THE POSSIBILITIES OF ENDOMETRIUM BLOOD SUPPLY IMPROVEMENT IN WOMEN WITH REDUCED OVARIAN RESERVE

Abstract

At the turn of the XX–XXI centuries highly effective assisted reproductive technologies (ART) were introduced into clinical practice, which made it possible to dramatically increase the effectiveness of overcoming infertility, regardless of its causes. Methods of assisted reproductive technology (ART) are the most effective in overcoming various forms of male and female infertility.

The aim of the study – to learn the effectiveness of endometrium scratching in improving its blood supply in women with a reduced ovarian reserve and unsuccessful in vitro fertilization (IVF) attempts in history.

Materials and Methods. There were examined 120 reproductive age patients with infertility due to reduced ovarian reserve and unsuccessful attempts of IVF in the anamnesis. All women were divided into 2 groups: basic (group O, n = 60) and comparison (group P, n = 60). In each group there were 2 subgroups: subgroup 1 included patients with reduced ovarian reserve due to ovarian surgery in the past (O1 and P1) and subgroup 2 with genetically reduced ovarian reserve (O2 and P2). All women on the 7–8th day of the menstrual cycle, preceded to cryoembriotransfer, underwent diagnostic hysteroscopy with endometrial biopsy. The women of the main group underwent endometrial scratching during the intervention. To determine the state of the blood supply of the endometrium was performed the echo­graphy of the small pelvis in the dynamics of two cycles (preceding the cryoembriothransfer and in the treatment cycle) on days 7, 14 and 21. The study included two-dimensional echography, three-dimensional echography and three-dimensional energy Doppler.

Results and Discussion. According to the obtained results, the endometrium volume increased in the dynamics of the treatment cycle, and this increasing was statistically significant in comparison with the previous cycle in the main group (2.85±0.06) cm³ in comparison to (2.69±0.05) cm³ in the subgroup O1 and (2.88±0.03) cm³ in comparison to (2.74±0.06) cm³ in the subgroup O2,
p <0.05). On the 21st day, a further tendency towards its increasing was observed only in women with operated ovaries and endometrial scratching (2.81±0.07) cm³ compared to (2.53±0.11) cm³, p <0.05). The determination of the vascularization index on the 21st day of the ET cycle showed its increasing in the group O, both in comparison with the previous cycle and in the dynamics of this: (33.85±1.17) % compared with (27.33±2.25) % in the previous cycle in the subgroup O1; (33.56±1.36) % and (26.43±2.17) % in the subgroup O2 (p <0.05). In group P vascularization index (VI) did not change significantly. The vascularization-flow index in patients of the subgroup O1 on the 7th day of the embryotransfer cycle was significantly higher than in the subgroups O2, P1 and P2 (1.83±0.04) compared to (1.14±0.02), (1.18±0.03) and (0.91±0.04), p <0.05). On the 21st day of the ET cycle, it remained significantly higher than that in the previous cycle in both subgroups of group O (p <0.05) without significant changes in group P (p> 0.05).

Conclusions. The study showed that endometrial scratching performed in the cycle preceding the embryotransphere improves its blood supply in women with a reduced ovarian reserve and unsuccessful IVF attempts in the anamnesis.