В настоящее время бездетные браки – важная медицинская и социальная проблема, их частота остается высокой и не имеет позитивных тенденций к снижению не только в России, но и во всем мире. В структуре женского бесплодия, возникающего вследствие различных патологических процессов в репродуктивной системе женщины, существенное место занимает бесплодие маточного происхождения, в том числе ассоциированное с внутриматочными синехиями и хроническим эндометритом. Статья отражает современные представления о тактике лечения этой группы пациенток по данным отечественной и зарубежной литературы.
Ключевые слова: бесплодие маточного происхождения, хронический эндометрит, внутриматочные синехии
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Both in our country and around the world, childless marriages currently remain an important medical and social problem, the frequency of which remains high and has no tendency to decrease. One of the main roles in the structure of this condition is the uterine factor of infertility. In the structure of the uterine factor, a separate place belongs to intrauterine synechiae associated with chronic endometritis. The high prevalence, unclear mechanisms of pathogenesis and the lack of a unified approach to therapy determines not only the relevance of the chosen topic, but also the need for an integrated approach to the management of patients suffering from uterine infertility. The article presents modern ideas about the tactics of treatment of patients with infertility of uterine genesis associated with chronic endometritis and intrauterine synechiae, according to domestic and foreign literature.
Keywords: infertility, chronic endometritis, uterine factor of infertility, adhesive process of the pelvis, intrauterine synechiae
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31. Al-Inany H. Intrauterine adhesions. An update. Acta Obstet Gynecol Scand. 2001;80(11):986-93.
32. Robinson JK, Colimon LMS, Isaacson KB. Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman’s syndrome). Fertil Steril. 2008;90(2):409-14. DOI:10.1016/j.fertnstert.2007.06.034
33. Johary J, Xue M, Zhu X, et al. Efficacy of Estrogen Therapy in Patients With Intrauterine Adhesions: Systematic Review. J Minim Invasive Gynecol. 2014;21:44-54. DOI:10.1016/j.jmig.2013.07.018
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1. Yatsenko SA, Rajkovic A. Genetics of human female infertility. Biol Reprod. 2019;101(3):549-66. DOI:10.1093/biolre/ioz084
2. Тюрина Е.П., Сайфетдинова Ю.Ф. Причины женского бесплодия. Огарев-Online. 2014;12(26):1-5 [Tiurina EP, Saifetdinova IuF. Prichiny zhenskogo besplodiia. Ogarev-Online. 2014;12(26):1-5 (in Russian)].
3. Saravelos SH, Cocksedge KA, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14:415-29. DOI:10.1093/humupd/dmn018
4. Vitagliano A, Noventa M, Saccone G, et al. Endometrial scratch injury before intrauterine insemination: is it time to re-evaluate its value? Evidence from a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2018;109(1):84-96. DOI:10.1016/j.fertnstert.2017.09.021
5. Vitagliano A, Saccardi C, Noventa M, et al. Does endometrial scratching really improve intrauterine insemination outcome? Injury timing can make a huge difference. J Gynecol Obstet Hum Reprod. 2018;47(1):33-4. DOI:10.1016/j.jogoh.2017.11.001
6. Оразов М.Р., Краснопольская К.В., Силантьева Е.С., и др. Эффективность альтернативных методов лечения бесплодия маточного генеза. Гинекология. 2021;23(1):92-6 [Orazov MR, Krasnopol'skaia KV, Silant'eva ES, et al. The efficacy of alternative treatment tactics for uterine infertility. Gynecology. 2021;23(1):92-6 (in Russian)].
DOI:10.26442/20795696.2021.1.200672
7. Sukhikh TA. Besplodnyi brak. Sovremennye podkhody k diagnostike i lecheniiu: rukovodstvo. Pod red. GT Sukhikh, TA Nazarenko. Moscow: GEOTAR-Media, 2010 (in Russian).
8. Di Pietro C, Cicinelli E, Guglielmino MR, et al. Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis. Am J Reprod Immunol. 2013;69(5):509-17. DOI:10.1111/aji.12076
9. Alam V, Bernardini L, Gonzales J, et al. A prospective study of echographic endometrial characteristics and pregnancy rates during hormonal replacement cycles. J Assist Reprod Genet. 1993;10:215-9. DOI:10.1007/BF01239224
10. Abdalla HI, Brooks AA, Johnson MR, et al. Endometrial thickness: a predictor of implantation in ovum recipients? Hum Reprod. 1994;9:363-5. DOI:10.1093/oxfordjournals.humrep.a138509
11. Richter KS, Bugge KR, Bromer JG, Levy MJ. Relationship between endometrial thickness and embryo implantation, based on 1294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertil Steril. 2007;87:53-9. DOI:10.1016/j.fertnstert.2006.05.064
12. Mahajan N. Endometrial receptivity array: Clinical application. J Hum Reprod Sci. 2015;8(3):121-9. DOI:10.4103/0974-1208.165153
13. Sidel'nikova VM. Nevynashivanie beremennosti: sovremennyi vzgliad na problemu. Obstetrics and Gynecology. 2007;5:24-7 (in Russian).
14. Radzinsky VE, Orazov MR, Toktar LR, et al. The contribution of chronic endometritis to reproductive system disorders in patients with repeated implantation failures. Gynecology. 2021;23(1):102-6 (in Russian). DOI:10.26442/20795696.2021.1.200671
15. Zinov'eva OS, Motovilova TM, Kachalina TS, et al. Issledovanie proliferativnogo potentsiala gipoplasticheskogo endometriia u patsientok s reproduktivnymi narusheniiami v anamneze metodom fluorestsentnoi immunotsitokhimii. Meditsinskii al'manakh. 2017;6(51):84-7 (in Russian).
16. Cozzolino M, Vitagliano A, Di Giovanni MV, et al. Ultrasound-guided embryo transfer: summary of the evidence and new perspectives. A systematic review and meta-analysis. Reprod Biomed Online. 2018;36(5):524-42. DOI:10.1016/j.rbmo.2018.01.015
17. March CM. Management of Asherman's syndrome. Reprod Biomed Online. 2011;23(1):63-76. DOI:10.1016/j.rbmo.2010.11.018
18. Korsak VS, Zabelkina OI, Isakova EV, Popov EN. Diagnostics of endometrial pathology in patients with tubal infertility. Zhurnal akusherstva i zhenskikh boleznei. 2005;3:50-3 (in Russian).
19. Di Speizio Sardo A, Palma F, Calagna G, et al. Chronic Endometritis. In: Genital Infections and Infertility. London: IntechOpen, 2016. DOI:10.5772/63023. Available at: https://www.intechopen.com/chapters/50294 Accessed: 02.03.2022.
20. Puente E, Alonso L, Laganà AS, et al. Chronic Endometritis: Old Problem, Novel Insights and Future Challenges. Int J Fertil Steril. 2020;13(4):250-6. DOI:10.22074/ijfs.2020.5779
21. Rice AD, Patterson K, Wakefield LB, et al. Ten-year Retrospective Study on the Efficacy of a Manual Physical Therapy to Treat Female Infertility. Altern Ther Health Med. 2015;21(3):36-44.
22. Orazov MR, Radzinsky VE, Lokshin VN. Besplodnyi brak. Versii i kontraversii. Moscow: GEOTAR-Media, 2019 (in Russian).
23. Volkova EIu, Korneeva IE, Silant'eva ES, Ponomarenko GN. Vliianie fizioterapii na implantatsionnyi potentsial «tonkogo» endometriia. Fizioterapevt. 2012;2:14-9 (in Russian).
24. Shuai Z, Li X, Tang X, et al. Transcutaneous electrical acupuncture point stimulation improves pregnancy outcomes in patients with recurrent implantation failure undergoing in vitro fertilisation and embryo transfer: a prospective, randomised trial. Acupunct Med. 2019;37(1):33-9. DOI:10.1136/acupmed-2017-011483
25. Sun B, Liu Z. Successful pregnancy in a woman with bilateral fallopian tube obstruction and diminished ovarian reserve treated with electroacupuncture: A case report. Medicine (Baltimore). 2019;98(38):e17160. DOI:10.1097/MD.0000000000017160
26. Okhowat J, Murtinger M, Schuff M, et al. Massage therapy improves in vitro fertilization outcome in patients undergoing blastocyst transfer in a cryo-cycle. Altern Ther Health Med. 2015;21(2):16-22.
27. Shishkanova OL. Optimizatsiia taktiki lecheniia khronicheskogo endometrita u patsientok s narusheniem reproduktivnoi funktsii s ispol'zovaniem impul'snoi elektroterapii. Avtoref. dis. ... kand. med. nauk. Moscow. 2008.
Available at: http://www.dslib.net/ginekologia/optimizacija-taktiki-lechenija-hronicheskogo-jendometrita-u-pacient... Accessed: 02.03.2022 (in Russian).
28. Adamian LV, Kulakov VI. Endoskopiia v ginekologii. Moscow: Meditsina, 2000 (in Russian).
29. Fernandez H, Gervaise A, de Tayrac R. Operative hysteroscopy for infertility using normal Saline solution and a coaxial bipolar electrode: a pilot study. Hum Reprod. 2000;15(8):1773-5. DOI:10.1093/humrep/15.8.1773
30. Yamamoto N, Takeuchi R, Izuchi D, et al. Hysteroscopic adhesiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes. Reprod Med Biol. 2013;12(4):159-66. DOI:10.1007/s12522-013-0149-x
31. Al-Inany H. Intrauterine adhesions. An update. Acta Obstet Gynecol Scand. 2001;80(11):986-93.
32. Robinson JK, Colimon LMS, Isaacson KB. Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman’s syndrome). Fertil Steril. 2008;90(2):409-14. DOI:10.1016/j.fertnstert.2007.06.034
33. Johary J, Xue M, Zhu X, et al. Efficacy of Estrogen Therapy in Patients With Intrauterine Adhesions: Systematic Review. J Minim Invasive Gynecol. 2014;21:44-54. DOI:10.1016/j.jmig.2013.07.018
34. Dreisler E, Kjer JJ. Asherman’s syndrome: current perspectives on diagnosis and management. Int J Women’s Health. 2019;11:191-8. DOI:10.2147/IJWH.S165474
35. Polishuk WZ, Kohane S. Intrauterine adhesions: diagnosis and therapy. Obstet Gynecol Digest. 1966;8:41.
36. Ventolini G, Zhang M, Gruber J. Hysteroscopy in the evaluation of patients with recurrent pregnancy loss. Surg Endosc. 2004;18:1782-4.
DOI:10.1007/s00464-003-8258-y
37. Zhang Y, Liu Q, Yang N, Zhang X. Hyaluronic acid and oxidized regenerated cellulose prevent adhesion reformation after adhesiolysis in rat models. Drug Design Develop Ther. 2016;10:3501-7. DOI:10.2147/DDDT.S103824
38. Sulima AN, Davydova AA, Rybalka AN, et al.The features of adhesions’ prevention and treatment in patients with chronic inflammatory pelvic diseases. Gynecology. 2018;20(1):62-7 (in Russian). DOI:10.26442/2079-5696_20.1.62-67
39. Rizzo A, Spedicato M, Mutinati M, et al. Peritoneal adhesions in human and veterinary medicine: from pethigenesis to therapy. A review. Immunopharmacol Immunotoxicol. 2010;32(3):481-94. DOI:10.3109/08923970903524367
40. Vartanyan EV, Devyatova EA, Tsaturova KA, Aglyamova DR. Role of combined therapy in the treatment of patients with infertility and reproductive failures. Obstetrics, Gynecology and Reproduction. 2018;12(1):5-15 (in Russian). DOI:10.17749/2313-7347.2018.12.1.005-015
41. Orazov MR, Radzinsky VE, Khamoshina MB, et al. Anti-adhesive barriers in clinical practice: personalized patient management. Gynecology. 2021;23(6):480-4 (in Russian). DOI:10.26442/20795696.2021.6.201292
42. Li J, Cen B, Chen S, He Y. MicroRNA-29b inhibits TGF-β1-induced fibrosis via regulation of the TGF-β1/Smad pathway in primary human endometrial stromal cells. Mol Med Rep. 2016;13(5):4229-37. DOI:10.3892/mmr.2016.5062
43. Van Beek JP, Kennedy L, Rockel JS, et al. The induction of CCN2 by TGFβ1 involves Ets-1. Arthritis Res Ther. 2006;8(2):R36. DOI:10.1186/ar1890
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1 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
2 ФГБНУ «Научно-исследовательский институт морфологии человека им. акад. А.П. Авцына», Москва, Россия
*omekan@mail.ru
________________________________________________
Mekan R. Orazov*1, Liudmila M. Mikhaleva2, Sevinc Ya. Ismayilzade1, Tatiana V. Bezuglova2, Elena V. Lagutina1
1 People’s Friendship University of Russia (RUDN University), Moscow, Russia;
2 Avtsyn Research Institute of Human Morphology, Moscow, Russia
*omekan@mail.ru