The dissertation is devoted to increasing the effectiveness of the restoration of
reproductive function in the programs of assisted reproductive technologies in
women with a history of infertility against the background of chronic endometritis,
through the development and implementation of an effective system of pre-gravid
medical and diagnostic measures. To solve the set goal, the following tasks were
defined: to conduct a clinical and statistical analysis of the features of somatic and
reproductive history in women with repeated unsuccessful attempts at ART and to
determine significant medical and social factors in the formation of chronic
endometritis and risk factors for reproductive failure; determine the profile of the
vaginal microbiota, cervical canal and endometrium in chronic endometritis in
patients with a history of unsuccessful ART attempts; to determine the diagnostic
value of clinical and anamnestic and instrumental research methods (ultrasound
examination of the pelvic organs, hysteroscopy, morphological and immunohistochemical examination) to assess the state of the endometrium during pregnancy
planning; to expand the understanding of the pathogenesis of chronic endometritis
in women with a history of unsuccessful ART attempts and to determine the criteria
for objective preparation for pregnancy; to develop and implement a system of
medical and preventive measures for pre-gravid preparation and management of the
gestational period in women in ART programs, against the background of chronic
endometritis in the anamnesis, and to prove its effectiveness.
The study was conducted on the basis of the Medical Center of LLC "ISIDA
– IVF" and on the basis of the clinical base of the Department of Obstetrics and
Gynecology No. 1 of Shupyk National Healthcare University of Ukraine of MН
Ukraine at Kyiv Regional Perinatal Center. The research was conducted in three
stages, 285 women who planned pregnancy during 2019-2022 were involved in the
research.
At the first stage of the retrospective study, a clinical and statistical analysis
of the outpatient charts of 127 women under the age of 45 with two or more
ineffective ART attempts in the anamnesis was performed (group 1). The control
group (CG) consisted of 50 healthy women without reproductive disorders.
At the second stage of the prospective study, 110 women of reproductive age
with chronic endometritis and repeated unsuccessful ART attempts (55 women with
pre-gravid preparation according to our algorithm – II group; 55 women without
pre-gravid preparation according to our algorithm – III group) were included in the
control group (CG). – 40 women of reproductive age without impaired fertility. The
II group of patients was prepared for ART in accordance with the order of the
Ministry of Health of Ukraine No. 787 dated 09.09.2013 «On approval of the
procedure for the use of assisted reproductive technologies in Ukraine» and the
order of the Ministry of Health of Ukraine dated 29.11.2013 No. 1030/102 «On
improving the family planning system and protection of reproductive health in
Ukraine»'.
At the third stage of the prospective study, after a comprehensive assessment
(microbiological, ultrasound, hysteroscopic, immunohistochemical) of the state of
the endometrium, women of the II group underwent comprehensive pre-pregnancy
preparation (developed by the author) before ART cycles. To restore receptivity and
adequate transformation of the endometrium, individualized hormonal therapy were
used in a cyclical mode, taking into account the identified macrotypes of chronic
endometritis. If the thickness of the endometrium is more than 8 mm, progesterone
preparations are prescribed and the date of embryo transfer into the uterine cavity is
determined. Embryo transfer was carried out in all patients, the average number of
embryos for transfer into the uterine cavity was 1.62±0.13, the thickness of the
endometrium was 9.6±0.4 mm. Pre-transfer preparation was carried out from the
moment the endometrial thickness reached more than 8 mm, but no earlier than 7
days after the appointment of estrogens, and continued (after the transfer of
embryos into the uterine cavity) with micronized progesterone intravaginal at a dose
of 600 mg per day for 14 days.
At the third stage of the study to evaluate the effectiveness of the use of pregravid preparation in pregnant women of the II group, we observed the course of
pregnancy, childbirth and the condition of newborns in this group of women.
