Clinical analysis of treatment outcomes in women with infertility against the background of polycystic ovaries syndrome and chronic endometritis

Abstract

Introduction. In women with polycystic ovary syndrome, infertility is a serious and urgent problem, which is caused not only by anovulatory menstrual cycles [1], but also by changes in the histological structure of the endometrium, which adversely affects embryo implantation and subsequent pregnancy. Thus, chronic endometritis and polycystic ovary syndrome are among the causative factors of repeated unsuccessful embryo implantation in assisted reproductive technology (ART) programs [2-3].

Aim of the study. To analyze the clinical outcomes of patients with infertility against the background of PCOS and chronic endometritis (CE) in ART protocols, depending on the treatment scheme.

Materials, methods and their discussion. The study included 140 patients with infertility against the background of PCOS and CE. Study group I comprised 43 patients with PCOS and CE, who were offered conventional treatment for chronic endometritis. Study group II comprised 63 patients with PCOS and CE, who were treated using a modified scheme that additionally included alpha-lipoic acid, endometrial plasma therapy and lipid infusions (to reduce cytotoxicity) on the day of frozen embryo transfer (FET). In both groups, delayed embryo transfer was performed in cryocycles after 2-4 months. Cryoprotocols were performed using HRT and in the NC. The control group comprised 35 women with infertility due to male causes.

Results and discussion. Comparing causes of infertility in the patients with PCOS and CE, we found no significant differences between the study groups. There was no significant difference between the study groups and the control group in the frequency of surgical interventions in the anamnesis of the patients. It should be noted, however, that the structure of surgical interventions in the first and second study groups was dominated by the IUDs (respectively, in 18.60% and 19.35% of the cases) relative to the control group (2.86%). The anamnesis records of the patients show no significant differences between both study groups in the frequency of scraping of the uterine cavity walls and laparoscopy, and these values do not significantly differ from the control group. Hysteroscopy was performed in 13.95% of patients of group I and 12.90% of group II, which was higher compared to the control group (8.57%). Laparotomies comprised the least frequent type of intervention in the anamnesis of patients in both study groups and the control group. The clinical picture of chronic inflammatory disorders in patients of the study groups included asymptomatic course, chronic pelvic pain, menstrual and sexual dysfunction, and vaginal discharge. In addition to menstrual dysfunction, the patients with comorbid PCOS and CE of the study groups I and II had high frequency of vaginal discharge (respectively, in 62.79% and 56.45% of the patients) and chronic pelvic pain (30.23% and 33.87%, respectively), which was significantly higher than the results of the control group. Notably, in patients with infertility against the background of the combined PCOS and CE (comprising study groups I and II), the asymptomatic course of chronic inflammatory disorders was significantly more timely compared to the control group (p = 0.025).

Conclusions. Results of this study indicate that patients suffering scleropolycystosis are prone to ascending infection due to the dysregulation of the vaginal microbial environment, which ultimately becomes the causative factor of chronic endometritis. The CE process has an extremely negative effect on embryo implantation and subsequent pregnancy. Endometritis can be linked to PCOS through metabolic and endocrine pathologies.