EFFECT OF ENDOMETRIAL INJECTION SCRATCHING IN CYCLES OF TREATMENT BY ASSISTED REPRODUCTIVE TECHNOLOGY METHODS.

Abstract

Objective:optimization of pregravid (pre-pregnancy) preparation in patients with tubal-peritoneal infertility factor and marked delay in endometrial development after unsuccessful assisted reproductive technology (ART) treatment by the use of endometrium injection scratching technology with autoplasma. Material and methods. Study included 40 cases of unsuccessful treatment attempts for tubal-peritoneal factor infertility with severe delay of endometrial development and 10 patients with tubal-peritoneal factor infertility with normal endometrium with one or more unsuccessful ART attempts on history and the existence of cryopreserved embryos of satisfactory quality from previous cycles of assisted reproductive technology. The average age was 39.5 ± 3.1 years. Patients were divided into groups: I – 21 patients who underwent endometrial injection scratching and hormonе replacement therapy (HRT) with a standard (4/6 mg) dose of estradiol; II – 19 patients who were prescribed HRT with a standard (4/6 mg) dose of estradiol; control – 10 patients with normal endometrium who underwent cryo-ET with standard (4/6 mg) dose of estradiol. Clinical results were evaluated and compared in terms of pregnancy rate per embryo transfer and pregnancy loss rate in the first trimester. The correspondence of the morphofunctional structure of the endometrium was evaluated by ultrasound, cytologically, Doppler measurements, histologically, immunohistochemically and via selective electron microscopy. Endometrium was 8.9 ± 1.1 mm during the period of progesterone prescription in the cryoembryo transfer cycle. All participants were transferred day 5 embryos. Results. In the cryo-ET program autoplasma injection scratching in patients with marked delay of endometrial development after the first seven days of monotherapy with a starting dose of estradiol was accompanied by a significant improvement in clinical outcomes in terms of pregnancy rate (25%) and definite decrease of early reproductive losses (25%). Conclusions. After pre-pregnancy preparation according to our method, it is quite sufficient to perform HRT with a standard dose of estradiol (4/6 mg/day) before starting progesterone irrespective of the endometrial development degree. Meanwhile, injection scratching is advisable to be prescribed in cases of marked delay in the endometrium development and it should be combined with physiotherapy methods.