Оптимізація циклів лікування методами допоміжних репродуктивних технологій у пацієнток з трубно-перитонеальною безплідністю шляхом застосування процедури ін’єкційного скретчингу аутоплазмою

The article presents the results of a study whose aim was to elucidate the effect of autologous injection of endometrial autotransplantation on clinical outcomes of tubal peritoneal infertility by ART (according to the standard protocol) in patients with varying degrees of lag in the development of the endometrium and unsuccessful attempts at treatment with ART in the anamnesis. The objective: was to determine the impact on the clinical consequences of the endometrial injection technique on the autoplasm in patients with tubal peritoneal infertility and the varying degree of (moderate and severe) lag in the development of the endometrium in repeated attempts to treat ART by the protocol of controlled ovarian stimulation (ETS) + embryotransfer (ET) . Materials and methods. In a prospective study included 105 cases of previous unsuccessful attempts to treat ART by the tubal peritoneal factor of infertility. Of these, 58 patients experienced a moderate lag in the development of the endometrium and in 47 cases a marked lag in the development of the endometrium. 105 patients were offered treatment with the use of estrogens and the technique of injection scratching with autoplasma in the cycle during CSC. The retrospective group included 112 patients with moderate hypoplasia and 64 patients with severe endometrial hypoplasia. Patients treated with tubal peritoneal infertility in combination with a moderate lag in the development of the endometrium under the CAS + ET protocol were allocated to: ІА group (comparison group) – 45 patients receiving estrogens from the 7th day of CSC (retrospective analysis indices); ІB group (control group) - 67 patients who did not receive estrogens from the 7th day of CAS (retrospective analysis indicators); IV group (main group) – 58 patients who were prescribed estrogen and an injection procedure for endometrial stitching on the 7th day of the stimulation cycle (CI) during CSC. Patients treated with tubal peritoneal infertility, in combination with a marked lag in the development of the endometrium according to the CAS + ET protocol, were allocated to: the IIA group (comparison group) - 31 patients who received estrogens from the 7th day of CSC (retrospective analysis); IIB group (control group) - 33 patients who did not receive estrogens from the 7th day of CSC (retrospective analysis indicators); IIB group (main group) - 47 patients who were prescribed estrogens and an injection procedure for endometrial streaking with autoplasma during the CSC at the 7th day of the CA. Clinical results were evaluated according to the frequency of pregnancy on embryo transfer (CHNBPE) and the frequency of pregnancy loss in the first trimester and compared with each other. Results. In the group of patients with a moderate lag in the development of the endometrium, the CHNBPE index did not differ significantly between the ІА, ІB and ІB groups and was 38%, 40.5% and 39.7%, respectively. The frequency of early reproductive losses was 17.6% for women in the ІА group, and 18.5% for women of the ІB group. The index of reproductive losses in the main IV group was 21.7% and did not differ significantly from the control and comparison groups. In the group of patients with a marked lag in the development of the endometrium, the CHNBPE index in the IIB group was 27.7% compared to 12.9% in the IIA group (p = 0.048) and 12.1% (p = 0.037) in the IIB group (comparison group ). The frequency of abortion in the I trimester in patients of groups IIA, IIB and IIB was 23.1%, 50% and 50%, respectively. The differences were not significant (p = 0.414). Conclusion. The application of the autoplasmic injection scratching procedure significantly improves the rate of CHNBPE in patients with a pronounced delay in the development of the endometrium in the ART treatment cycles.Key words: infertility, methods of assisted reproductive technology, hypoplasia of the endometrium, injection screetching of endometrium.