Optimization of preconception care in the program of miscarriage prevention in patients with reduced reproductive potential due to endometrial hyperplasia and obesity

Abstract

Summary. One of the most severe consequences of endometrial hyperplasia in the reproductive age is infertility, and the fact of miscarriage and an increase in the rate of spontaneous abortions in obesity is currently proven. The aim of the study is to evaluate the effectiveness of an optimized program of preconception care and pregnancy monitoring in patients with impaired reproductive function against the background of endometrial hyperplasia and obesity. Research materials and methods. All 100 women with impaired reproductive function against the background of endometrial hyperplasia and BMI>30 kg/m2 underwent a comprehensive clinical and laboratory examination and were divided into two groups by the method of blind sampling: the main group included 50 patients, who were offered an optimized program of preconception care, and the comparison group consisted of 50 women who received traditional folate therapy. The effectiveness of therapeutic options and rehabilitation measures was evaluated 3 months after the completion of the endometrial pathology treatment program and monitored during the year based on the results of natural fertility cycles, cycles of the IVF program, taking into account the proportion of pregnancy complications, its consequences and the percentage of live births. Research results and their discussion. Pregnancy in overweight women is accompanied by a higher percentage of early reproductive loss (20.0%), preterm birth (16.0%), preeclampsia, especially severe form (45.0%), placental dysfunction, and low birth weight babies (15.0%), as well as failed IVF program attempts. Out of 100 examined patients with endometrial hyperplasia against the background of a violation of fat metabolism, 15 patients (15.0%) decided to postpone reproductive plans, 32 women (32.0%) were offered an IVF program after two unsuccessful ovulation inductions in a natural fertility cycle, 43 patients (43.0%) had a spontaneous pregnancy, 10 women (10.0%) did not get pregnant. At the time of the analysis of the final conclusions, it should be noted a 1.9 times higher share of spontaneous pregnancy, a 2.1 times higher share of successful IVF attempts, a 1.5 times higher share of live births, and 4.2 times less reproductive failures. The risk of retrochorial hematoma in the comparison group increases 4.1 times (OR=4.14, 95% CI: (1.30-13.21; p<0.05), as well as the risk of early reproductive losses (OR= 3.12, 95% CI: (1.21-8.02; p<0.05), and the possibility of successful termination of pregnancy in the main group exceeds such data in the comparison group by 6.0 times (OR=6.0, 95%, CI: (1.75-20.62; p<0.05). Conclusions. Careful monitoring and diagnostic algorithm in patients with endometrial hyperplasia, as a significant factor in subfertility, allows choosing a rational personalized approach to the use of minimally invasive visual techniques and rehabilitative therapeutic options for restoring the morphofunctional state of the endometrium and metabolic parameters, as well as developing adequate preconception care, reducing probable reproductive losses in 4.2 times and creating prerequisites for a 1.5-fold increase in the proportion of live births in this category of patients.