urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.2.17EFHGOFurmj-1492Research ArticleОригинальные статьи | Original articlesOriginal articlesГистероскопия с вакуум-аспирацией эндометрия при повторных неудачах имплантации: диагностическая значимость и влияние на успех ЭКОHysteroscopy with Endometrial Vacuum Aspiration in Repeated Implantation Failure: Diagnostic Significance and the Effect on IVF Successhttps://orcid.org/0009-0001-5105-9200КузнецовС. И.KuznetsovS. I.

Семён Иванович Кузнецов — студент лечебно-профилактического факультета

Екатеринбург

Semen I. Kuznetsov — Student of the Faculty of General Medicine

Ekaterinburg

kuzs2018@gmail.comhttps://orcid.org/0009-0008-3855-5374ОпатовскаяЯ. В.OpatovskayaYa. V.

Яна Владимировна Опатовская — студент лечебно-профилактического факультета

Екатеринбург

Yana V. Opatovskaya — Student of the Faculty of General Medicine

Ekaterinburg

gvo1999@yandex.ruhttps://orcid.org/0000-0002-0705-9748АскероваМ. Г.AskerovaM. G.

Марина Геннадьевна Аскерова — кандидат медицинских наук, доцент кафедры акушерства и гинекологии с курсом медицинской генетики

Екатеринбург

Marina G. Askerova — Candidate of Sciences (Medicine), Associate Professor of the Department of Obstetrics and Gynecology with Medical Genetics Course

Ekaterinburg

mgaskerova@gmail.comhttps://orcid.org/0000-0002-0307-4609АскеровР. А.AskerovR. A.

Роман Аскерович Аскеров — акушер-гинеколог

Екатеринбург

Roman A. Askerov — Obstetrician-Gynecologist

Ekaterinburg

roman.askerov@gmail.comУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationКлинический институт репродуктивной медициныРоссияClinical Institute of Reproductive MedicineRussian Federation2024080520242321724Copyright © Кузнецов С.И., Опатовская Я.В., Аскерова М.Г., Аскеров Р.А., 20242024Кузнецов С.И., Опатовская Я.В., Аскерова М.Г., Аскеров Р.А.Kuznetsov S.I., Opatovskaya Y.V., Askerova M.G., Askerov R.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1492Введение

Введение. В исследовании рассматривается вопрос диагностической и терапевтической ценности проведения гистероскопии с вакуум-аспирацией эндометрия у пациенток с повторными неудачами имплантации (англ. Recurrent Implantation Failure, RIF) в программах экстракорпорального оплодотворения (ЭКО).

Цель работы — определение особенностей структуры маточной патологии у женщин с RIF, по данным гистероскопии с аспирационной биопсией эндометрия, и изучение влияния гистероскопического вмешательства с последующей вакуум-аспирацией эндометрия упациенток с повторными неудачами имплантации в анамнезе на частоту клинических беременностей.

Материалы и методы

Материалы и методы. Исследование проводилось в Клиническом институте репродуктивной медицины (Екатеринбург). В этом ретроспективном когортном исследовании принимало участие 143 пациентки, которыми пройдена процедура ЭКО. Исследовалась частота выявления патологии матки с применением гистероскопии и вакуум-аспирацией эндометрия у пациенток с RIF (n = 36) и контрольной группы без RIF (n = 89). Анализировались различия в вероятности клинической беременности после переноса эмбриона (-ов) в программе ЭКО упациенток с RIF после проведения гистероскопии с вакуум-аспирацией эндометрия (n = 30) и группы контроля (n = 18).

Результаты

Результаты. Структура внутриматочной патологии статистически не различалась у пациенток с RIF и без этого состояния (p > 0,05 для всех нозологий). Проведение гистероскопии с вакуум-аспирацией эндометрия статистически значимо повышало частоту клинических беременностей у пациенток с RIF в сравнении с группой контроля (23/30 (77,0 %) и8/18 (44,0 %), p = 0,032).

Обсуждение

Обсуждение. Полученные данные о структуре патологии матки соотносятся с результатами аналогичных исследований. Лечебный эффект гистероскопии при бесплодии остается предметом споров.

Заключение

Заключение. Гистероскопия с последующим патоморфологическим исследованием аспирируемого эндометрия является одинаковым по диагностической эффективности вмешательством для пациенток без выявленной на ультразвуковом исследовании патологии матки вне зависимости от статуса RIF. Гистероскопическое исследование с лечебным повреждением эндометрия может увеличить частоту успешных имплантаций при переносе эмбрионов у пациенток с RIF.

Introduction

Introduction. This study raises the issue of diagnostic and therapeutic value of hysteroscopy with endometrial vacuum aspiration in patients with recurrent implantation failure (RIF) in IVF programs.

The purpose of the study is to determine the structure of uterine pathology in women with RIF according to hysteroscopy with endometrial aspiration biopsy and to study the effect of hysteroscopy with subsequent endometrial vacuum aspiration in patients with a history of repeated implantation failures on clinical pregnancy rate.

Materials and methods

Materials and methods. In this retrospective cohort study we investigated a sample of 143 patients who passed the program of IVF at the Clinical Institute of Reproductive Medicine (Ekaterinburg, Russia). We studied the frequency of detection of uterine pathology using hysteroscopy and endometrial vacuum aspiration in patients with RIF (n = 36) and in the control group without RIF (n = 89). We analyzed the differences in the chance of clinical pregnancy aſter embryo transfer (s) in the IVF program in patients with RIF aſter hysteroscopy with endometrial vacuum aspiration (n = 30) and in the control group (n = 18).

Results

Results. The structure of intrauterine pathology was not statistically different in patients with RIF and without this condition (p > 0.05 for all pathologies). Hysteroscopy with endometrial vacuum aspiration significantly increased the incidence of clinical pregnancies in patients with RIF compared with the control group (23/30 (77.0 %) and 8/18 (44.0 %), p = 0.032).

Discussion

Discussion. The obtained data on the structure of the pathology of the uterus correlate with the results of similar studies. The therapeutic effect of hysteroscopy in infertility remains a matter of controversy.

Conclusion

Conclusion. Hysteroscopy with pathomorphological examination of the aspirated endometrium is the same intervention in terms of diagnostic efficiency for patients without identified uterine pathology on ultrasound, regardless of RIF status. Hysteroscopic examination with curative endometrial injury may increase the success rate of embryo transfer implants in patients with RIF.

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The authors declare that there are no conflicts of interest present.