When using assisted reproductive technologies (ART), recurrent implantation failures in patients with chronic endometritis (CE) are observed in 7.7—67.5% of patients. You can avoid high time costs for diagnosis and treatment, the impact on the emotional state of the couple and financial losses by having information about the expected success of IVF before it is performed.
OBJECTIVE
To determine predictors of success in achieving pregnancy and live birth in women with uterine infertility caused by cholecystectomy after complex treatment in the pregravid period at the stage of selection into IVF programs with cryotransfer using laser conversion testing technology.
MATERIAL AND METHODS
Design — secondary analysis of the results of the randomized controlled trial TULPAN 2. A database containing information about patients (n=600) who underwent IVF was used for the analysis. The results of a comprehensive examination of patients were used, including laser conversion testing (FOTON-BIO device, Russia). In group I (n=300) treatment included antibacterial (AB) and local immunomodulatory therapy, in group II (n=300) — only AB therapy (1 course), in both groups with the use of gestagen in phase 2 of the cycle.
RESULTS
The pregnancy rate as a result of IVF was 57.0% (171/300) versus 38.7% (116/300) in groups I and II, respectively, p<0.001, the live birth rate was 45.3% (135/300) and 20.7% (62/300), respectively, p<0.0001. The likelihood of pregnancy and live birth in IVF cycles was higher in patients with a duration of infertility of less than 5 years and resolution of cholecystectomy as a result of treatment. For the prediction of pregnancy and live birth, three indicators turned out to be informative: indices of oxygenation, proliferative activity and, to a lesser extent, the structure index, obtained by LCT using the FOTON-BIO apparatus, which was confirmed by graphs of ROC curves with AUC from 0.665 to 0.748 with a sensitivity 80% and forecast accuracy of 75%.
CONCLUSION
The positive outcome of cryotransfer in patients with uterine infertility depends on the duration of infertility and the resolution of cholecystectomy, while it differs significantly for the better in those who received complex treatment at the preconceptional stage, which included the immunomodulatory drug Superlymph. A personalized forecast based on several predictors obtained by LCT using a FOTON-BIO spectrometer allows one to determine the readiness of the endometrium for egg implantation and the probability of pregnancy and live birth in IVF programs with cryotransfer with high accuracy (75%).
