FEATURES OF THE HORMONAL STATUS OF WOMEN WITH INFERTILITY AGAINST THE BACKGROUND OF POLYCYSTIC OVARIAN SYNDROME AND CHRONIC ENDOMETRITIS UNDERGOING MODIFIED TREATMENT

Abstract

SUMMARY. The main approach to restoring fertility in patients with PCOS is the use of assisted reproductive technologies. Chronic endometritis is diagnosed in 30.3 % of patients with repeated failed implants following IVF. There is a significantly higher rates of clinical pregnancies and deliveries in IVF treatment protocols if the patients first receive an adequate, long-term treatment for chronic endometritis (CE). The issue of developing an optimal treatment for the patients with comorbid PCOS and chronic endometritis in ART protocols remains a relevant one.

The aim –  to analyze the effect of a modified treatment scheme on the hormonal status of women with infertility against the background of PCOS and chronic endometritis who underwent an in vitro fertilization protocol.

Material and Methods. 105 women with endocrine infertility against the background of PCOS and chronic endometritis were included in this study. The patients were placed into two study groups depending on the cause of infertility and treatment scheme. The first study group comprised 43 women (30.71 %) with endocrine infertility against the background of PCOS and chronic endometritis, who were offered a conventional treatment for chronic endometritis and after 2–4 months had a delayed frozen embryo transfer with the use of hormone replacement therapy. The second study group comprised 62 women (44.29 %) with endocrine infertility against the background of PCOS and chronic endometritis who, prior to COS and after follicle puncture prior to embryo transfer, received a combination therapy, which included a vitamin complex with inositol (FT 500 Plus, 1 sachet once a day), and alpha-lipoic acid (Pelvidol in the average prophylactic dose of up to 1 tablet once a day for 2–4 months). The patients underwent delayed frozen embryo transfer 2–4 months after the treatment of chronic endometritis according to a modified scheme, which included alpha-lipoic acid, PRP-therapy of the endometrium and Lipofundin infusion on day 2–3 of the menstrual cycle and on the day of frozen embryo transfer. The control group (25.0 %) comprised 35 women with infertility due to male-related causes.

Results. Anti-Müllerian hormone levels did not significantly differ in the study groups both before and after the proposed treatment. Notably, the progesterone levels on the day of the trigger were the highest in the first study group, which significantly exceeded these values in both the second group (treated using a modified scheme) and control group, which in turn may adversely affect embryo implantation. The modified treatment scheme resulted in a significant increase in progesterone levels on days 21–23 of the menstrual cycle, 1.45 times compared to the values before treatment. The use of the modified treatment regimen also resulted in a probable decrease of the LH / FSH ratio, by 80.28 % compared to the values before treatment.

Conclusions. The modified treatment scheme, in comparison to the standard protocol, resulted in an increase of FSH level (by 25.8 %) and progesterone on day 21-23 of MC (by 29.71 %), as well as a decrease of LH / FSH ratio (by 34.57 %), progesterone level on the day of trigger (29.71 %), estradiol (17.46 %) and testosterone (19.58 %) levels.