Characteristics of parameters of folliculogenesis in women with infertility on the background of uterine leiomyoma in programs of assistant reproductive technologists

Abstract

There is much discussion about the effect of uterine leiomyoma on the results of assisted reproductive technologies (ART). Myomas reduce the frequency of positive results of in vitro fertilization (IVF) and increase the frequency of miscarriages. The aim of the study – to study the effectiveness of the proposed treatment regimen, which includes the introduction of hormone releasing agonist, hysteroresectoscopy, conservative myomectomy in women with infertility on the background of uterine leiomyoma (UL) and pregravide training in assisted reproductive technologies for folliculogenesis. Materials and methods. The clinical study was performed during 2014–2020 on the basis of the medical center "Clinic of Professor Stefan Khmil". There were 175 women of reproductive age diagnosed with UL, who were divided into the following groups: main group A - 137 women with UL, which was further divided into subgroups A1 - 55 women with UL after conservative myomectomy with the proposed medical complex (MC), A2 - 45 women with UL after hysteroscopy and MC, A3 - 37 with UL and the proposed drug treatment without surgical removal of MC; comparison (PG B) group - 38 women with UL and conservative myomectomy. All patients with subcomous-intramural and subserous arrangement of myomatous nodes underwent hormonal training with gonadotropin-releasing hormone agonists before myomectomy. Surgical interventions were performed by different methods, depending on the location of fibroids (hysteroresectoscopy, laparotomy and laparoscopic methods). After the operation, the patients were prescribed pre-pregnancy preparation 3 months before and in the controlled ovarial stimulation (COS) protocol before the follicle puncture. Results. In women with infertility on the background of UL analysis of the parameters of the effectiveness of COS showed that women with UL after hysteroscopy and the proposed treatment complex were probably higher average number of follicles with a diameter of more than 18 mm (16.00%), the average number of mature oocytes (30.91 %), the average number of fertilized oocytes (by 36.00 %) and the average number of transferred embryos (by 45.16 %), relative to the comparison group. Conclusions. The use of the proposed treatment regimen, which includes the introduction of hormone releasing agonist, hysteroresectoscopy in women with infertility on the background of uterine leiomyoma and pregravide training in assisted reproductive technology programs, which includes vitamin complex with inositol, vitamin D3 and alpha-lipoic acid with magnesium, reduces the dose of gonadotropins, the duration of controlled ovulatory stimulation, and improves the parameters of oocyte induction, vs patients with uterine leiomyoma after conservative myomectomy

Keywords

• uterine leiomyoma
• hysteroresectoscopy
• laparoscopy
• in vitro fertilization
• pragravide training
• effectiveness