No abstract

Relevance: To date, the success of in vitro fertilization (IVF) programs in Kazakhstan is 38%. The purpose of the study was to evaluate the mechanisms of influence of various risk factors on endometrial receptivity in women in IVF programs. Materials and Methods: This review was based on a search conducted for domestic and foreign publications available in Russian and international search systems (PubMed, eLibrary) for the past 25 years. Results: Chronic endometritis is a verified cause of impaired receptivity. Many studies have proven the beneficial effect of complex empirical treatment using antibacterial, anti-inflammatory, hormonal therapy with transdermal forms of estrogens and vitamin therapy on the outcome of IVF. Conclusion: The problem of recurrent implantation disorders in IVF programs is multifactorial. Women with unrealized reproductive function require rehabilitation after an unsuccessful fertilization attempt to prevent disorders of homeostasis and ensure adequate pain relief during transvaginal puncture of ovarian follicles. In addition to hormone therapy with transdermal forms of estradiol, complex rehabilitation measures shall include immunomodulatory therapy, psychotherapy, and vitamin therapy.

The article presents the results of examination of 21 patients with miscarriage and “thin endometry” syndrome compared with 20 patients without reproductive losses and the presence of normal endometrial thickness. Interferon gamma intracellular production by cytotoxic endometrial lymphocytes was investigated by flow cytofluorometry. Based on the study, it was found that in patients with miscarriage and “thin endometry” syndrome, the interferon gamma intracellular production by cytotoxic CD8+ lymphocytes was sharply suppressed by almost 36 times, by CD56+ lymphocytes - by 13 times, by CD16+ lymphocytes - by 4.5 times.

В статье представлены результаты обследования 30 пациенток с невынашиванием беременности в анамнезе и «тонким» эндометрием в сравнении с 20 пациентками без репродуктивных потерь и наличием нормальной толщины эндометрия. На фоне комплексной терапии, включающей элиминацию патогенных возбудителей, внутриматочную УЗ кавитацию и персонифицированную гормональную терапию с использованием трансдермальных эстрогенов и микронизированного прогестерона (Лютеина) интравагинально, исследовалась динамика УЗИ параметров эндометрия. До лечения у пациенток с невынашиванием беременности наблюдалось уменьшение толщины эндометрия. После комплексной терапии отмечено увеличение толщины эндометрия: М-эхо с 5,4±0,6 до 10,3 ±1,7; увеличивалась частота визуализации сосудов матки до 80-100%; в спиральных артериях достоверно снижался пульсационный индекс - PI (1,43±0,04 против 0,79±0,06), индекс резистентности RI (0,96±0,05 против 0,54±0,04), систоло/диастолическое соотношение - S/D в маточных (4,5±0,04 против 2,3±0,05) и аркуатных артериях (3,67±0,04 против 2,41±0,02). The article presents the results of checking up 30 patients with a history of miscarriage and "thin" endometrium in comparison with 20 patients without reproductive loss and the presence of normal endometrial thickness. Against the background of complex therapy including the elimination of pathogenic agents, intrauterine ultrasound cavitation and personalized hormonal therapy using transdermal estrogens and micronized progesterone (Luteina) intravaginally was studied the ultrasound changes of endometrial parameters. Before treatment patients with miscarriage were found to have decreased endometrial thickness. An increase in the thickness of endometrium has been noted after comprehensive therapy: M-echo from 5.4 ± 0.6 to 10.3 ± 1.7; the frequency of visualization of uterine vessels increased to 80-100%; in the spiral arteries, the pulsation index significantly decreased - PI (1.43 ± 0.04 versus 0.79 ± 0.06), resistance index RI (0.96 ± 0.05 versus 0.54 ± 0.04), systole / diastolic ratio - S / D in the uterine (4.5 ± 0.04 versus 2.3 ± 0.05) and arcuate arteries (3.67 ± 0.04 versus 2.41 ± 0.02).