Characteristics of parameters of folliculogenesis in women with infertility on the background of uterine leiomyoma in programs of assistant reproductive technologists

S.V. Khmil; Yu.B. Drozdovska

Resume. There is much discussion about the effect of uterine leiomyoma on the results of assisted reproductive technologies (ART). Myomas reduce the frequency of positive results of in vitro fertilization (IVF) and increase the frequency of miscarriages. The aim of the study – to study the effectiveness of the proposed treatment regimen, which includes the introduction of hormone releasing agonist, hysteroresectoscopy, conservative myomectomy in women with infertility on the background of uterine leiomyoma (UL) and pregravide training in assisted reproductive technologies for folliculogenesis. Materials and methods. The clinical study was performed during 2014–2020 on the basis of the medical center "Clinic of Professor Stefan Khmil". There were 175 women of reproductive age diagnosed with UL, who were divided into the following groups: main group A - 137 women with UL, which was further divided into subgroups A1 - 55 women with UL after conservative myomectomy with the proposed medical complex (MC), A2 - 45 women with UL after hysteroscopy and MC, A3 - 37 with UL and the proposed drug treatment without surgical removal of MC; comparison (PG B) group - 38 women with UL and conservative myomectomy. All patients with subcomous-intramural and subserous arrangement of myomatous nodes underwent hormonal training with gonadotropin-releasing hormone agonists before myomectomy. Surgical interventions were performed by different methods, depending on the location of fibroids (hysteroresectoscopy, laparotomy and laparoscopic methods). After the operation, the patients were prescribed pre-pregnancy preparation 3 months before and in the controlled ovarial stimulation (COS) protocol before the follicle puncture. Results. In women with infertility on the background of UL analysis of the parameters of the effectiveness of COS showed that women with UL after hysteroscopy and the proposed treatment complex were probably higher average number of follicles with a diameter of more than 18 mm (16.00%), the average number of mature oocytes (30.91 %), the average number of fertilized oocytes (by 36.00 %) and the average number of transferred embryos (by 45.16 %), relative to the comparison group. Conclusions. The use of the proposed treatment regimen, which includes the introduction of hormone releasing agonist, hysteroresectoscopy in women with infertility on the background of uterine leiomyoma and pregravide training in assisted reproductive technology programs, which includes vitamin complex with inositol, vitamin D3 and alpha-lipoic acid with magnesium, reduces the dose of gonadotropins, the duration of controlled ovulatory stimulation, and improves the parameters of oocyte induction, vs patients with uterine leiomyoma after conservative myomectomy

uterine leiomyoma, hysteroresectoscopy, laparoscopy, in vitro fertilization, pragravide training, effectiveness

[1] Tikhomirov A.L., Ledenkova A.A., Batayeva A.E. & Abishova V.G. Antagonisty retseptorov progesterona v strukture kompleksnogo organosokhranyayushchego lecheniya miomy matki [Progesterone receptor antagonists in the structure of complex organ-preserving treatment of uterine myoma]. Akusherstvo i ginekologiya – Obstetrics and Gynecology. 2012; 5: 115-119. [in Russian].

[2] Boyko V.I. & Terekhov V.A. Dyferentsiiovanyi pidkhid do khirurhichnoho likuvannia miomy matky velykykh rozmiriv [Differentiated approach to surgical treatment of large uterine fibroids] Zdorovie zhenshchiny – Health of Women. 2016; 7 (113): 57-61. [in Ukrainian].

[3] Zhylka N.Ya. Innovatsiini pidkhody do likuvannia leiomiomy matky [Innovative approaches to treatment of uterine leiomyomas]. Zdorovye zhenshchiny – Health of Women. 2016; 7 (113): 104-106. [in Ukrainian].

[4] Storozhuk M.S., Protsenko O.O. & Martynyshyn O.B. Klinichna kharakterystyka zhinok reproduktyvnoho viku, khvorykh na miomu matky [Clinical characteristics of women of reproductive age, patients with myoma of the uterus]. Zdorovye zhenshchiny – Health of Women. 2012; 7 (73): 16-157. [in Ukrainian].

[5] Kornatska A.H., Raksha I.I., Kolesnychenko I.S. & Chubei H.V. Suchasni pohliady na etiolohiiu, patohenez ta likuvannia leiomiomy matky u zhinok reproduktyvnoho viku (ohliad literatury) [Modern views on the etiology, pathogenesis and treatment of uterine leiomyomas in women of reproductive age (review of literature).]. Zdorovye zhenshchiny – Health of Women. 2015; 1 (97): 10-13. [in Ukrainian].

[6] Vdovychenko Yu.P., Holyanovskyy O.V. & Lepushyn V.I. Leiomioma matky: etiopatohenez, profilaktyka, diahnostyka ta likuvannia [Leiomyoma of the uterus: etiopathogenesis, prophylaxis, diagnosis and treatment]. Zdorovye zhenshchiny – Health of Women. 2012; 3 (69): 52-61. [in Ukrainian].

[7] Yoshida S., Ohara N., Xu Q., Chen W., Wang J. & Nakabayashi K. Cell-type specific actions of progesterone receptor modulators in the regulation of uterine leiomyoma growth. Semin. Reprod. Med. 2010; 28: 260-273.

[8] Avramenko N.V., Barkovskyi D.Ye., Kabachenko O.V. & Letsyn D.V. Suchasni pohliady reproduktoloha na etiopatohenez i likuvannia leiomiomy matky [Modern views of the reproductionist on etiopathogenesis and treatment of uterine leiomyomas]. Zaporizkyi medychnyi zhurnal – Zaporizhzhia Medical Journal. 2017; 3 (102): 381-386. [in Ukrainian].

[9] Jei-Won Moon, Chung-Hoon Kim, Jun-Bum Kim, Sung-Hoon Kim, Hee-Dong Chae, & Byung-Moon Kang. Alterations in uterine hemodynamics caused by uterine fibroids and their impact on in vitro fertilization outcomes. Clin. Exp. Reprod. Med. 2015; 42 (4): 163-168.

[10] Shchukina N.A., Sheina E.N. & Barinova I.V. The clinical and morphological features of uterine myoma in young women. Rossiyskiy vestnik akushera ginekologa. 2014; 5: 28-31.

[11] Guven S., Kart C., Unsal V.A. & Odaci E. Intramural leoimyoma without endometrial cavity distortion may negatively affect the ICSI - ET outcome. Reprod. Biol. Endocrinol. 2013; 11: 102. doi: 10.1186/1477-7827-11-102

[12] Sunkara S.K., Khairy M., El-Toukhy T., Khalaf Y., & Coomarasamy A. The effects of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum. Reprod. 2010; 25 (2): 418-429.

[13] Clark N.A., Mumford S.L. & Segars J.H. Reproductive impact of MRI-guided focused ultrasound surgery for fibroids: a systematic review of the evidence. Curr. Opin. Obstet. Gynecol. 2014; 26 (3): 151-161.

[14] Jayagopal V., Kilpatrick E.S., Jennings P.E., et al. The Biological Variation of Testosterone and Sex Hormone-Binding Globulin (SHBG) in Polycystic Ovarian Syndrome: Implications for SHBG as a Surrogate Marker of Insulin Resistance. JCEM. 2003; 88(4):1528–1533.

[15] Diamanti-Kandarakis E., Dunaif A. Insulin Resis-tance and the Polycystic Ovary Syndrome Revisited: An Up-date on Mechanisms and Implications. Endocr. Rev. 2012; 33(6): 981–1030.

[16] Unfer V., Facchinetti F., Orrù B. Myo-inositol effects in women with PCOS: a meta-analysis of randomized con-trolled trials. Endocrine Connections. 2017; 6(8): 647–658.

[17] Zhao J., Liu S. , Wang Y. et al. Vitamin D improves the outcome of in vitro fertilization (IVF) in infertile women with polycystic ovary syndrome and insulin resistance. Minerva med. 2019; 110(3): 199–208.