Management of women with infertility and uterine leiomyoma in assisted reproductive technology programs

Autor: S. V. Khmil, Yu. B. Drozdovska
Rok vydání: 2020
Předmět:
Zdroj: Journal of Education, Health and Sport, Vol 10, Iss 10, Pp 344-357 (2020)
ISSN: 2391-8306
DOI: 10.12775/jehs.2020.10.10.033
Popis: Khmil S. V., Drozdovska Yu. B. Management of women with infertility and uterine leiomyoma in assisted reproductive technology programs. Journal of Education, Health and Sport. 2020;10(10): 344-357. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.10.033 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.10.033 https://zenodo.org/record/4535889 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 18.09.2020. Revised: 12.10.2020. Accepted: 30.10.2020. UDC 618. 177–089.888.11–006.363.03/618.14.004.14 MANAGEMENT OF WOMEN WITH INFERTILITY AND UTERINE LEIOMYOMA IN ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAMS S. V. Khmil1,2, Yu. B. Drozdovska1 1SHEI “I. Horbachevsky Ternopil National Medical University of the MoH of Ukraine”, Ternopil, Ukraine 2Medical Center “Clinic of Prof. Stefan Khmil”, Ternopil, Ukraine Khmil, Stefan Volodymyrovych – Professor of the Department of Obstetrics and Gynecology No. 1, SHEI “I. Horbachevsky Ternopil National Medical University of the MoH of Ukraine”, honored scientist of Ukraine, professor, doctor of medicine, director of Medical Center “Clinic of Prof. Stefan Khmil”. Drozdovska, Yuliia Bohdanivna – a post-graduate student of the Department of Obstetrics and Gynecology No. 1, SHEI “I. Horbachevsky Ternopil National Medical University of the MoH of Ukraine”; tel.: +38 (068) 583-67-39. Abstract In the structure of female infertility, one of the important causes is the uterine factor of infertility, namely, uterine leiomyoma, which is diagnosed in 13.3–24.0% of cases and leads to loss of reproductive function and pregnancy pathology. Aim of research: to increase the incidence of pregnancy in infertile women with uterine leiomyoma by analyzing the main factors in the development of this pathology and optimizing the treatment and prevention complex. Material and research methods. A randomized clinical trial was performed among 175 (29.0%) women of reproductive age with a UL diagnosis, and the control group (CG) of 32 somatically healthy women with normal menstrual and reproductive functions, who were divided into the following groups: Main Group A (MG) – 137 women with UL, who were further divided into subgroups for evaluation of the treatment: subgroup A1 – 55 women with UL after laparoscopy and hysteroscopy with the proposed treatment complex (TC), subgroup A2 – 45 women with UL after hysteroscopy and TC, subgroup A3 – 37 women with UL and the proposed drug treatment without surgical removal of UL; comparison group B – 38 women with UL and conventional treatment. Results. The age of the examined patients was (33.9 ± 7.8) years (26–42 years), BMI - (23.5 ± 5.2) kg / m², AMH – 1.8 ng / ml (0.4–5), 2 ng / ml). The duration of infertility was 2–15 years on average (5.4 ± 0.5 years). Primary infertility was diagnosed in 43 patients (24.5%), and secondary – in 132 women (75.5%). 93 (53.7%) women developed hypermenorrhea, of which one in three indicated a history of anemia. 31 (17.7%) women complained of algodysmenorrhea; in 43 (24.6%) women, dysmenorrhea occurred after the appearance of uterine fibroids, and 23 women (13.2%) had irregular menstruation. During hysteroresectoscopy, single submucosal nodes “on the pedicle”, which had clear contours, a rounded shape, a dense consistency, and deformed the uterine cavity, were found in 71 (40.8%) patients. Of these, 51 (71.8%) nodes were whitish in color with isolated small hemorrhages, and in the remaining 20 (28.2%) cases, the nodes were covered with a lace of stretched and altered blood vessels. Analysis of the location and size of the nodes revealed that in every third patient (25 patients, 35.2%) the size of the node was about 2.5 cm, in every fourth (19 patients, 26.7%) nodes were up to 4 cm, in other patients (27 patients, 38.0%) the nodes were up to 5 cm and greater in size Interstitial-submucosal myomas with a combination of subserous nodes were diagnosed in 104 (59.2%) of the examined women and visualized as a bulge of one of the uterine walls. During hysteroresectoscopy, we visualized endometrial hyperplasia in 89 (50.8%) patients, which was subsequently confirmed histologically in 67 (38.3%) women, and secretory transformation of the endometrium in the remaining 22 (12.5%). In 22 (12.6%) patients, we observed hysteroscopic signs of chronic endometritis; this diagnosis was also confirmed morphologically, which was manifested by uneven thickening of the endometrium and micropolyps. The use of our improved algorithm of rehabilitation measures allowed to reduce the period of menstrual bleeding in 42 (48.8%) women in group A2, which was 1.3 times more effective than in the comparison group and 1.4 times more effective than in patients of group A3. Menstrual discharge was 1.9-fold and 1.8-fold lower compared to A1 women who refused surgery and 1.2-fold lower than in the comparison group. The effectiveness of the proposed treatment was analyzed, and the frequency of pregnancy was evaluated; findings indicate that the highest efficiency was observed in women of group A2 – 31.1% of cases, which was 2 times higher than the comparison group and 2.3 times higher than in group A3. Conclusion. Uterine leiomyoma is mainly the cause of infertility due to a mechanical factor. Laparo- and hysteroresectoscopy is the optimal method of pre-pregnancy treatment for women with uterine leiomyoma who are undergoing infertility treatment with assisted reproductive technologies. Laparo- and hysteroresectoscopy is an organ-sparing operation that has a number of advantages: easy postoperative period, no adhesions, which, in turn, increases the frequency of pregnancy and reduces premature delivery. Key words: uterine leiomyoma; laparo- and hysteroscopy; controlled ovarian stimulation; assisted reproductive technologies.
Databáze: OpenAIRE
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