ksmaКубанский научный медицинский вестникKuban Scientific Medical Bulletin1608-62282541-9544Kuban State Medical University10.25207/1608-6228-2023-30-5-15-40ksma-3197Research ArticleОБЗОРЫREVIEWХронический эндометрит и инфертильность — исходы экстракорпорального оплодотворения (систематический обзор и метаанализ)Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysishttps://orcid.org/0000-0002-4792-5380ЛокшинВ. Н.LokshinV. N.

Локшин Вячеслав Натанович — доктор медицинских наук, профессор, академик Национальной академии наук Республики Казахстан, генеральный директор товарищества с ограниченной ответственностью «Международный клинический центр репродуктологии “Persona”»

ул. Утепова, д. 32а, г. Алматы, 050000

Vyacheslav N. Lokshin — Dr. Sci. (Med.), Prof., academician, National Academy of Sciences, Republic of Kazakhstan; Director General, “Persona” International Clinical Center for Reproductive Medicine

Utepova str., 32a Almaty, 050000

https://orcid.org/0000-0003-0938-8286КуценкоИ. И.KutsenkoI. I.

Куценко Ирина Игоревна — доктор медицинских наук, профессор, заведующая кафедрой акушерства, гинекологии и перинатологии

ул. им. Митрофана Седина, д. 4, г. Краснодар, 350063

Irina I. Kutsenko — Dr. Sci. (Med.), Prof., Head of the Obstetrics, Gynecology and Perinatology Department

Mitrofana Sedina str., 4, Krasnodar, 350063

https://orcid.org/0000-0001-8576-1359БоровиковИ. О.BorovikovI. O.

Боровиков Игорь Олегович — доктор медицинских наук, доцент, доцент кафедры акушерства, гинекологии и перинатологии

ул. им. Митрофана Седина, д. 4, г. Краснодар, 350063

Igor O. Borovikov — Dr. Sci. (Med.), Assoc. Prof., Obstetrics, Gynecology and Perinatology Department

Mitrofana Sedina str., 4, Krasnodar, 350063

bio2302@mail.ruhttps://orcid.org/0000-0002-8388-8644БулгаковаВ. П.BulgakovaV. P.

Булгакова Вера Павловна — аспирант кафедры акушерства, гинекологии и перинатологии

ул. им. Митрофана Седина, д. 4, г. Краснодар, 350063

Vera P. Bulgakova — postgraduate student, Obstetrics, Gynecology and Perinatology Department

Mitrofana Sedina str., 4, Krasnodar, 350063

https://orcid.org/0000-0001-8987-7375КравцоваЕ. И.KravtsovaE. I.

Кравцова Елена Иосифовна — кандидат медицинских наук, доцент кафедры акушерства, гинекологии и перинатологии

ул. им. Митрофана Седина, д. 4, г. Краснодар, 350063

Elena I. Kravtsova — Cand. Sci. (Med.), Assoc. Prof., Obstetrics, Gynecology and Perinatology Department

Mitrofana Sedina str., 4, Krasnodar, 350063

https://orcid.org/0000-0003-1941-0571БирюковаМ. И.BiryukovaM. I.

Бирюкова Мария Игоревна — аспирант кафедры акушерства, гинекологии и перинатологии

ул. им. Митрофана Седина, д. 4, г. Краснодар, 350063

Maria I. Biryukova — postgraduate student, Obstetrics, Gynecology and Perinatology Department

Mitrofana Sedina str., 4, Krasnodar, 350063

https://orcid.org/0000-0002-7275-9388БоровиковаО. И.BorovikovaO. I.

Боровикова Ольга Игоревна — аспирант кафедры акушерства, гинекологии и перинатологии

ул. им. Митрофана Седина, д. 4, г. Краснодар, 350063

Olga I. Borovikova — postgraduate student, Obstetrics, Gynecology and Perinatology Department

Mitrofana Sedina str., 4, Krasnodar, 350063

https://orcid.org/0000-0003-0068-3385НикогдаЮ. В.NikogdaJ. V.

Никогда Юлия Викторовна — кандидат медицинских наук, ассистент кафедры акушерства, гинекологии и перинатологии

ул. им. Митрофана Седина, д. 4, г. Краснодар, 350063

Julia V. Nikogda — Cand. Sci. (Med.), Teaching Assistant, Obstetrics, Gynecology and Perinatology Department

Mitrofana Sedina str., 4, Krasnodar, 350063

Товарищество с ограниченной ответственностью «Международный клинический центр репродуктологии “Persona”»Казахстан“Persona” International Clinical Center for Reproductive MedicineKazakhstanФедеральное государственное бюджетное образовательное учреждение высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKuban State Medical UniversityRussian Federation2023261020233051540Copyright © Локшин В.Н., Куценко И.И., Боровиков И.О., Булгакова В.П., Кравцова Е.И., Бирюкова М.И., Боровикова О.И., Никогда Ю.В., 20232023Локшин В.Н., Куценко И.И., Боровиков И.О., Булгакова В.П., Кравцова Е.И., Бирюкова М.И., Боровикова О.И., Никогда Ю.В.Lokshin V.N., Kutsenko I.I., Borovikov I.O., Bulgakova V.P., Kravtsova E.I., Biryukova M.I., Borovikova O.I., Nikogda J.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ksma.elpub.ru/jour/article/view/3197

Введение. Актуальность проблемы связана с высокой распространенностью хронического эндометрита, его ролью в женской инфертильности, неудачах имплантации при проведении процедур вспомогательных репродуктивных технологий и привычном невынашивании беременности, а также отсутствии единой стратегии в диагностике и лечении данной патологии. Этот систематический обзор с метаанализом посвящен оценке влияния хронического эндометрита и его терапии на исход экстракорпорального оплодотворения. Также был проведен анализ влияния хронического эндометрита различных степеней тяжести на исходы вспомогательных репродуктивных технологий. Цель исследования — анализ влияния хронического эндометрита различной степени тяжести и его лечения на исходы экстракорпорального оплодотворения. Методы. С помощью поисковых систем PubMed, Medline, Scopus, Embase, ELibrary, Cochrane Central Register of Controlled Trials (CENTRAL), Международного реестра клинических испытаний Всемирной организации здравоохранения, национальной библиографической базы данных научного цитирования был проведен систематический литературный поиск за последние 12 лет статей, отвечающих следующим критериям: рандомизированное контролируемое исследование влияния хронического эндометрита различной степени тяжести на фертильность и способы его лечения. Рассчитаны показатели: частота продолжающейся беременности/рождаемости, частота клинической беременности и частота выкидышей. Включено в общей сложности 4145 пациентов (из десяти исследований). Метаанализ выполнялся с помощью прикладных программ Stata 11.0 (The Cochrane Collaboration, Оксфорд, Великобритания). Оценка степени неоднородности: считалась низкой при I2 < 30 %, умеренной — 30–50 %, высокой — >50 %. Результаты. Женщины с хроническим эндометритом имели более низкую частоту продолжающейся беременности/рождаемости (OR 1,97; p = 0,02) и частоту клинической беременности (OR 2,28; p = 0,002) по сравнению с женщинами без него. Излечение хронического эндометрита увеличило частоту продолжающейся беременности/рождаемости (OR 5,33; p < 0,0001) и частоту клинической беременности (OR 3,64; p = 0,0001). Результаты экстракорпорального оплодотворения были сопоставимы между женщинами после терапии хронического эндометрита и женщинами без него (частота продолжающейся беременности/рождаемости, частота клинической беременности и частота выкидышей: p = ns). Женщины с тяжелой степенью хронического эндометрита имели более низкую частоту продолжающейся беременности/рождаемости (OR 0,43; p = 0,003) и частоту клинической беременности (OR 0,40; p = 0,0007). Легкая степень хронического эндометрита не демонстрировала существенного влияния на исходы экстракорпорального оплодотворения (частота продолжающейся беременности/рождаемости, частота клинической беременности и частота выкидышей: p = ns). Заключение. Проведенный метаанализ показал, что хронический эндометрит значительно снижает частоту продолжающейся беременности/рождаемости и частоту клинической беременности у инфертильных женщин, проходящих процедуру экстракорпорального оплодотворения. Важно отметить, что антибактериальная терапия таких пациенток способствует улучшению результатов вспомогательных репродуктивных технологий, сопоставимых с результатами пациенток без хронического эндометрита. Негативное влияние этой патологии на имплантационные свойства эндометрия наиболее часто проявляется при ее тяжелом течении, тогда как легкая форма практически не влияет на успех экстракорпорального оплодотворения.

Background. The relevance of the problem is related to the high prevalence of chronic endometritis (CE); its role in female infertility, implantation failures during assisted reproductive technology procedures, and recurrent miscarriage; as well as the lack of a unified strategy in the diagnosis and treatment of this pathology. The present systematic review with a meta-analysis focuses on evaluating the impact of CE and its therapy on the outcome of in vitro fertilization. In addition, the effect of CE of various severity on the outcomes of assisted reproductive technologies is analyzed. Objective. To analyze the effect of CE of varying severity and its treatment on the outcomes of in vitro fertilization. Methods. Using PubMed, Medline, Scopus, Embase, ELibrary, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry, and Russian Science Citation Index, a systematic search was conducted for articles published over the past 12 years that met the following criteria: randomized controlled trial examining the effect of CE of varying severity on fertility and ways to treat it. The following indicators were calculated: ongoing pregnancy/live birth, clinical pregnancy, and miscarriage rates. A total of 4145 patients (from ten studies) were included. A meta-analysis was performed using Stata 11.0 software (The Cochrane Collaboration, Oxford, UK). The heterogeneity was considered low at I2 <30%, moderate at 30–50%, and high at >50%. Results. Women with CE exhibited lower ongoing pregnancy/live birth (OR 1.97; p = 0.02) and clinical pregnancy rates (OR 2.28; p = 0.002) as compared to women without it. CE treatment increased the ongoing pregnancy/live birth (OR 5.33; p < 0.0001) and clinical pregnancy rates (OR 3.64; p = 0.0001). In vitro fertilization outcomes were comparable in women treated for CE and women without CE (ongoing pregnancy/live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Women with severe CE exhibited lower ongoing pregnancy/live birth (OR 0.43; p = 0.003) and clinical pregnancy rates (OR 0.40; p = 0.0007). Mild CE showed no significant effect on in vitro fertilization outcomes (ongoing pregnancy/ live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Conclusion. The conducted meta-analysis showed that CE significantly reduces the ongoing pregnancy/live birth and clinical pregnancy rates in infertile women undergoing in vitro fertilization. Noteworthy is that antimicrobial therapy in such patients improves the results of assisted reproductive technologies, which are comparable to those of patients without CE. The negative impact of this pathology on the implantation capacity of the endometrium is most often observed in the severe form, while its mild form has virtually no effect on the in vitro fertilization outcome.

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