Issue: 2024, Vol. 29, No. 4

A. M. Gerasimov, D. A. Malyshkina, A. S. Filippova, E. Yu. Oshurkova, E. A. Shilova, T. V. Verteletskaya

PROGNOSIS OF FERTILITY RESTORATION AFTER TREATMENT OF CHRONIC ENDOMETRITIS

Keywords

chronic endometritis, impaired fertility, treatment effectiveness, prognostic criteria

Abstarct

Objective: to determine possible criteria of predicting the treatment effectiveness based on the onset of spontaneous pregnancy during one year of dynamic observation through the study of clinical and anamnestic features of patients with reproductive dysfunction against the background of chronic endometritis (CE). Material and methods. We observed 92 patients admitted to the 3rd gynecological department of the Federal State Budget Institute Ivanovo scientific-research institute motherhood and childhood named after V.N. Gorodkov with a history of miscarriage due to CE. Dynamic observation continued for a year after accomplished inpatient treatment, and, if pregnancy occurred, up to 227 weeks of pregnancy. The patinets were divided into the two groups: Group 1 – 73 women who became pregnant during the first year, Group 2 – 19 patients who developed secondary infertility. Results and discussion. Patients in the second group have the following characteristics: a slightly earlier age of menarche and sexual debut, heavier menstruation, they are more often diagnosed with hyperandrogenism, infertility and chlamydia in the anamnesis, adhesive disease, hypothyroidism due to autoimmune thyroiditis. Possible prognostic factors may be a sfollows: history of infertility: group 1 – in 5,48 %, group 2 – in 36,84 % (OR – 0,4269, CI 95 % – 0,1943-0,9377, p = 0,001112); the presence of adhesive disease – in 5,48 and 31,86 %, respectively (OR – 0,4754, CI 95 % – 0,2212-1,021, p = 0,004559); the presence of chlamydia in the anamnesis – in 1,37 and 15,79 % (OR – 0,3056, CI 95 % – 0,0558-1,673, p = 0,02670); thyroid pathology – in 19,18 and 36,84 %, (OR – 0,8046, CI 95 % 0,5839–1,109, p = 0,09782). Conclusion. Patients with chronic endometritis and a history of pregnancy loss after the treatment for chronic endometritis should be referred to ART clinics to restore fertility as they have a high risk of developing secondary infertility. Moreover, such clinical and anamnestic features as early age of menarche and sexual debut, heavy menstruation, hyperandrogenism, the presence of adhesive disease, thyroid pathology in the form of hypothyroidism, infertility and chlamydia in the anamnestic history only complicate the condition.

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