EVALUATION OF EFFICIENCY OF SHORT EXTRACORPOREAL FERTILIZATION PROTOCOLS IN WOMEN WITH INFERTILITY AGAINST THE BACKGROUND OF POLYCYSTIC OVARY SYNDROME AND CHRONIC ENDOMETRITIS
DOI:
https://doi.org/10.11603/1811-2471.2021.v.i4.12816Keywords:
infertility, polycystic ovary syndrome, chronic endometritis, inflammatory diseases of the genitourinary system, controlled ovarian stimulationAbstract
SUMMARY. In women who seek medical help for anovulation, approximately 80–90 % are diagnosed with PCOS. Data on the prevalence of chronic endometritis varies, from very low to very high frequency, or 2,8 % to 67,6 % of patients with infertility and failed implantation. These figures suggest the need to study infertility against the background of PCOS and chronic endometritis.
The aim: to study the features of oogenesis, fertilization, pregnancy programs in patients undergoing IVF and with endocrine infertility against the background of PCOS as well as the background of comorbid polycystic ovary syndrome and chronic endometritis.
Materials and methods. A retrospective analysis of medical records of 110 women with endocrine infertility and 1) polycystic ovary syndrome; 2) comorbid PCOS and chronic endometritis; and 3) control group (n=30). The patients were divided into three groups. The first study group comprised 52 women with endocrine infertility against the background of PCOS, the second of 58 women with infertility against the background of PCOS and chronic endometritis (this group included patients whose pregnancies have terminated prematurely and/or had implantation failure ), and the third group of 30 patients with infertility caused male-related factors, which constituted a control group.
We conducted a comparative analysis of general clinical parameters of patients with endocrine infertility against the background of PCOS as well as comorbid PCOS and chronic endometritis. Additionally, we analyzed the outcomes of short IVF protocols with GnRH antagonist in these patients, including the characteristics of folliculogenesis, the number of produced oocytes and embryos, and clinical results of pregnancy and childbirth.
Results. The retrospective analysis of surgical interventions in patients with comorbid PCOS and chronic endometritis showed that 24.14 % of these patients had a history of uterine wall scraping and 20.69 % had IUDs, which could be one of the causative factors of chronic endometritis. Analysis of the results of superovulation stimulation revealed a higher number of stimulation days, a higher total dose of gonadotropins, a lower number of blastocysts, as well as a lower probability of pregnancy. These findings allow us to determine preferable methods to prepare the patients of the second study groups for a cryoprotocol in order to realize their reproductive function.
Conclusions. Patients with endocrine infertility with comorbidity of PCOS and chronic endometritis, compared the patients with infertility against background of PCOS only, a higher total dose of rFSG to stimulate superovulation, longer duration of GnRH antagonist administration and COS, significantly lower number of oocytes, fertilized eggs and blastocysts, as well as a lower pregnancy rate.
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