Sudoma I. Sudoma I.O. Pathogenetic variants of fertility disturbances and methods of infertility treatment in patients with adenomyosis and combined adenomyosis and endometriosis.

The work is devoted to the investigation of pathogenesis of infertility in patients with adenomyosis, diagnostic algorithm and treatment options. The echographic, Doppler, hysteroscopic symptoms and morphologic peculiarities of eutopic and heterotopic endometrium were investigated in patients with adenomyosis and infertility and with normal fertility. The retrospective analysis of IVF cycles data and immunologic status was fulfilled in patients with adenomyosis and tubal-peritoneal infertility. The "implantation window" markers such as pinopodes formation, estrogen and progesterone receptors, integrins ?3 and ?4?1, apoptosis regulators Bcl-2 and р53, endometrial natural killer cells CD56+ expression were studied in patients with multiple IVF failures and healthy oocites donors. It was found that in patients with adenomyosis reliably more often the echographic and Doppler anomalies of endometrium and endometrial-myometrial junction zone were seen, hysteroscopic and morphological symptoms of inactive (inendometriotic heterotopias stromal and connective tissue prevailed) adenomyosis type were seen, which can be due to the pathological activity of basal or/and stromal endometrium. The results of IVF cycles were reliably worse in patients with adenomyosis in comparison with women with tubal - peritoneal infertility (pregnancy rate/cycle was 14,90% and 26,1%). The predominated cause of IVF failures in patients with adenomyosis was uterine-endometrial factor (56,7%). The substrate for its realization is pathological endometrial structure, the disturbances in "implantation window" cascade, endometrial apoptosis regulation. In 33,9% of cases the cause of IVF failures was in gamete-oocite factor. It is realized through the ovary reserve diminishing, bad oocytes quality and predominantly it is seen in patients of older age and with combination of adenomyosis and endometriosis. Immunological disorders were the causes of IVF ineffectiveness in 7,5% women. Proposed diagnostic and treatment algorithm gives the possibility to improve the effectiveness of infertility treatment from 22,1% (for patient) to 49,3%. The developed protocol contains new modifications of diagnostic methods (pinopode investigations, estrogens and progesterone receptors, integrins ?3 and ?4?1) and treatment IVF options (controlled hyperstimulation protocol modifications and method of transfer of different age embryos).