RELEVANCE
Infertility is one of the most pressing, socially significant problems today. Despite the introduction and improvement of methods of assisted reproductive technologies, it is difficult to achieve pregnancy in patients with a reduced ovarian reserve using their own oocytes. The method of activating of follicular growth, first described by K. Kawamura, A. Hsueh and co-authors, the effectiveness of which has been confirmed clinically, as well as by the data of molecular and genetic studies, has now found application in various modifications in more than 6 countries of the world. In Russia, the first operation based on the surgical activation of ovarian function was performed by Academician L.V. Adamyan 03/06/2019.
OBJECTIVE OF THE STUDY
Optimization of infertility treatment methods in patients with diminished ovarian reserve using a one-stage surgical procedure for activation of ovarian function.
MATERIAL AND METHODS
A prospective clinical and laboratory study of 50 patients in reproductive age with POI (group 1 — n=22) and «poor» response to stimulation of ovarian function (group 2 — n=28) was carried out. After receiving informed voluntary consent to participate in the study, all patients underwent surgical intervention: laparoscopy, revision of the abdominal and pelvic cavity, biopsy of the cortical layer of both ovaries, followed by its fragmentation and one-stage reimplantation into the ovary, hysteroscopy, endometrial biopsy, chromohydrotubation. In the postoperative period, to date, stimulation of ovarian function after surgery has been performed in 28 patients (13 patients with POI and 15 patients with a «poor» response).
RESULTS
As a result of the management tactics developed by us, including clinical, laboratory and instrumental examination, hormonal administration, as well as the surgical stage — a one-stage surgical procedure for activation of ovarian function, an improvement in general well-being, psychoemotional background in a number of patients, changes in ovarian reserve parameters, namely positive dynamics of the hormonal status, associated with the activation of follicular growth according to ultrasound data, the response to the stimulation of ovarian function in IVF cycles with obtaining their own gametes and embryos and achieving pregnancy in a number of patients (the study is ongoing). The study allows us to consider this operation as expedient to perform in patients with a pronounced decrease in ovarian reserve, as an alternative to oocyte donation.
