actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problems10.29413/ABS.2021-6.3.3actabiomedica-2843Research ArticleАКУШЕРСТВО И ГИНЕКОЛОГИЯOBSTETRICS AND GYNAECOLOGYВлияние узловой и тяжелой форм диффузного аденомиоза на репродуктивную функцию: обзор репродуктивных исходов оперативных вмешательств и ЭКОInfluence of nodular and severe forms of diffuse adenomyosis on reproductive function: a review of reproductive outcomes of surgical interventions and IVFhttps://orcid.org/0000-0003-2149-5957КрыловК. Ю.KrylovK. Yu.

 к.м.н, врач акушер-гинеколог, старший научный сотрудник отдела гинекологии 

 ул. Будапештская, 3А, 192242, Санкт-Петербург, Россия 

 Cand. Sc. (Med.), Obstetrician-Gynaecologist, Senior Research Officer, Department of Gynaecology 

192242, St. Petersburg, Budapestskaya str, 3 

drkrylov@mail.ruhttps://orcid.org/0000-0002-3548-0468РухлядаН. Н.RukhliadaN. N.

 д.м.н, профессор, заведующий, кафедра акушерства и гинекологии 

 ул. Литовская, д. 2, 194100, Санкт-Петербург, Россия 

 Dr. Sc. (Med.), Professor, Head of Department of Obstetrics and Gynaecology

194100, St. Petersburg, Litovskaya str, 2 

nickolasr@mail.ruБирюковаЕ. И.BiryukovaE. I.

 к.м.н., заведующая отделением гинекологии №2 

 ул. Будапештская, 3А, 192242, Санкт-Петербург, Россия 

 Cand. Sc. (Med.), head of Department of Gynaecology 2

192242, St. Petersburg, Budapestskaya str, 3 

79112252131@yandex.ruЦечоеваЛ. Ш.TsechoevaL. S.

 к.м.н., заведующая отделением гинекологии №1 

 ул. Будапештская, 3А, 192242, Санкт-Петербург, Россия 

 Cand. Sc. (Med.), head of Department of Gynaecology 2

192242, St. Petersburg, Budapestskaya str, 3 

doctor-leila@mail.ruВинниковаС. В.VinnikovaS. V.

 аспирант кафедры акушерства и гинекологии 

 ул. Литовская, д. 2, 194100, Санкт-Петербург, Россия 

 Postgraduate of the Department of Obstetrics and Gynecology 

194100, St. Petersburg, Litovskaya str, 2 

simona.vinnikova@yandex.ruГБУ СПб НИИ скорой помощи им. И.И. ДжанелидзеSaint-Petersburg research Institute of emergency medicineСанкт-Петербургский Государственный педиатрический медицинский университетSaint Petersburg State Pediatric Medical University202111082021633142Copyright © Крылов К.Ю., Рухляда Н.Н., Бирюкова Е.И., Цечоева Л.Ш., Винникова С.В., 20212021Крылов К.Ю., Рухляда Н.Н., Бирюкова Е.И., Цечоева Л.Ш., Винникова С.В.Krylov K.Y., Rukhliada N.N., Biryukova E.I., Tsechoeva L.S., Vinnikova S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.actabiomedica.ru/jour/article/view/2843

 Представленный обзор включает в себя данные различных клинических исследований, в которых оценивалось действие узловой и тяжелой формы диффузного  аденомиоза на репродуктивную функцию, а также обзор репродуктивных исходов в зависимости от хирургического  лечения. Различные исследования групп женщин после  экстрокорпорального оплодотворения (ЭКО) и/или  интрацитоплазматической инъекции сперматозоидов (ЭКО/ ИКСИ), а также женщин, которым выполнялось  хирургическое лечение по поводу глубокого аденомиоза  показали, что аденомиоз в обоих случаях оказывает негативное влияние на репродуктивный исход, хотя в данных популяциях есть и существенные отличия. В  литературе сравнительно мало данных о степени влияния глубины поражения на реализацию репродуктивной  функции, однако между ними выявлена достоверная  корреляция. Положительный эффект хирургического  лечения с дальнейшим применением агонистов  гонадотропинрилизинг гормона также описан в нескольких литературных источниках, однако контролируемых  исследований на эту тему не проводилось. Многие  исследования не отвечают критериям достоверности в связи с отсутствием четких критериев включения и исключения из исследования.Выбор оптимальных вариантов лечения аденомиоза на  основе фактических данных затруднен из-за отсутствия  достоверных доказательств взаимосвязи между фертильностью и степенью распространенности аденомиоза. Однако известно, что аденомиоз может  настолько сильно снизить вероятность успешной имплантации, что будет обоснованно рекомендовать хирургические или другие варианты лечения. При этом необходимо оценить возможный положительный эффект  имеющихся в арсенале врача вариантов лечения. Таким образом, решающее значение для успешной реализации репродуктивной функции у пациенток с подозрением или с  установленным диагнозом аденомиоз в сочетании с  привычным невынашиванием беременности,  отказывающихся от использования вспомогательных  репродуктивных технологий, может иметь своевременное направление в специализированные по лечению  аденомиоза медицинские учреждения. В этом обзоре будет  проанализирована связь между бесплодием и аденомиозом, а также рассмотрены исследования  репродуктивных исходов при разных вариантах хирургического лечения аденомиоза у пациентов с бесплодием. 

 This review includes an analysis of clinical studies evaluating the effect of adenomyosis on reproductive function, as well as a review of studies on the relationship between surgical treat-ment options for adenomyosis and reproductive outcomes. Different studies of women populations after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) and after surgical treatment of  deep adenomyosis have shown that adenomyosis in both cases has a negative effect on the reproductive outcome, although there are significant differences in these populations. In the literature, there are relatively few data on the degree of influence of the depth of the lesion on the realization of the reproductive function, however, a significant correlation was revealed between them. The positive effect of treatment with gonadotropin-releasing hormone agonists, followed by surgical treatment of adenomyosis, has also been described in several literary sources, but there have been no controlled studies on this topic. Many studies do not meet the validity criteria due to the lack of clear criteria for inclusion and exclusion from the study.The choice of the optimal treatment options for adenomyosis based on the actual data is difficult due to the lack of reliable evidence of the relationship between fertility and the degree of adenomyosis. However, it is known that adenomyosis can reduce the likelihood of successful implantation so  ramatically that surgical or other treatment options are reasonably recom-mended. At the same time, it is necessary to assess the possible positive effect of the treatment options available in the doctor’s arsenal. Thus, timely referral to specialized treatment of ade-nomyosis may be crucial for the successful implementation of reproductive function in patients with suspicion or with an established diagnosis of adenomyosis in combination with recurrent miscarriage, who refuse to use assisted reproductive technologies, medical institutions. This review will analyze the relationship between infertility and adenomyosis, as well as review studies of reproductive outcomes in different options for surgical treatment of adenomyosis in infertile patients. 

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The authors declare that there are no conflicts of interest present.