• Optimization of treatment by ART methods in patients with tubal-perientional infertility by application of the injection screetching procedure
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Optimization of treatment by ART methods in patients with tubal-perientional infertility by application of the injection screetching procedure

HEALTH OF WOMAN. 2018.5(131):97–103; doi 10.15574/HW.2018.131.97

Suslikova L. V. , Serbenuyk  A. V.
Ukrainian State Institute of Reproduction of Shupyk National Medical Academy of Postgraduate Education, Kiev
National Medical Academy of Shupyk National Medical Academy of Postgraduate Education, Kyiv
Clinic of Reproductive Technologies, UDIR of Shupyk National Medical Academy of Postgraduate Education, Kyiv

The article presents the results of a study whose aim was to elucidate the effect of autologous injection of endometrial autotransplantation on clinical outcomes of tubal peritoneal infertility by ART (according to the standard protocol) in patients with varying degrees of lag in the development of the endometrium and unsuccessful attempts at treatment with ART in the anamnesis.

The objective: was to determine the impact on the clinical consequences of the endometrial injection technique on the autoplasm in patients with tubal peritoneal infertility and the varying degree of (moderate and severe) lag in the development of the endometrium in repeated attempts to treat ART by the protocol of controlled ovarian stimulation (ETS) + embryotransfer (ET) .

Materials and methods. In a prospective study included 105 cases of previous unsuccessful attempts to treat ART by the tubal peritoneal factor of infertility. Of these, 58 patients experienced a moderate lag in the development of the endometrium and in 47 cases a marked lag in the development of the endometrium. 105 patients were offered treatment with the use of estrogens and the technique of injection scratching with autoplasma in the cycle during CSC. The retrospective group included 112 patients with moderate hypoplasia and 64 patients with severe endometrial hypoplasia.

Patients treated with tubal peritoneal infertility in combination with a moderate lag in the development of the endometrium under the CAS + ET protocol were allocated to: ІА group (comparison group) – 45 patients receiving estrogens from the 7th day of CSC (retrospective analysis indices); ІB group (control group) – 67 patients who did not receive estrogens from the 7th day of CAS (retrospective analysis indicators); IV group (main group) – 58 patients who were prescribed estrogen and an injection procedure for endometrial stitching on the 7th day of the stimulation cycle (CI) during CSC.

Patients treated with tubal peritoneal infertility, in combination with a marked lag in the development of the endometrium according to the CAS + ET protocol, were allocated to: the IIA group (comparison group) – 31 patients who received estrogens from the 7th day of CSC (retrospective analysis); IIB group (control group) – 33 patients who did not receive estrogens from the 7th day of CSC (retrospective analysis indicators); IIB group (main group) – 47 patients who were prescribed estrogens and an injection procedure for endometrial streaking with autoplasma during the CSC at the 7th day of the CA.

Clinical results were evaluated according to the frequency of pregnancy on embryo transfer (CHNBPE) and the frequency of pregnancy loss in the first trimester and compared with each other.

Results. In the group of patients with a moderate lag in the development of the endometrium, the CHNBPE index did not differ significantly between the ІА, ІB and ІB groups and was 38%, 40.5% and 39.7%, respectively. The frequency of early reproductive losses was 17.6% for women in the ІА group, and 18.5% for women of the ІB group. The index of reproductive losses in the main IV group was 21.7% and did not differ significantly from the control and comparison groups.

In the group of patients with a marked lag in the development of the endometrium, the CHNBPE index in the IIB group was 27.7% compared to 12.9% in the IIA group (p = 0.048) and 12.1% (p = 0.037) in the IIB group (comparison group ).

The frequency of abortion in the I trimester in patients of groups IIA, IIB and IIB was 23.1%, 50% and 50%, respectively. The differences were not significant (p = 0.414).

Conclusion. The application of the autoplasmic injection scratching procedure significantly improves the rate of CHNBPE in patients with a pronounced delay in the development of the endometrium in the ART treatment cycles.Key words: infertility, methods of assisted reproductive technology, hypoplasia of the endometrium, injection screetching of endometrium.

Key words: infertility, methods of assisted reproductive technology, hypoplasia of the endometrium, injection screetching of endometrium.

REFERENCES 

1. Ahmerov RR, Zarudiy RF, Ryichkova IN i dr. 2011. Avtostimulyatsiya regenerativnyih protsessov v chelyustno-litsevoy hirurgii i kosmetologi. Sbornik tezisov H Mezhdunarodnogo simpoziuma po esteticheskoy meditsine. Moskva: 16.

2. Afanasova EA. 2014. Informativnyie i prognosticheskie sotsialno-ekonomicheskie faktoryi riska ostrogo endometrita. Izvestiya Yugo-Zapadnogo gosudarstvennogo universiteta. Ser. Upravlenie, vyichislitelnaya tehnika, informatika. Meditsinskoe priborostroenie 4:63–69.

3. Boyarskiy KYu, Gaydukov SN, Palchenko NA. 2013. Sovremennyiy vzglyad na problemu retseptivnosti i tonkogo endometriya v programmah VRT: obzor literaturyi. Problemyi reproduktsii (4):51–60.

4. Vorobei-Vykhivska VM. 2017. Rol systemy hemostazu v rezultatyvnosti prohram dopomizhnykh reproduktyvnykh tekhnolohii. avtoreferat. Kyiv, Nats. med. akad. pisliadyplom. osvity imeni P.L. Shupyka MOZ Ukrainy: 20.

5. Haivoronskaia SY, Hryshchenko NH, Parashchuk VIu. 2015. Vlyianye faktorov ryska na razvytye syndroma hyperstymuliatsyy yaychnykov v prohramme vspomohatelnыkh reproduktyvnыkh tekhnolohyi. V: Teoretychni ta praktychni aspekty rozvytku suchasnoi medytsyny: zbirnyk tez naukovykh robit uchasnykiv mizhnarodnoi naukovo-praktychnoi konferentsii 2015 chervnia 26, Lviv, Ukraina. Lviv, Lvivska medychna spilnota: 17–18.

6. Hryshchenko NH. 2011. Patohenetychni osnovy vdoskonalennia dopomizhnykh reproduktyvnykh tekhnolohii u zhinok, yaki perenesly khronichni zapalni zakhvoriuvannia orhaniv maloho taza. Kharkiv: 363.

7. Gyulmamedova ID. 2008. Problemyi implantatsii v programme IVF. Novosti meditsinskoy farmatsii. Ginekologiya 253:17-27.

8. Dakhno FV, Kaminskyi VV, redaktory. 2011. Dopomizhni reproduktyvni tekhnolohii likuvannia bezpliddia: navchalnyi posibnyk dlia likariv-slukhachiv zakl. (f-tiv) pisliadyplom. osvity. Kyiv: 320.

9. Donskoi BV. 2014. Imunni faktory u reproduktsii. Prohnozuvannia uspishnosti reproduktyvnoho protsesu. Medytsynskye aspektы zdorovia zhenshchynы (4):53-9.

10. Zarudiy RF, Ahmerov RR. Primenenie obogaschennoy trombotsitami autoplazmyi dlya lecheniya fotodermatoza. Elektronnyiy zhurnal «Regenerativnaya hirurgiya».

11. Kaminskyi VV, Priadko NH. 2014. Medyko-sotsialni ta zakonodavchi aspekty medykamentoznoho abortu v Ukraini. Reproduktyvnaia эndokrynolohyia (3):30-5.

12. Kaminskyi VV, Sehedii LI. 2010. Vplyv syndromu hiperstymuliatsii yaiechnykiv na perebih ta zavershennia vahitnosti pislia zaplidennnia in vitro ta perenosu embrioniv u porozhnynu matky. Praktychna medytsyna 16(2):10-5.

13. Lesovska LH. 2017, kvit. Stan vprovadzhennia dopomizhnykh reproduktyvnykh tekhnolohii v Ukraini. Slovo o zdorove (2):12-6.

14. Onyshchuk OD. 2009. Diahnostychna histeroskopiia pislia nevdalykh poperednikh sprob zaplidnennia in vitro. Zdorove zhenshchynу (3):213-4.

15. Chayka VK, Chayka AV, Nosenko EN i dr. 2011. Retseptivnost endometriya u patsientok s besplodiem. Donetsk, Izdatelstvo Noulidzh, Donetskoe otdelenie: 243: il. Bibliogr: 221-243.

16. Rudakova EB, Davyidov PV, Davyidov VV. 2015. Diagnostika vnutrimatochnoy patologii pri podgotovke k ekstrakorporalnomu oplodotvoreniyu. Lechaschiy vrach (1):83-6.

17. Bourgain C, Devroey Р. 2007. Histologic and functional aspects of the endometrium in the implantatory phase. Gynecol. Obstet. Invest. 64;3:131–133. https://doi.org/10.1159/000101735; PMid:17934307

18. Garcia Velasco J. 2012. Auto-immunity and/or thrombophilia as causes for recurrent implantation failure: myth or reality? Instituto Valenciano de Infertilidad, Reproductive Endocrinology and Infertility. Madrid, Spain. PMCid:PMC3288136

19. Granot I, Gnainsky Y, Dekel N. 2012. Endometrial inflammation and effect on implantation improvement and pregnancy outcome. Reproduction 44:61. https://doi.org/10.1530/REP-12-0217

20. Li TC. 2012. Evidence­based management of the couple with recurrent implantation failure. ESHRE. O­088.

21. Wynn RM. 1977. Ultrastructural development of the human decidua /In: Biology of the Uterus. New York: 341-376.

22. Xu CK, Tang SB. 2014, Feb. Alteration of endometrial receptivity in rats with ovarian hyperstimulation syndrome. J Obstet Gynaecol. 34(2):146-52. https://doi.org/10.3109/01443615.2013.832735. PMID: 24456435

23. Young SL. 2013, Nov. Oestrogen and progesterone action on endometrium: a translational approach to understanding endometrial receptivity. Reprod Biomed Online. 27(5):497-505. https://doi.org/10.1016/j.rbmo.2013.06.010. PubMed PMID: 23933037; PubMed Central PMCID: PMC3818404.

24. Yu N, Yang J, Guo Y, Fang J, Yin T, Luo J et al. 2014, Jan. Intrauterine administration of peripheral blood mononuclear cells (PBMCs) improves endometrial receptivity in mice with embryonic implantation dysfunction. Am J Reprod Immunol. 71(1):24-33. https://doi.org/10.1111/aji.12150. PubMed PMID: 239099171.

25. Zheng C, Chen S, Yang D. 2011. Neuromuscular electrical stimulation and biofeedback therapy may im- prove endometrial growth for patients with thin endometrium during frozen-thawed embryo transfer: A preliminary report Madafeiton MA Bodombossou-Djobo. Text. Reprod Biol Endocrinol. 9:122. https://doi.org/10.1186/1477-7827-9-122; PMid:21867532 PMCid:PMC3180360

26. Zhioua A, Elloumi H, Fourati S, Merdassi G, Ben Ammar A, Sajia BS et al. 2012, May. Morphometric analysis of the human endometrium during the implantation window. Light and transmission electron microscopy study. J Gynecol Obstet Biol Reprod. 41(3):235-42. Paris. https://doi.org/10.1016/j.jgyn.2011.11.009. PubMed PMID: 22257733.