of its use, and the impact on endometrial functional status and readiness for implantation; no prognostic criteria for pregnancy in patients with unsuccessful attempts at treatment with assisted reproductive technology (ART) have been developed. That is why the task of finding new methods for improving endometrial receptivity and developing complex approaches to medication correction of the processes of regeneration and reception, as well as individualized preparation of a woman's body for implantation, remains relevant [2, 4, 5, 9, 10]. Prolonged and often asymptomatic ischemia and tissue hypoxia in the endometrium lead to marked changes in the tissue structure, interfering with normal implantation and placentation, forming a pathological response to pregnancy, and causing impaired proliferation and normal cyclic transformation of the endometrium. Disorders in the receptive apparatus can lead to insufficiency of the endometrium to exogenous hormonal effects and cases of gestagen resistance
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