Kulik I. Improving the effectiveness of diagnosis and treatment of infertility of women with genital endometriosis in assisted reproductive technology programs

The dissertation summarizes and solves in a new way the scientific task of improving the effectiveness of infertility treatment of women with genital endometriosis by improving the treatment with sclerotherapy, optimization of controlled ovarian stimulation, which includes the proposed pregravidary therapy with a vitamin complex with inositol and vitamin D3 in assisted reproductive technology programs. Scientific data on the features of ovarian damage in women with EAI have been expanded. A significant increase of the FSH, LH and estradiol levels, decreased levels of inhibin B, progesterone and AMH in women with endometriosis-associated infertility with unoperated and operated cysts in the medical history relative to data with tuboperitoneal infertility factor were found. It is proved that the lowest levels of AMH and inhibin B in women were after cystectomy. Analysis of tumor-associated marker levels by type of correction revealed for the first time significantly higher levels of CA-125 and HE-4 in patients with mono- and bilateral cysts, as well as at recurrences after cystectomy, whereas at cystectomy without recurrences these indicators do not differ from the comparison group. The efficacy of COS using a long GnRH agonist protocol in women with endometriosis-associated infertility was refined and its low efficacy was established, which is confirmed by the significantly higher total dose of recombinant FSH and duration of stimulation, significantly lower parameters of superovulation induction with the lowest values in patients with a medical history of cystectomy compared to patients with unoperated endometriomas. As a result of the retrospective analysis, the frequency of pregnancy was established, which was with unoperated cysts (25.9 %) and with a medical history of cystectomy (without recurrences – 17.4 %, with diagnosed recurrences – 16.2 %). ART regimens have been improved with the inclusion of sclerotherapy and vitamin complex with inositol and vitamin D3 in long GnRH agonist protocol for COS in women with EAI. It has been proven that performing of sclerotherapy with the use of pregravidary preparation has a positive effect on the hormonal background, in particular, significantly lower levels of FSH, LH and estradiol against their values before sclerotherapy. This significantly reduces the diameter of the cysts in relation to the experimental group without pregravidary preparation, as well as in relation to the group with a medical history of cystectomy, which was performed pregravidary preparation. The effectiveness of COS in women with EAI with the inclusion of sclerotherapy and vitamin complex with inositol and vitamin D3 is confirmed by the number of follicles, oocytes and embryos, as well as the frequency of pregnancies, which is 35.29 %.