ULTRASTRUCTURAL RESEARCH OF THE ENDOMETRIUM RECEPTIVITY IN CONDITIONS OF PRE-CONCEPTIONAL PREPARATION IN REFRACTORY PREGNANCY LOSS

Background. Refractory pregnancy loss (RPL) is a multifactoral pathology in women of reproductive age which treatment represents great difficulties. Great role in RPL pathogenesis is stipulated by chronic endometritis resulting from disturbances of implantation followed by gestational sac malfunction, which is not less significant than progesterone deficiency.Objective. The aim of research was to study the dynamics of ultrastructural changes of endometric epithelial cells in the conditions of pre-conception preparation in refractory pregnancy loss.Methods. 63 samples of endometrium bioptates obtained from female patients of reproductive age with insufficient middle luteal phase of the cycle were studied. Light and electronic microscopy was used to study the morphological changes in endometric epithelial cells.Results. Pre-conceptional cyclic hormone therapy (1 mg 17-estradiol and 20 mg of didrogesteron) in comparison with monotherapy of 20 mg of didrogesteron during 3 months contributed to intracellular regeneration and restoration of secretor phenotype of endometrium epithelial cells corresponding to the status of receptivity with “opened window of implantation”.Conclusions. Cyclic hormonotherapy in combination with complex metabolic therapy as a pre-conceptional preparation contributing to pregnancy illustrates much higher effectiveness of pathogenetically proved preconceptional hormonotherapyKEY WORDS: refractory pregnancy loss, endometrium receptivity, hormone therapy, ultrastructure

New approach in screening and treatment of chronic endometritis in patients with repeated failures of in vitro fertilization

Introduction. The article presents the results of the study of preparation for assisted reproductive technology (ART) programs in patients with infertility combined with repeated failures of in vitro fertilization (IVF) programs against the background of chronic endometritis. New information about the pathogenesis of chronic endometritis in patients with failures of IVF programs was obtained in the study. The new integrated approach to treatment includes aspiration of endometrial cavity to remove pathological endometrium, intrauterine administration of highly purified hyaluronic acid sodium salt with carboxymethyl cellulose in the form of a gel (Antiadgezin) to prevent fibrosis in combination with human placenta hydrolyzate (“Laennec”) and two-phase hormone therapy, which significantly (by 34.67%) increases the onset of pregnancy. Aim of the study is to develop a comprehensive algorithm that includes an effective solution for the examination and subsequent treatment of chronic forms of endometritis, including patients with failed IVF programs and assess its effectiveness. Materials and methods. A study was carried out on 110 patients with one or two unsuccessful in vitro fertilization programs, diagnosed with chronic endometritis, who underwent a comprehensive diagnostic study and “classical” treatment of chronic endometritis. The comprehensive treatment included endometrial cavity aspiration on day 26–27 of the menstrual cycle, intrauterine administration of highly purified hyaluronic acid sodium salt with gel carboxymethyl cellulose (Antiadgezin) in combination with intravenous application of human placenta hydrolyzate and subsequent two-phase hormone therapy. Used: Evaluation of the status of urogenital tract microbiota using PCR, pelvic ultrasound on days 5–7 and 19–21 of the menstrual cycle + doppler velocimetry of vessels (uterine, arcuate, radial arteries), determination of the hormonal background on the 2nd–3rd day of the menstrual cycle (FSH, LH, AMH, TSH, PRL, T4 free), hysteroscopy for the second phase of the menstrual cycle on the 19th–21st day, as well as a detailed histological examination of the endometrium (pipelle biopsy): Immunohistochemistry, PCR-diagnostics of viruses (adenovirus, Epstein-Barr virus, enterovirus), light-optical examination of pinopods, morphological determination of endometrium development stages in the second phase of menstrual cycle

ULTRASTRUCTURAL RESEARCH OF THE ENDOMETRIUM RECEPTIVITY IN CONDITIONS OF PRE-CONCEPTIONAL PREPARATION IN REFRACTORY PREGNANCY LOSS

Background. Refractory pregnancy loss (RPL) is a multifactoral pathology in women of reproductive age which treatment represents great difficulties. Great role in RPL pathogenesis is stipulated by chronic endometritis resulting from disturbances of implantation followed by gestational sac malfunction, which is not less significant than progesterone deficiency. Objective. The aim of research was to study the dynamics of ultrastructural changes of endometric epithelial cells in the conditions of pre-conception preparation in refractory pregnancy loss. Methods. 63 samples of endometrium bioptates obtained from female patients of reproductive age with insufficient middle luteal phase of the cycle were studied. Light and electronic microscopy was used to study the morphological changes in endometric epithelial cells. Results. Pre-conceptional cyclic hormone therapy (1 mg 17-estradiol and 20 mg of didrogesteron) in comparison with monotherapy of 20 mg of didrogesteron during 3 months contributed to intracellular regeneration and restoration of secretor phenotype of endometrium epithelial cells corresponding to the status of receptivity with “opened window of implantation”. Conclusions. Cyclic hormonotherapy in combination with complex metabolic therapy as a pre-conceptional preparation contributing to pregnancy illustrates much higher effectiveness of pathogenetically proved preconceptional hormonotherapy KEY WORDS: refractory pregnancy loss, endometrium receptivity, hormone therapy, ultrastructure