Recurrent implantation failure and chronic endometritis: possibilities of local cytokine therapy
DOI:
https://doi.org/10.37800/RM.3.2022.41-49Keywords:
infertility, recurrent implantation failure, chronic endometritis, in vitro fertilization, preimplantation preparation, recombinant interleukin-2, intrauterine cavitationAbstract
Relevance: The article discusses the experience of preimplantation preparation of patients with recurrent implantation failure (RIF) against the background of chronic endometritis (CE). The authors describe a variant of preparation for in vitro fertilization with a thawed embryo (IVF-TE) using a cavitated solution of recombinant interleukin-2 (rIL-2), injected into the uterine cavity against the background of decontamination and contamination therapy, and assess the clinical, sonographic, and
immunohistochemical efficacy.
The study aimed to assess the effectiveness of using a cavitated solution of recombinant interleukin-2 for preimplantation preparation in patients with repeated implantation failures against the background of chronic endometritis.
Methods: The study compared the results of preparation for IVF-TE of 52 women with repeated implantation failures against the background of chronic endometritis. During preparation for IVF-TE, the women in Group I (n=28) received classical decontamination and contamination therapy –doxycycline, metronidazole, and miconazole orally; as a contamination therapy – a probiotic with a culture of L. casei rhamnosus Doderleini. Group II (n=24) received decontamination and contamination therapy similar to Group I, with intrauterine ultrasound cavitation of the rIL-2 solution. The onset of biochemical and clinical
pregnancy was the main criterion for effectiveness.
Results: The integrated approach to RIF and CE therapy used in the present study has contributed to the normalization of the endometrial microbiome in our patients, changed the reactions of immunocompetent cells with the leveling of the autoimmune inflammatory response, and prepared the endometrium for the in vitro fertilization protocol in a more efficient way than in the comparison group.
Conclusion: The proposed method of adding the intrauterine irrigation with the cavitated rIL-2 solution into the preparation of patients with repeated implantation failures and chronic endometritis resulted in higher IVF-TE efficiency: 1.8 times (preimplantation growth of the endometrium), 3.1 times (onset of clinical pregnancy), and 3.5 times (live birth).
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