PREPARATION OF THE ENDOMETRIUM FOR IMPLANTATION IN WOMEN OF THE REPRODUCTIVE AGE

Abstract

Despite the success achieved by the use of assisted reproductive technologies, infertility remains one of the main problems of the present day medicine.The experts in this field consider that the tubal-peritoneal form of female infertility is the most leading form of infertility (60-70%). The second most important form is the endocrine form of infertility (20-25%). In 5-7% cases the cause of infertility remains unknown and it is considered to be idiopathic infertility. Idiopathic infertility is connected with inability to detect any dysfunctions of the reproductive system using the current diagnostics methods. Today there is no general consensus concerning the question how to prepare the endometrium for implantation. The majority of researchers suggest that the use of estrogens and progesterones in the cyclic regime as the main therapy-rehabilitation influences upon all the functions of the endometrium including proliferation and immune response modulation. In some cases, however, the endometrium abnormally responds to hormonal stimulation and can even show resistance, which explains spontaneous abortions and unsuccessful cycles of the extracorporal fertilization (ECF), the absence of pregnancy after laparascopic treatment of ovarian polycystic syndrome (OPCS).The objective of the study was to develop the optimal method to prepare the endometrium for implantation in women of the reproductive age.Materials and methods. The study involved 60 women of the reproductive age who were consulted concerning the problem of infertility. All the women examined with "inadequate" endometrium, were divided into two groups I and II, depending on the method of preparation of the endometrium for implantation. Group I (basic) included 30 women who underwent vacuum aspiration of the uterus. Group II (comparison) consisted of 30 women who underwent hormone (estradiol valerate) preparation of the endometrium.To determine the inclusion and exclusion criteria of "inadequate" endometrium the following examinations and tests were performed: somatic and gynecological examination of women, ultrasound investigation, aspiration paypel-biopsy followed by histological examination of the material, determination of blood hormone: follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, prolactin, testosterone, cortisol.Results of the study. Menstrual cycle disorders were observed in 56.6% of women in the I gr. and 63.3% in gr. II; miscarriage in 26.7% and 33.3%, repeated unsuccessful attempts of ECF in 16.7% and 23.3%, endoscopic surgery on the internal genital organs (salpingolysis, salpingostomy, salpingoplastiс, fimbrioplastic, resection of the ovaries, fenestration of the ovarian capsule, myomectomy) - 33.3% and 26.7%, respectively.In the blood of patients with "inadequate" endometrium a statistically significant increase of estradiol (p <0.01) was found. No significant differences in the content of other hormones were identified (r˃0,05).The results of histological studies have shown that in the I gr. 15 (50%) and in gr. II in 17 (56.6%) women the endometrium corresponded to the phase of the menstrual cycle; in 12 (40%) in I gr. and in 10 (33.3%) in gr. II glandular hyperplasia of the endometrium was found and in 3 (10%) in I gr. and 3 (10%) in gr. II - endometrial polyp diagnosed. Thus, 53.3% of women have not had any histological changes in the endometrium.Out of 30 women of gr. I, who underwent vacuum aspiration - pregnancy occurred within 6 months in 25 (83.3%) women and in 23 (92%) cases the outcome of pregnancy was the birth of term infants with Apgar scores of 7-9 points with body weight 3150,0 ± 240,0 g; 2 (8%) women - had premature labour, which was significantly different from group II (women who underwent hormonal preparation of the endometrium ). Pregnancy occurred within 6 months in 10 (33.3% ) women, in 8 (80%) cases the outcome of pregnancy was the birth at 37 weeks of gestation and in 2 cases the pregnancy resulted in miscarriage (p <0.01).Conclusion. The study performed has found that significantly more frequently pregnancy occurred in patients with «inadequate» endometrium who underwent endometrial preparation for implantation by using vacuum aspiration, than women with hormonal preparation of the endometrium.