АКТУАЛЬНЫЕ ВОПРОСЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ БЕСПЛОДИЯ У ЖЕНЩИН С ВНУТРЕННИМ ГЕНИТАЛЬНЫМ ЭНДОМЕТРИОЗОМ

Abstract

The problem of infertility in women with internal genital endometriosis is one of the main reasons among the reasons for this infertility problem. The review presents modern literature data of recent years, in which endometriosis is considered as one of the main causes of infertility. Despite the existing methods of diagnosis and treatment of infertility associated with endometriosis, today there is no single algorithm for conducting such a category of patients. The need to define survey tactics is an important component in the effectiveness of treatment. When developing a plan for managing patients with infertility associated with endometriosis, the age of the woman, duration of infertility, the presence of pain and the stage of the disease should be taken into account. Treatment of infertility associated with endometriosis includes surgical methods, hormone treatment and the use of ART. According to some authors, the development of adenomyosis occurs during menstruation against the backdrop of regeneration, healing and re-epithelialization of the uterine mucosa. At this point, the introduction of endometrial cells into the “weakened” transition zone, which has structural and functional differences compared to the rest of the myometrium, can occur. The JZ “transition zone” is the region in the inner layer of the myometrium, which has received many definitions: an intermediate zone, an archiometry, an internal myometrium, a subendometric myometrium. This zone is a basal layer of myometrium and consists of longitudinally placed smooth muscle fibers, usually its thickness in women of reproductive age does not exceed 2–8 mm. Many researchers consider mechanical damage to the transition zone as the key pathogenetic link in adenomyosis. The main method of screening and the “gold standard” of primary instrumental diagnostics in gynecology remains transvaginal ultrasound examination of pelvic organs. Magnetic resonance imaging can also be used, the advantage of which in comparison with ultrasound is the possibility of obtaining an image in any plane and the absence of “invisible” zones, has a high resolution. A systematic review and meta-analysis of data obtained with transvaginal ultrasound and MRI in women with histologically confirmed adenomyosis showed a similarly high level of accuracy of diagnosis, but an important advantage of MRI was the standardization of images. However, not always with the deviations of the transitional zone of the uterus revealed with the help of MRI, histologically confirmed adenomyosis is subsequently diagnosed. There is a significant need to develop a common terminology and classification of violations of the transition zone of the myometrium, as well as systematization of ideas about instrumental criteria for diagnosis of adenomyosis.