HYSTERORESECTOSCOPY AS A STRATEGY FOR INCREASING THE CHANCES OF EMBRYO IMPLANTATION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME AND METABOLIC SYNDROME

Abstract

The aim of the work: the aim of the study was to evaluate the effect of pre-pregnancy metabolic optimization and operative hysteroresectoscopy before embryo transfer on the condition of the endometrium and in vitro fertilization (IVF) results in patients with polycystic ovary syndrome (PCOS) and metabolic syndrome (MS), in particular on the frequency of implantation and clinical pregnancies.

Materials and Methods. The study included 128 women of reproductive age with PCOS, divided into three groups: 1st – PCOS+MS, routine pre-protocol preparation; 2nd – PCOS+MS, metabolic optimization 8–12 weeks before the IVF program; 3rd – control, PCOS without MS. The indications for hysteroscopy were ultrasound and clinical signs of intrauterine pathology, thin or heterogeneous endometrium, repeated failed implantations, suspicion of chronic endometritis. The procedure was performed in the early proliferative phase with removal of detected formations, targeted biopsy, and subsequent morphological/immunohistochemical examination.

Results. Hysteroscopy was indicated in 42.2 % of patients, mainly in the PCOS+MS group without metabolic optimization. Hysteroscopy most often revealed endometrial polyps (up to 37.5 % in group 1) and simple hyperplasia without atypia (up to 25 %), less often proliferation disorders, signs of endometritis, and micropolyposis. In the group with pre-pregnancy optimization, the frequency of clinical pregnancies was 8.0% higher than in the routine preparation group and 5.7 % higher than in the control group; the live birth rate exceeded these figures by 10.5 % and 6.2 %, respectively. Although no statistically significant differences were found, there is a clinically significant trend toward improved IVF outcomes.

Conclusions. Women with PCOS, especially when combined with metabolic syndrome, often experience endometrial changes that reduce the effectiveness of IVF programs. The combination of pre-pregnancy metabolic optimization with operative hysteroscopy before embryo transfer improves the condition of the endometrium and has shown a tendency to increase the frequency of clinical pregnancies and live births.