Adamovskaya T. Clinical and genetic rationale for differentiated approach to the management of women with infertility associated with endometriosis depending on the ovarian-reserve

The thesis is devoted to the actual problem of improving treatment of patients with cndometriosis-associaled infertility (EAI) through the study of ovarian reserve along with the influence of polymorphisms of FSH receptor (I'SHR Asn680Ser). It is shown that the levels of markers of ovarian reserve (FSH, AMH, 1GF-1) in women with infertility, combined with endometriosis are characterized by significant decrease . The dependence of AMH secretion of age was marked. The correlation between ultrasonographic and hormonal indicators of ovarian reserve was revealed. It was shown that the most significant prognostic marker of ovarian reserve is AMG (PPR=0.98), and the level of IGF-1 is an important predictor of pregnancy in a natural cycle against conservative therapy (PPR=0,95). It was shown that the homozygous genotype for the mutant allele of functional polymorphism ISHR Asn680Ser doubles the prognosis of endometriosis-associated infertility (OR = 2.14 (95 % CI 1.03, 4.73). The proposed method of differential approach to the management of women with EAI on the basis of determining the deviation of biological reproductive age women from the passport on the basis of I'SHR gene genotype is an effective method for assessing the reproductive capacity of women, that allows to evaluate its fertility in the short term and substantially improve the effectiveness of conservative treatment (up to 52,9-60,0 % of pregnancy without the use of assisted reproductive technologies). Key words: ovarian reserve, endometriosis, infertility, treatment.