The dissertation provides a synopsis of infertility treatment approach using assisted reproductive technology programs in women with uterine leiomyoma, and proposes a new methodology to increase effectiveness of the treatment by administering a gonadotropin-releasing hormone agonist and myomectomy and optimizing controlled ovarian stimulation, which involves pre-pregnancy pre-treatment with inositol-containing vitamin complex, alpha-lipoic acid and vitamin D3, in.
The study included 175 women of reproductive age with uterine leiomyoma and a control group of 32 somatically healthy women with normal menstrual and reproductive functions. The patients with uterine leiomyoma involved in the study were divided into the main group A, which included 137 women with uterine leiomyoma and comparison group B, which included 38 women with uterine leiomyoma who underwent a conventional treatment protocol. To evaluate the treatment outcomes, the patients in group A were further subdivided into the following subgroups: A1 included 55 women with uterine leiomyoma after conservative myomectomy who underwent the proposed treatment scheme, A2 included 45 women with uterine leiomyoma after hysteroscopy and proposed treatment scheme, and A3 included 37 women diagnosed with uterine leiomyoma who did not undergo its surgical removal but received medication part of the proposed treatment scheme. The group A2 patients underwent hysteroresectoscopy, a modern organ-preserving minimally invasive surgical method for treating patients with uterine leiomyoma. The other patients underwent conservative myomectomy with removal of intramural and sub-mucosal myomas using laparotomy and laparoscopy methods.
The study expands research data on risk factors (low physical activity and unhealthy eating, manifested by overweight and endocrine diseases, as well as chronic stress as a factor in menstrual dysfunction) and the features of obstetric and gynaecological histories (dominated by hypermenorrhea, dysmenorrhea and algodysmenorrhea, surgical procedures in the anamnesis, high frequency of abortions and significantly lower number of births) in women with infertility against the background of uterine leiomyoma. The study elucidates the hormonal balance in women with uterine leiomyoma and infertility, which is characterized by a significant increase in oestradiol levels on day 5-7 of the menstrual cycle and a significant decrease in progesterone on day 21 of the cycle, accompanied by reduced ovulatory reserve in 30% of cases. The study demonstrates changes in specific and nonspecific immunity, which are subcompensated in nature, as well as dyslipidemia resulting from hypercholesterolemia and hypertriglyceridemia. This pathology background validates the use of vitamin complex with inositol, vitamin D3 and alpha-lipoic acid with magnesium as pre-pregnancy pre-treatment in assisted reproductive technology programs. The study demonstrates that in infertile women with uterine leiomyoma use of the proposed treatment scheme, which includes the administration of a gonadotropin-releasing hormone agonist, hysteroresectoscopy and pre-pregnancy pre-treatment, reduces the dose of gonadotropins and duration of controlled ovulatory stimulation, and significantly improves the parameters of oocyte induction, compared to the outcomes in patients with uterine leiomyoma after conservative myomectomy.
This study determined that the use of the proposed treatment and pre-pregnancy pre-treatment in assisted reproductive technologies programs equally affects the incidence of clinical pregnancy in women with uterine leiomyoma after hysteroresectoscopy and after conservative myomectomy, however live foetal delivery rate was the highest after conservative myomectomy. This proposed infertility treatment approach for the patients with uterine leiomyoma improves the effectiveness of ovulatory stimulation, as evidenced by a decrease in the additional average dose of recombinant gonadotropin and of the total duration of stimulation, as well as improved parameters of oocyte induction.
