Endometriosis occurs in 50 % of women with infertility. Ovarian endometriosis affects 55 % of women with this disease. Surgical treatment of endometrium is indicated if its size is over 3 cm. After removal of the endometriomas there are used diathermic, bipolar energy, radio wave energy, argon plasma coagulation for hemostasis of ovarian tissue. The use of argon plasma coagulation in ovarian hemostasis causes not only hemostatic but also protective effect, which is mediated by the induction of HSP27, SOD2, VEGF and iNOS, which renders an organ−preserving effect when applied to ovarian tissues. Repeated surgery for ovarian endometrium should be performed taking into account the risk of reduced levels of antimullerian hormone, which may adversely affect the further implementation of reproductive function, including the use of assisted reproductive technologies. The authors comparatively have evaluated the treatment of 900 patients of reproductive age with endometrioid cysts of the ovaries and other concomitant gynecological pathology, which were three clinical groups. The patients received radiowave energy, argonoplasmic coagulation, intraoperative use of various anti−adhesive drugs and combinations of drugs in the postoperative period. It was found that the use of argon plasma coagulation for hemostasis of ovarian tissues after removal of endometrioid cysts, polyethylene oxide gel with carboxymethylcellulose intraoperatively and gonadotropin−releasing hormone agonists, dienogest 2 mg per day for three months contributed to the pregnancy onset in post−srugery period in 56.7 % of patients. It has been noted that in women the presence of adhesions in combination with corpus luteum cysts, endometrial polyps, uterine leiomyoma reduces the onset of pregnancy by 8.0, 12, and 24 times, respectively. Key words: endometrial ovarian cysts, diagnosis, treatment, rehabilitation in the post−surgery period.
The main goal of Asherman’s syndrome treatment is to restore the volume and shape of the uterine cavity, regenerate the endometrium and reproductive function. Recently, in addition to ultrasound diagnostics of intrauterine synechiae, office hysteroscopy is widely used. The most standardized stages of Asherman’s syndrome treatment are hysteroscopic dissection of the uterine cavity synechiae and endometrium re-adhesion prevention in the postoperative period, which is achieved by the introduction of the intrauterine device, anti-adhesive drugs or balloon catheters inserted intrauterinely. The main difficulties are to find effective ways to prevent adhesion that occurs after removal of mechanical means from the uterine cavity and ways to restore the endometrium morphology in patients wishing to achieve pregnancy. The most promising technique in this area is the use of autologous endometrial stem cells. Here is a case of treatment of a reproductive age patient with infertility and Asherman’s syndrome. The clinical case was a part of a clinical trial Clinical Trials.gov Identifier: NCT04675970. On the eve of the operative stage for uterine cavity synechiae separation 20.0 ml of venous blood was taken. Mesenchymal stem cells (MSCs) were isolated from the patient’s peripheral blood using the magnetic separation method of the autoMACS Pro Separator (Miltenyi Biotec). According to the international instructions, 6th passage MSCs were clinically used. Confirmation of belonging the derived cells to the MSCs group was performed using the set Bio-Techne FMC-020 (Great Britain). In addition, MSCs were differentiated to endometrial cells, which was confirmed using endometrial cell matching markers in generations P0-P3 (passage 0 – passage 3) with the MicroBead Kit (USA). The operative stage of treatment included office hysteroscopy, mechanical synechiolysis in the endocervix and endometrium and introduction of a silver-containing intrauterine device. Subendometrial injection of autologous endometrial MSCs was performed to restore the endometrium structure at the end of hysteroscopy. High dose adjuvant estrogen therapy followed for 3 weeks. Pregnancy was achieved spontaneously 2 years after the intervention. The patient gave birth to a full-term baby girl.The results of the clinical case indicate the prospects for the use of autologous blood stem cells converted into endometrial cells in the treatment of infertility in patients with CA in the absence of effect from previous attempts to restore fertility by traditional therapies.
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