Female infertility is one of the most significant problems in the modern medicine. The ovarian reserve is the most important factor in the effectiveness of infertility treatment, including methods of assisted reproductive technologies. Despite the indisputable screening value of determining the ultrasound parameters and the level of AMH in the blood serum in assessing the state of the ovarian reserve, histological examination is more informative in this regard. A special assessment and special study of the relationship between the state of the ovarian tissue and the endometrium is required in patients with reduced ovarian reserve, who do not have the effect of previous treatment, including methods of assisted reproductive technologies, in order to optimize the treatment of infertility in this cohort of patients.
OBJECTIVE
To increase the effectiveness of infertility treatment in patients with reduced ovarian reserve by determining the morphological and immunohistochemical markers in the ovarian tissue and endometrium.
MATERIAL AND METHODS
The state of ovarian tissue and endometrium was studied in 14 patients of reproductive age suffering from infertility associated with reduced ovarian reserve, resistant to standard treatment methods, including ART. Surgical treatment — a one-stage surgical procedure for activating of ovarian function was performed in all patients as part of the complex treatment of infertility. For the first time, the degree of expression of proteins of the Hippo signaling pathway (YAP, MST-1, LATS-1) and the inhibitor of phosphoinositol-3 — kinase signaling pathway — PTEN in the stroma, glandular component of the endometrium and in the ovarian tissue was established with the definition of correlations in terms of the degree of expression of the above markers in ovarian biopsies and in endometrial tissue.
RESULTS
As a result of complex treatment of infertility using a one-stage surgical method for activating of ovarian function, 10 pregnancies have occurred so far out of 70 patients included in the study, the period of postoperative follow-up of which ranges from 14 days to 1.5 years. (the research is ongoing). A comparative analysis of indicators of the endometrial state with a pathomorphological assessment of the ovarian biopsies structure revealed significant parallels, which indicates a functional relationship between the ovarian tissue and the endometrium in patients with infertility associated with reduced ovarian reserve. However, there is no statistically significant correlation between the expression of tissue markers determined by immunohistochemistry in ovarian and endometrial tissues, which may be related to the volume of the sample of patients included in this study.
