PREDICTION OF UTERINE FACTOR OF INFERTILITY IN LATE REPRODUCTIVE AGE WOMEN

Abstract

Restoration of women's reproductive health in modern conditions is a multifactorial problem for specialists (obstetricians, gynecologists, endocrinologists, hematologists, therapists), often requiring the use of assisted reproductive technologies (ART) [1,3]. According to available data, 46.7% of women who need ART have primary infertility, 53.3% have secondary infertility, and the average age is less than 35 years [2,4]. Despite the fact that only 10-20% of married couples have a verified cause of infertility, in most cases the etiopathogenesis of impaired fertility cannot be corrected [5,6]. One of the factors of a woman's infertility is the uterine factor, caused by various pathologies of the uterine cavity. The variety of pathologies (endometrial polyps, submucosal leiomyomas, intrauterine synechiae, chronic endometritis, congenital anomalies of the uterus) explains the variety of approaches to the diagnosis and treatment of uterine infertility [7]. The uterine form of infertility is the dominant cause of female infertility, exceeding the frequency of tubal-peritoneal and endocrine factors. Today, the connection between the occurrence of infertility and the age aspect has been proven.
 Materials. A sample and analysis of medical records of women who required the use of ART due to uterine infertility (n = 100) for 2017-2020.
 Results. The majority of women are residents of Ivano-Frankivsk region. The average age of women is 32.98 ± 0.4 years. When comparing the age of women, depending on the causes of the uterine form of infertility, differences were found. In adenomyosis, the age was the highest (34.44 ± 0.8 years) and can be compared with age in uterine fibroids (MM), but significantly higher than in hyperplastic processes of the endometrium (GPE), chronic endometritis (CE) or congenital anomalies of uterine development. (VARM) (p <0.001). Thus, VARM, DPE and CE can lead to infertility in women over the age of 23, which requires timely prevention and early diagnosis in this age cohort of women.
 Uterine factor remains one of the main factors in a woman's infertility. The probable cause of infertility in 33.4% of cases was uterine fibroids (MM), in 24.3% - adenomyosis, in 25.6% - endometrial hyperplastic processes (GPE), in 7.8% - saddle-shaped uterus as a manifestation of congenital anomaly development of the uterus (VARM), in 9.9% of women - chronic endometritis (CE). Infertility was primary in 13 (40.63%) women with MM, in 10 (43.48%) women with adenomyosis, in 21 (80.77%) women with GPE, in 2 (25%) women with VARM and in 2 women (18.18%) women with CE. The variety of pathologies (endometrial polyps, submucosal leiomyomas, intrauterine adhesions, chronic endometritis, congenital anomalies of the uterus) explains the variety of approaches to the diagnosis and treatment of uterine infertility.
 Conclusions. It was found that women, depending on the cause of the uterine form of infertility, had a correlation between different studied parameters. Differentiated differences in the clinical and social, anamnestic portrait of women depending on the cause of uterine infertility, which require further detailed study and analysis, which allows to differentiate approaches to timely diagnosis and targeted prevention of uterine infertility.