Optimization Ways of Therapeutic Measures in Women With Endometrial Polyps and Infertility

Abstract

Іntroduction. Currently, endometrial polyps (EMP)are the most common pathology of the uterine mucosa,detected in miscarriage and infertility. However, thequestion of the relationship between the mechanisms thatregulate proliferation processes and the morphofunctionaland microbiological features of the endometrium, whichare often confirmed by changes in immunohistochemicalparameters and may be important in treatment, remainsopen.The aim is to optimize the results of treatment inpatients with EMP and infertility by using antioxidantsin combination with immunomodulatory therapy andnonsteroidal anti-inflammatory drugs.Materials and methods. We examined 30 healthywomen who hadn’t had any gynecological diseases,abortions or intrauterine interventions in history and hadnot used intrauterine contraception (the control group), and60 women with EMP and infertility (the main group) byusing clinical, microbiological, bacteriological, ultrasound,hysteroscopic pathohistological and laboratory methods,statistical analysis.Results. In order to assess the effectiveness of theproposed treatment, the main group was divided into twosubgroups: the first one included 30 patients who have beenreceiving the proposed treatment and prevention algorithmand the second one with 30 patients receiving traditionaltreatment.After targeted polypectomy with the basal layer of theendometrium at the site of EMP had been provided, thepatients of the first subgroup were prescribed to take 100mg of doxycycline orally twice a day for 2 weeks and 100mg of vitamin E per day for 4 weeks in combination withimmunomodulatory therapy - cycloferon 12.5% 2.0 mlintramuscularly №10 every other day and anti-inflammatorytherapy with the appointment of rectal suppositoriescontaining non-steroidal anti-inflammatory components - 1suppository per night for 10 days.The patients of the second subgroup were prescribedtraditional antibiotic prophylaxis after hysteroscopy: 100mg of doxycycline orally twice a day for 5 days. Also, thepatients of the main group have been receiving 10 mg ofduphaston twice a day from the 11th to the 25th day of MC.The species composition of the vaginal microflora inwomen with EMP is represented mainly by anaerobic flora.Every second patient with EMP (46%; р І-ІІІ = 0,007) in theabsence of clinical symptoms, and along with a moderateor reduced number of lactobacilli, was diagnosed withopportunistic bacteria, uremicoplasma or Candida fungus.Pregnancies occurred in 9 (47%) of the 19 patients in thefirst natural menstrual cycle after polypectomy and proposedtreatment. Six (31%) women became pregnant during thefirst three menstrual cycles. The remaining patients havebeen observed during six months and were recommendedin vitro fertilization due to long-term infertility. Women ofthe main group who did not plan to get pregnant had norecurrence of EMP for two years. 19 (63.3%) patients ofthe second subgroup faced the recurrence of EMP duringtwo years of follow-up. 11 (30.5%) pregnant womengave physiological childbirth; the labor of 3 patients wascomplicated by hypotonic bleeding in the early postpartumperiod; 3 (11.1%) women are currently pregnant. In patientsof the second subgroup, pregnancy occurred in 5 (16.6%)cases only.Conclusions. The use of the developed method of EMPand infertility treatment allows to restore reproductivefunction in more than half of women. Thus, theimplementation of the method of EMP treatment indicatesits positive effect. In addition, it helps to achieve lastingremission and solves the medical and social problems ofwomen's health and motherhood.