Guschina M Yu, Zhumanova E N, Korchazhkina N B, Kolgaeva D I, Koneva E S
Center of gynecology, oncology, reproductive and aesthetic medicine, Clinical Hospital «MEDSI» in Otradnoe, Krasnogorsk, Russia.
FSBSI «Petrovsky National Research Centre of Surgery», Moscow, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2023;100(6):92-98. doi: 10.17116/kurort202310006192.
Globally, 13% of the population has difficulty conceiving. In Russia, the proportion of infertile marriages ranges from 8 to 17.5%, with half of all forms of female infertility being the uterine form. The main etiological factors for impaired endometrial receptivity are infectious diseases leading to the development of chronic endometritis (most often found in tuboperitoneal infertility), dishormonal background associated with the development of hyperplastic processes in endocrine infertility, uterine fibroids, chronic endometritis and endometriosis. The frequency of detection of uterine cavity diseases in patients with repeated unsuccessful IVF programs ranges from 18 to 50%. The review examines the etiological factors and other causes of endometrial pathology leading to the development of chronic endometritis, possible mechanisms for the development of impaired growth and receptivity of the endometrium, and, as a consequence, the impossibility of pregnancy. Therapeutic strategies for restoring endometrial thickness and receptivity using pharmacological and non-pharmacological methods are described. Based on the analysis of literature data, it is shown that the use of physiotherapeutic factors in treatment programs that have pronounced anti-inflammatory, immuno- and hormone-modulating, reparative-regenerative, metabolic, vasocorrective and defibrosing effects allows for a relatively short period of time to improve endometrial receptivity, normalize hormonal levels and restore fertility in women of reproductive age, which ensures the possibility of successful embryo implantation, fetal development and childbirth.
全球范围内,13%的人口存在受孕困难。在俄罗斯,不孕婚姻的比例在8%至17.5%之间,所有女性不孕形式中,有一半是子宫性不孕。导致子宫内膜容受性受损的主要病因包括传染病引发慢性子宫内膜炎(多见于输卵管-腹膜性不孕)、与内分泌性不孕增生性病变相关的激素失衡背景、子宫肌瘤、慢性子宫内膜炎和子宫内膜异位症。在多次体外受精(IVF)程序失败的患者中,子宫腔疾病的检出率在18%至50%之间。本综述探讨了导致慢性子宫内膜炎的子宫内膜病理的病因及其他原因、子宫内膜生长和容受性受损的可能机制,以及由此导致的妊娠不可能发生的情况。描述了使用药物和非药物方法恢复子宫内膜厚度和容受性的治疗策略。基于文献数据分析表明,在具有显著抗炎、免疫和激素调节、修复再生、代谢、血管矫正和抗纤维化作用的治疗方案中使用物理治疗因素,能够在相对较短的时间内提高子宫内膜容受性、使激素水平正常化并恢复育龄女性的生育能力,从而确保胚胎成功着床、胎儿发育和分娩的可能性。