Pidhaina I. Morpho-functional optimization of protocols pretreatment of assisted reproductive technologies in patients with infertility on the background of endometriosis

The dissertation summarizes and solves the scientific task in a new way, which consists in optimizing the pre-gravid management of women with infertility on the background of endometriosis in modified protocols of assisted reproductive technologies by means of the proposed method of choosing a sclerosant in the minimally invasive manipulation of sclerotherapy of endometrioid cysts with the aim of effective impact on the endometrioma capsule, without ovarian tissue damage. A new line of treatment for endometriosis-associated infertility has been improved and developed, which includes Dienogest, alpha-lipoic acid, DHEA and sclerotherapy 2 months before a short protocol of controlled ovarian stimulation with a GnRH antagonist, which was carried out using a recombinant FSH ("Puregon"). A method of choosing a sclerosant in the protocol for conducting minimally invasive sclerotherapy manipulation of ovarian endometrioid cysts in complex protocol pretreatment of women with endometriosis-associated infertility for ART programs was proposed, and the morphological and structural changes of the endometrioid cyst capsule under the influence of ethanol as a sclerosant of different concentrations and exposures were studied. It was established that in patients who underwent complex protocol pretreatment with sclerotherapy, the level of anti-Müllerian hormone was higher compared to patients who underwent laparotomy cystectomy. Stabilization of the follicle-stimulating hormone level was also established. Such changes affected the hormonal homeostasis of the reproductive system of women with endometriosis-associated infertility, as well as the recruitment of follicles, egg quality, and subsequently fertilization, implantation, and pregnancy. It has been shown that women with endometriosis-associated infertility who underwent the proposed modified scheme of protocol pretreatment in protocols of controlled ovulation stimulation had better clinical results, which were accompanied by a lower total dose of gonadotropins, the duration of the protocol, the duration of administration of the GnRH antagonist, as well as a higher number of oocytes , fertilized cells of normal shape, blastocysts relative to patients with endometriosis-associated infertility, who in the anamnesis only underwent surgical treatment. It was also established that the proposed protocol pretreatment in the protocols of controlled ovulation stimulation contributed to a decrease in the frequency of interrupted pregnancies, an increase in the number of achieved clinical pregnancies and an increase in the percentage of term births in ART programs.