EVALUATION OF THE HORMONAL BACKGROUND OF WOMEN WITH ENDOMETRIOSIS-ASSOCIATED INFERTILITY

Abstract

Introduction. Endometriosis is an estrogen-dependent chronic inflammatory disease that causes endometriosis-associated infertility in approximately 30–50 % of women with a confirmed case.

The aim of the study – to analyze the reproductive hormonal panel of patients with endometriosis-associated infertility to choose the optimal ovulation stimulation protocol in the programs of assisted reproductive technologies.

Research Methods. In accordance with the purpose, a comparative retrospective analysis of the results of the hormonal panel was carried out in 116 women with infertility on the background of endometriosis with long and short ovulation stimulation protocols and a control group in the programs of assisted reproductive technologies. Patients were divided into 3 groups. Group 1 consisted of 44 women with endometriosis-associated infertility who underwent controlled ovarian stimulation according to a long protocol with a-GnRH. Group 2 consisted of 42 patients with endometriosis-associated infertility who underwent controlled ovarian stimulation according to a short protocol with anti-GnRH. Comparison group 3 (control) consisted of 30 women with tubal factor infertility. The level of anti-Mullerian hormones (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol E2, and total testosterone in blood serum was determined by the enzyme-linked immunosorbent assay (ELISA) method in the laboratory of the Medical Center “Clinic of Professor Stefan Khmil” (accreditation No. 268604/2019). Indicators of the listed hormones were determined on certain days of the menstrual cycle. The level of total testosterone, follicle-stimulating, luteinizing hormone, estradiol was determined on the day 2–3 of the cycle, the level of progesterone was determined on the day 21–22 of the cycle, and on the day of the trigger injection the level of estradiol and progesterone was determined. The level of all the listed hormones was determined by the immunoenzyme analyzer “StatFax” and the test system “Diagnostic Systems Laboratories, Inc.” (USA).

Results and Discussion. A certain regularity of the hormonal panel of women with endometriosis-associated infertility was established, in particular, an increased level of FSH, an increased level of LH, a decreased ratio of LH to FSH, decreased anti-Mullerian hormone, which correlated with the degree of prevalence of the process, progesterone and androgen deficiency. However, the hyperestrogenic state inherent in endometriosis has been found to directly contribute to lesion growth through its proliferative and inflammatory effects on endometrial tissue.

Conclusions. Endometriosis-associated infertility is caused by a malfunction of the hypothalamic-pituitary-ovarian system, which requires more detailed further study in order to develop new technologies and treatment protocols. Undoubtedly, the best method of treating endometriosis associated infertility is the use of assisted reproductive technologies, however, patient management tactics and the stimulation protocol must be selected individually for each individual case of the diagnosis, depending on the reproductive potential (ovulatory reserve, hormonal profile) and the woman's history.