Преконцепційна підготовка жінок із видаленими матковими трубами з приводу гідросальпінксів задовго до ініціації циклів допоміжних репродуктивних технологій

Background. Some women with hydrosalpinx undergo isolated salpingectomy at a stage when they have not yet started a family and are not planning pregnancy in the near future. When such patients are referred for assisted reproductive technologies (ART) a long time after surgery, changes in the cervicovaginal microbiota, imbalance of reproductive hormones, signs of oxidative stress and chronic endometritis are often detected. Objective of the study: to evaluate the effectiveness of the proposed comprehensive preconception preparation in women who underwent salpingectomy for hydrosalpinx long before the initiation of ART cycles. Materials and methods. A total of 128 women with isolated salpingectomy for hydrosalpinx long before the start of ART programs were examined. The main group underwent preconception preparation according to the author’s method, and the comparison group received preparation according to standard protocols. The control group consisted of 34 healthy women who entered ART cycles due to male-factor infertility of non-inflammatory origin. The proposed preconception preparation included: extended diagnostics of the state of the cervicovaginal microbiota; assessment of free radical oxidation and antioxidant defense; immunohistochemical determination of CD138+ expression in endometrial samples; and a complex of therapeutic and preventive measures, which included restoration of the cervicovaginal microbiota, cyclic hormone therapy, the use of combined antioxidant-vitamin and nutraceutical agents, as well as targeted treatment of chronic endometritis. Results. The use of comprehensive preconception preparation according to the author’s method contributed to the normalization of gonadotropic regulation and an increase in the levels of major steroid hormones. At the same time, a decrease in the intensity of free radical oxidation, an improvement in the state of antioxidant defense, regression of inflammatory changes in the endometrium, as well as a significant increase in the cumulative pregnancy rate and live birth rate were noted. Conclusions. Personalized preconception preparation is appropriate and effective in women with removed fallopian tubes due to hydrosalpinx, even if salpingectomy was performed long before the initiation of ART cycles.