Deterioration of women’s reproductive health causes an increase in the general number of oocyte donation and surrogacy programs. The formation of an allogeneic fetus in such cases affects the course of implantation and placentation, which is reflected in the increased frequency of obstetric and perinatal complications. The psychological status of these patients also has a significant impact on the course of pregnancy, childbirth and the postpartum period, which differs from that of women who are carrying their own child and/or have undergone infertility treatment. Purpose - to perform a comparative clinical and statistical analysis of somatic and reproductive history, obstetric and perinatal complications in pregnant women with an allogeneic fetus and pregnant women who were involved in in vitro fertilization (IVF) programs with their own oocytes. Materials and methods. Clinical and statistical analysis of the medical records of 200 patients, who were divided into two groups, was performed: the Group I - 150 pregnant women who were involved in IVF programs with the formation of an allogeneic fetus; the Group II (control) - 50 pregnant women who underwent IVF using the woman's own oocytes. Results. Among patients with an allogeneic fetus, a significantly lower number of various complications of somatic and reproductive anamnesis were recorded. The rates of obstetric and perinatal complications were comparable or higher as in the control group; the criteria for statistical significance of the difference were fulfilled for the indicators of gestational anemia, which was more often registered in the main group. The proportion of deliveries by caesarean section was significantly lower among pregnant women with an allogeneic fetus. The average weight of the newborn of the main group was significantly lower compared to the control. Conclusions. Despite the significantly lower frequency of detection of factors aggravating somatic and reproductive anamnesis, patients with an allogeneic fetus are characterized by comparable or higher rates of obstetric and perinatal complications, which makes it necessary to provide further investigation of the potential causes of this phenomenon, the features of the functioning of the fetoplacental complex, and the influence of the psychological status of the patients in order to improve the algorithm of pregravid preparation and antenatal surveillance. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The widespread use of assisted reproductive technologies is owed to the rapid development of biomedical science. However, progress is accompanied by a steady decline in the reproductive health of the population, so the lack of knowledge today on theoretical and practical aspects remains significant. Despite the improvement of donor oocyte manipulation techniques and the outstanding success in obstetric and perinatal outcomes in cases of pregnancies with fully allogeneic fetus, the actual data on the incidence of complications of pregnancy, childbirth and postpartum period in this category of patients remain unclear. Purpose - to analyze the results of obstetric and perinatal complications in pregnant women with allogeneic fetuses, and factors that may affect them. This article summarizes the current data on obstetric and perinatal complications in pregnant women with allogeneic fetus, analyzes the biological preconditions for their occurrence, features of the fetoplacental complex in such patients, as well as the psychological status of pregnant women with allogeneic fetus, it’s potential impact on pregnancy, childbirth and the postpartum period. No conflict of interests was declared by the authors.

Purpose - to evaluate the effectiveness of the complex preconception preparation in patients after unsuccessful attempts at assisted reproductive technologies (ART) against the background of chronic endometritis. Materials and methods. At the stage of pregnancy planning, we conducted complex preconceptional training for 55 women of reproductive age with chronic endometritis and repeated unsuccessful attempts at ART. These women represented the first main group of the study. The group II (comparison) - 40 women of reproductive age with chronic endometritis and repeated unsuccessful attempts at ART, who did not use the preconception training developed by us. Results. The percentage of pregnancy by determining the level of human chorionic gonadotropin for embryo transfer was 47.2% (26 cases) in the group I versus 34.5% (19 cases) in the group II (p<0.05). In the group I women, such complications of pregnancy as the threat of termination of the first half of pregnancy, the threat of premature birth, preeclampsia, placental dysfunction and the syndrome of fetal growth retardation and gestational anemia were significantly lower compared to women in the group II. Term delivery was observed in 21 (86.0%) of women of the group I, while in pregnant women without preconception preparation, the frequency of delivery on time did not exceed 11 (64.7%), (p<0.05). Caesarean section in both groups, performed in almost half of the examined pregnant women (10 (40.0%) versus 9 (52.9%), respectively, p<0.05), varied significantly depending on the indications for caesarean section. In a planned manner, caesarean section was performed in 9 (90.0%) of cases of pregnant women in the group I and 4 (44.4%) of cases in the group II (p<0.05). Of the 28 newborns from mothers of the group I, full-term children were 23 (92.0%) and 5 (8.0%) were premature, of which 3 were born at gestational times of 33-36 weeks and one of the twins at 28-32 weeks. In the group II, term babies were 14 (70.0%) cases, and 6 (30.0%) cases were premature and all of them were twins: the first twins were born at 24-27 weeks, the second twins were born at 28-32 weeks and the third twin was born at 33-36 weeks (p<0.05). Conclusions. The complex pregravid training in patients after unsuccessful attempts of ART against the background of chronic endometritis had a positive effect on the onset of pregnancy, a favorable course of pregnancy, childbirth in the postpartum period and the condition of newborns in this group of patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

The subject of discussion is the effectiveness of sonographic examination in the diagnosis of chronic endometritis, despite the high availability of this method of research and ultrasound criteria of chronic endometritis. The validity of the ultrasound diagnosis of chronic endometritis is denied by many experts, but there is a consensus on the high prognostic detectable values of the signs for further verification of this nosology. Purpose — to determine the diagnostic value of pelvic ultrasound to assess the condition of the endometrium in women with unsuccessful attempts at ART in the history of chronic endometritis. Materials and methods. The prospective study of women with chronic endometritis and unsuccessful attempts at ART, based on MC LLC «ISIDA-IVF», for the period from 2019 to 2021. I and II groups were 110 women of childbearing age with chronic endometritis and repeated unsuccessful attempts at ART, and 40 women of reproductive age without impaired fertility, who formed a control group. Ultrasound of the pelvic organs was performed in all patients of the studied groups on days 5–7, 12–15, 22–24 of the menstrual cycle. The threshold value of static reliability is p<0.05. Results. In women with infertility on the background of chronic endometritis in history, the average thickness of the median M-echo in the periovulatory period in group I (with pre-conception preparation) was 9.1±0.08 mm, in group II (without pre-conception preparation) — 7.6±0.9 mm, in the CG — 9.3±0.1 mm and had statistically significant differences (p1,2<0.05, p1,3>0.05, p2,3<0.05). Thin endometrium was detected in patients of group I with pre-conception preparation in 16.3% and twice as often in women in group II without pre-conception preparation — 30.9% (p1,2<0.05). The inconsistency of endometriality was approximately the same in the number of patients in the 1st and 2nd group, which was seen during the day in the cohort of the control group. In case of hyperplastic chronic endometritis macrotype in both groups, polypendometry was tested, as in 2.5 times it was diagnosed in patients of the II group — 9.6% versus 3.6% in women of the I group (p1,2<0.05). The incidence of diagnosed hyperplasia endometrial in pre-existing groups is not small statistically significant differences — 1.8% and 5.4% (p1,2>0.05) apparently. In case of hypoplastic chronic endometritis macrotype, thin endometrium is 2 times and more often in the II group. Conclusions. Transvaginal echography has high specificity (96.6%), sensitivity (55.2%) and diagnostic accuracy (68.2%). Criterias for the active readiness of women to the vagina for pre-conception health improvement are updating the photographic picture of endometries with values of M-exo>7 mm; normalization of uterine hemodynamics (RI<0.9, PI<3.0). The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: ultrasound examination, assisted reproductive technologies, chronic endometritis.

Purpose - to determine the diagnostic value of a hysteroscopic examination of the uterine cavity to assess the state of the endometrium in women with a history of unsuccessful ART attempts against the background of chronic endometritis. Materials and methods. A prospective study was conducted in women with a history of chronic endometritis, on the basis of the Medical Center LLC «ISIDA-IVF», for the period 2019-2021. It was enrolled 110 women of reproductive age with chronic endometritis and repeated untreated ART (55 women with barrier training - group I; 55 women without barrier training - group II). To achieve the set goals, taking into account the clinical and anamnestic data of women in the studied groups, at the stage of pregnancy planning, we resorted to endoscopic examination of the uterine cavity and endometrium on days 7-11 of the menstrual cycle. Endoscopic examination of the uterine cavity was performed using a rigid hysteroscope manufactured by Karl Storz (Germany). The threshold value of static reliability was taken as p<0.05. Results. In groups I and II, hysteroscopy was performed in almost every 2 patients - 28 (50.9%) and 27 (49.1%), respectively. The hysteroscopic sign of chronic endometritis was the uneven thickness of the endometrium, which was in 21 (75.0%) patients of group I and in 20 (74.1%) of group II (p>0.05). Evaluation of the color of the mucosa showed a sign of inflammation - hyperemia of the mucosa, which occurred in every second patient of group I - 16 (57.1%) and group II - 15 (55.5%), respectively (p>0.05). according to the combination of hysteroscopic signs, the diagnosis of chronic endometritis was justified in 24 (85.7%) patients of group I and in 23 (85.1%) patients of group II, a normal hysteroscopic picture was noted in 4 (14.3%) and 4 (14.9%) of women, respectively. When visualizing the uterine cavity, various hysteroscopic signs of chronic endometritis were revealed, the combination of which made it possible to identify variants of macrotypes: hyperplastic, hypoplastic, without signs of hyper- and hypoplasia. In group I, hyperplastic macrotype of chronic endometritis occurred in 11 (39.3%) patients versus 7 (25.9%) among patients of group II (p<0.05). Hypoplastic macrotype of chronic endometritis in the studied groups was observed in 6 (21.4%) patients and 5 (18.5%), respectively (p>0.05). chronic endometritis without signs of hyper- and hypoplasia was 11 (39.2%) among patients of group I and 15 (44.4%) in group II (p<0.05). Conclusions. An analysis of the diagnostic significance of hysteroscopy showed that, based on the totality of hysteroscopic signs, the diagnosis of chronic endometritis was correct in 85.7% and 85.1% of patients. with a history of unsuccessful ART attempts against the background of chronic endometritis. In these patients, the hyperplastic macrotype of chronic endometritis prevailed - 39.3%. It was found that hysteroscopy in the differential diagnosis of macrotypes of chronic endometritis has low specificity (33.3%), but high sensitivity (91.1%) and diagnostic accuracy (89.4%). The diagnostic value of the hysteroscopy method turned out to be higher in the hyperplastic macrotype of chronic endometritis, which in turn contributed not only to the visualization of the pathological process, but also to the rational removal of altered tissue areas. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was adopted by the Local Moral Committee of the institution indicated in the work. Informed consent was obtained from the women for the study. No conflict of interests was declared by the author. Key words: hysteroscopy, assisted reproductive technologies, chronic endometritis.