Kazakova N. Differentiated approach to the rehabilitation of reproductive health in women with infertility who have undergone organ-preserving operations on the uterine appendages

The thesis presents a new solution of the scientific problem, which consists in theoretical and practical generalization of the results of studying the mechanisms and factors contributing to impaired reproductive health in women with infertility after organ-preserving operations on the uterus and based on them - a pathogenetically substantiated differentiated approach to rehabilitation methods in the postoperative period . The study examined 140 women of reproductive age, 120 of them (main group) with infertility and benign ovarian tumors, ectopic pregnancy, who received organ-sparing surgery on the uterine appendages. 76 (63.7%) patients of the main group (I group) underwent surgical treatment according to a planned procedure, 44 (36.7%) patients of the main group (II group) underwent surgical treatment. Changes in the vaginal microbiome of the examined women with infertility were revealed, who were hospitalized for surgical treatment in the urgent order, indicating a significant imbalance between the rates of contamination of the genital tract with conditionally pathogenic and normal microflora, more often they had an STI. Patients with infertility before surgery on the uterine appendages showed varying degrees of personal and reactive anxiety, which to some extent depends on the plannedness of the operation, the intended operational access. Organ-preserving operations on the uterine appendages negatively affect the ovarian reserve, which is manifested by a decrease of AMH almost 4 times, the volume of the ovaries almost doubled, the number of antral follicles - 2.5 times in women after urgent operations in relation to healthy women. Analysis of the results of blood flow assessment in the intra-ovarian arteries indicates a significant decrease in the resistance index and the pulsation index in women who were operated on urgently, especially these changes were detected during ovarian surgery. In the study of ovulatory function, it was found that, despite the presence of ovulation in the operated ovary, the plannedness of the operation, almost every second patient revealed late formation of the dominant follicle and insufficiency of the yellow body perfusion according to energy Doppler. The use of the proposed algorithm for treating women with infertility who underwent organ-preserving operations on the uterine appendages indicates the restoration of the ovarian reserve after 6 months in 94.4% of patients who were operated on in a planned manner and in 88.9% of women after urgent operations. The pathogenetically based treatment carried out allowed normalization of local and sexual function, psycho-emotional state of women in the postoperative period.