TY - JOUR AU - Khmil, S. V. AU - Drozdovska, Yu. B. PY - 2020/10/30 Y2 - 2024/03/29 TI - Management of women with infertility and uterine leiomyoma in assisted reproductive technology programs JF - Journal of Education, Health and Sport JA - J Educ Health Sport VL - 10 IS - 10 SE - Research Articles DO - 10.12775/JEHS.2020.10.10.033 UR - https://apcz.umk.pl/JEHS/article/view/JEHS.2020.10.10.033 SP - 344-357 AB - <p>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.</p><p><strong>Aim of research: </strong>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.</p><p><strong>Material and research methods. </strong>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.</p><p><strong>Results. </strong>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.</p><p>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.</p><p>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 about2.5 cm, in every fourth (19 patients, 26.7%) nodes were up to4 cm, in other patients (27 patients, 38.0%) the nodes were up to5 cmand greater in size</p><p>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.</p><p>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.</p><p>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.</p><p><strong>Conclusion. </strong>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.</p> ER -