Эффективность эндометриального скретчинга при лечении бесплодия с помощью вспомогательных репродуктивных технологий

Имплантация эмбрионов является ключевым фактором, ограничивающим эффективность вспомогательных репродуктивных технологий, и зависит от качества бластоцисты и восприимчивости эндометрия. Предложены различные методы лечения, направленные на улучшение рецептивности слизистой оболочки матки, в том числе скретчинг эндометрия. При этом основные механизмы, лежащие в основе данного вмешательства, остаются неясными. Более того, не определены оптимальный срок воздействия на слизистую оболочку матки и группы пациенток, в которых оно может оказать положительное влияние. Цель – исследовать основные механизмы и оценить эффективность локального повреждения эндометрия, выполненного в различные сроки перед переносом эмбрионов в программе вспомогательных репродуктивных технологий у женщин с наличием и отсутствием неудач имплантации в анамнезе на основе анализа научной литературы. Изучены клинические исследования, систематические обзоры и метаанализы в базах данных PubMed, Embase, Cochrane Library, Web of Science, издательств Elsevier, Springer, Wiley, на платформах eLIBRARY, Research Gate, в открытых источниках научного и образовательного сегмента сети интернет. Литературный поиск проведен по ключевым словам: скретчинг эндометрия, локальное повреждение эндометрия, неудачи имплантации, рецептивность эндометрия, вспомогательные репродуктивные технологии, бесплодие. Глубина поиска – 20 лет. Основные механизмы влияния скретчинга на повышение рецептивности эндометрия включают децидуализацию, развитие местной воспалительной реакции, а также улучшение синхронизации между слизистой оболочкой матки и перенесенным эмбрионом за счет предупреждения преждевременного созревания эндометрия. Исследования, показавшие положительный эффект локального повреждения слизистой оболочки матки, преимущественно были проведены у пациенток с повторными неудачами имплантации и с осуществлением вмешательства в лютеиновую фазу цикла, предшествовавшего стимуляции. Вместе с тем работы, выполненные  в неселективной популяции женщин и не стандартизированные по времени воздействия, в большинстве случаев не выявили преимуществ скретчинга эндометрия. В связи с этим требуется проведение дополнительных качественных рандомизированных контролируемых исследований с большим объемом выборки и четким выделением групп пациентов, для которых данное вмешательство может принести пользу.

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