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THE IMPACT OF UTERINE FIBROIDS ON THE EFFECTIVENESS OF ICSI IN WOMEN OF ADVANCED REPRODUCTIVE AGE
Maksudova Mukhayo Mansurovna, competitor of scientific degree of PhD, Republican specialized scientific-practical medical center of obstetrics and gynecology, Tashkent, Uzbekistan
E-mail: baron-codli@mail.ru
THE IMPACT OF UTERINE FIBROIDS ON THE EFFECTIVENESS OF ICSI IN WOMEN OF ADVANCED REPRODUCTIVE AGE
Abstract. This publication presents the results of a study conducted among women of older reproductive age on the impact of uterine fibroids on the effectiveness of ICSI.
Keywords: uterine fibroids, in vitro fertilization, advanced reproductive age.
Introduction. Uterine fibroids are a common gynecological problem among women of reproductive age, and there are conflicting reports of their impact on fertility and pregnancy outcome. This is a common cause of gynecological consultations in most hospitals, as well as the most common benign genital tract tumor associated with insufficient fertility and early pregnancy loss in women of reproductive age [3].
According to a 2010 world health organization report, 20-25% of women suffer from myoma, and an estimated 235 million women worldwide are affected, representing 6.6% of the world's female population [2].
The relationship between myoma and fertility is observed, but the responsibility of infertility fibroids remains unclear and controversial [3].
Myomectomy is an alternative to hysterectomy for women who want to preserve their uterus, regardless of their fertility desires. Removal of fibroids should be considered if they are thought to be associated with severe mental bleeding, pelvic pain and / or pressure symptoms, and in some cases reproductive health problems [4].
Fibriod of the uterus - heterogeneous tumor composition, size, location and quantity; Differences in any of these factors can affect woman's fertility. Recommendations as to which infertile women with uterine myoma could benefit from myomectomy are varied, given the potential risks and consequences of
surgery. A number of studies have been conducted to determine the effect of fibroids on fertility, with widely disparate data, and many of the studies suffer from methodological shortcomings. Studies are often poorly planned and often uncontrolled or historically controlled, analyses often do not correct for important mixed variables, sample sizes are usually small, and conclusions are often given that are not supported by available data [1].
The relationship between myoma and infertility has been clarified in numerous studies of patients with art, which have been summarized in several meta-analyses and systematic reviews. Although abnormal transfer of gametes and blockage of the fallopian tubes are bypassed by assisted reproductive technologies (art), fibroids can also disrupt fertility, altering the susceptibility of the endometrium, thereby adversely affecting embryo implantation and reducing the chances of pregnancy [2].
The location of the fibroid is crucial in the results HERE. In particular, submucosal fibroids significantly reduce implantation and pregnancy HERE. It was found that submucosal fibroids, which distort the uterine cavity, carry a relative risk of 0.3 for pregnancy and 0.28 for implantation after art compared with infertile women without fibroids [1].
Research result. Interesting results were obtained when calculating the data of patients with uterine myoma. According to different estimates of R are very consistent. So, the dose of gonadotropins for
Section 4. Medical science
ovarian stimulation is much higher in the presence of fibroids in patients. The number of follicles and further oocytes is higher in patients without uterine fibroids. And also, the number of correctly fertilized zygotes with two pronuclei is almost 2 times more in patients without uterine fibroids. The total number of embryos is also higher in patients without fibroids, in particular class b embryos.
Also, a significant difference was obtained in the number of oocytes obtained. From patients with uterine cancer received 22 of the o ocyte(75,86%), no uterine fibroids - 87 oocytes (92,55%).
The same relationship is observed in the group of patients with myomectomy. Puncture of patients with myomectomy resulted in 11 oocytes, without myomectomy - 98 oocytes.
Interesting results were obtained when calculating the data of patients with uterine myoma. According to different estimates of R are very consistent. So, the dose of gonadotropins for ovarian stimulation is much higher in the presence of fibroids in patients. The number of follicles and further oocytes is higher in patients without uterine fibroids. And also, the number of correctly fertilized zygotes with two pronuclei is almost 2 times more in patients without uterine fibroids. The total number of embryos is also higher in patients without fibroids, in particular class b embryos.
References:
1. Effect of salpingectomy on ovarian response to hyperstimulation during in vitro fertilization: a metaanalysis, Minghui Fan M. D.LinMa, Fertil Steril 2016. Aug, 22; 106(2): 322-329. e9. Epub 2016. Apr 22., Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
2. Effect of Laparoscopic Tubectomy on Ovarian Response to Controlled Ovarian Stimulation For Ivf-Et R. Almog, I. Wagman, I. Eldar, Y. Raz, G. Barkan, J. Lessing, A. Amit, T. Swartz, N. Mey Raz, I. Levin, B. Almog, IVF Unit, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, - Tel-Aviv, Israel, - 32 p.
3. Human Ovarian Reserve from Conception to the Menopause W. Hamish B. Wallace, Thomas W. Kelsey Published: January 27, 2010. URL: https://doi.org/10.1371/journal.pone.0008772
4. Lobo R. A (September 2003). "Early ovarian ageing: a hypothesis. What is early ovarian ageing?". Hum. Reprod. 18(9): 1762- Doi:10.1093/humrep/deg377. PMID12923124.
We studied a significant difference in the higher dose of gonadotropins consumed in myomectomy, as opposed to non-operated patients. So when myomectomy takes on average 2437.67 ± 241.15 IU of gonadotropins during stimulation. And with the stimulation of patients not operated for fibroids 1953.57 ± 80.35 IU.
Also, a significant difference was obtained in the number of oocytes obtained. From patients with uterine cancer received 22 of the oocyte(75.86%), no uterine fibroids - 87 oocytes (92.55%).
The same relationship is observed in the group of patients with myomectomy. Puncture of patients with myomectomy resulted in 11 oocytes, without myomectomy - 98 oocytes.
Summary. The presence of myomectomy in the history of patients can lead to an increase in the dose of gonadotropins for stimulation, which increases the financial cost of the stimulation Protocol. However, fibroids are mainly present in women of reproductive age, and there is a higher prevalence of fibroids in women aged 30-40 years. Thus, age is a critical factor determining the reproductive outcome in women with myoma. In the absence of uterine fibroids, patients received significantly more oocytes. The presence of myomectomy in the history does not affect the quality of oocytes, embryos.
