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1 . 2021

Patients with previous failures of IVF against the background of chronic inflammation of the uterine cavity: a rational management algorithm

Abstract

The aim of this work was to develop an algorithm for preparing patients with a history of recurrent implantation failures against the background of chronic endometritis for in vitro fertilization (IVF) protocols, as well as to assess its effectiveness. Main pathogenetic features of chronic endometritis, leading to IVF failures, have been determined. The authors identified main criteria for morphological diagnosis of chronic endometritis, significance of immunohistochemical diagnostics, practicability of assessing receptor expression and intensity of local immunity of the inner lining of uterus for successful implantation. In the article clinically significant markers of chronic inflammation of endometrial mucosa (sclerosis of spiral arteries, fibrosis of glands and stroma), which play an important role in embryo invasion failures, as well as role of opportunistic viruses were underlined. The results obtained by the authors made it possible to improve traditional therapy of chronic endometritis due to: its inclusion in complex therapy of endometrial aspiration on 24-25th day of menstrual cycle; administration of highly purified hyaluronic acid sodium salt with carboxymethylcellulose gel (Antiadhesin®) after aspiration to prevent fibrosis formation; systemic administration of human placenta hydrolysate (Laennec®) to stimulate angiogenesis. In the article role of hormonal endometrial stimulation in preparation of patients for embryo transfer in IVF programs is underlined.

Keywords:chronic endometritis, in vitro fertilization, endometrial receptivity, fibrosis, "regenerationwithout inflammation"

Funding. The authors declare no sponsorship.

Conflict of interests. The authors declare no conflict of interests.

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CHIEF EDITORS
CHIEF EDITOR
Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
CHIEF EDITOR
Kurtser Mark Arkadievich
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Obstetrics and Gynecology Subdepartment of the Pediatric Department, N.I. Pirogov Russian National Scientific Research Medical University, Ministry of Health of the Russian Federation
CHIEF EDITOR
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Department in the Russian People?s Friendship University

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