Serbenyuk A. Optimization of the preparation of endometrium after unsuccessful attempts of АRT in tubal-peritoneal infertility.

The work is devoted to the effectiveness of treatment with ART methods of tubal peritoneal infertility factor associated with the poor development of endometrium in women of reproductive age by developing a set of diagnostic and treatment measures based on the study of clinical, ultrasonic, cytological, dopplerometric features of lagging endometrium development in treatment cycles using ART methods. In the cycles of infertility treatment of tubal-peritoneal genesis using ART, the incidence of lagging development of the endometrium (of varying degrees of severity) is 1/3 of the total number of cycles performed. A significant decline in the incidence of pregnancy and an increase in the incidence of early reproductive loss in infertility treatment programs using ART methods is observed only in cases of marked lag in the development of the endometrium - with its thickness of 4 mm or less on the 7th day of the stimulation cycle / HRT with the planned embryo transfer. Ultrasound signs of lagging development of endometrium include a decrease in its thickness (up to 4 mm or less with pronounced lag) and a disturbance of the macrostructure (absence of a clear three-layer structure in 74.8 % of patients with expressed and 46.2 % of patients with moderate lag). Additional appointment in the standard program of treatment with ART methods and increasing the daily dose in monotherapy during pre-glare preparation in CRIO-ET cycles of estrogen preparations in patients with signs of lagging development of endometrium on the 7th day of the stimulation cycle / or HRT does not provide an increase in the thickness of the endometrium prior to the day of administration hHG and does not improve clinical results. Performing injection scratching by autoplasma on the 7th day of SC in women with marked lag in the development of endometrium in the standard treatment with ART methods provides a probable increase in the incidence of pregnancy (from 9.8 to 27.5 %) and a decrease in the incidence of early reproductive losses (from 50,0 to 27.3 %). In the CRIO-ET program, the use of injectable scratching by autoplasma in patients with marked lagging development of the endometrium after the first 7 days of monotherapy with the starting dose of estradiol is accompanied by a significant improvement in clinical outcomes in terms of the incidence of pregnancy (an increase from 11.1 to 23.5 %) and a significant decrease in the incidence of early reproductive loss (from 100 to 25 %).