GynecologyGynecologyГинекология2079-56962079-5831Consilium Medicum4190310.26442/20795696.2020.5.200405REVIEWОБЗОРResearch ArticleOvarian endometriosis associated infertility: a modern view to the problemБесплодие, ассоциированное с эндометриозом яичников: современный взгляд на проблемуhttps://orcid.org/0000-0002-5342-8129OrazovMekan R.ОразовМекан Рахимбердыевич
Russian Federation

D. Sci. (Med.), Prof., People’s Friendship University of Russia

д-р мед. наук, проф., проф. каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН

omekan@mail.ruhttps://orcid.org/0000-0003-1940-4534KhamoshinaMarina B.ХамошинаМарина Борисовна
Russian Federation

D. Sci. (Med.), Prof., People’s Friendship University of Russia

д-р мед. наук, проф., проф. каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН

khamoshina@mail.ruhttps://orcid.org/0000-0002-2684-5322AbitovaMarianna Z.АбитоваМарианна Заурбиевна
Russian Federation

Graduate Student, People’s Friendship University of Russia

аспирант каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН

abitovamarianna@yandex.ruhttps://orcid.org/0000-0003-2052-914XMikhalevaLyudmila M.МихалеваЛюдмила Михайловна
Russian Federation

D. Sci. (Med.), Prof., Research Institute of Human Morphology

чл.-кор. РАЕ, д-р мед. наук, проф., дир. ФГБНУ «НИИ морфологии человека»

mikhalevam@yandex.ruhttps://orcid.org/0000-0003-2198-7927VolkovaSnezhana V.ВолковаСнежана Владимировна
Russian Federation

Graduate Student, People’s Friendship University of Russia

аспирант каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН

dr.slupus@yandex.ruAryutinDmitry G.АрютинДмитрий Геннадьевич
Russian Federation

Cand. Sci. (Med.), Clinical Assistant of Prof., Peoples’ Friendship University of Russia, the head of the gynecological department, Bauman State Clinical Hospital №29

канд. мед. наук, ассистент каф. акушерства и гинекологии с курсом перинатологии Mедицинского института ФГАОУ ВО РУДН, зав. гинекологическим отд-нием ГБУЗ «Государственная клиническая больница №29 им. Н.Э. Баумана»

aryutin@mail.ruhttps://orcid.org/0000-0003-4397-0042ShustovaVictoria B.ШустоваВиктория Борисовна
Russian Federation

Obstetrician-Gynecologist, Reproductologist of MedInServis – Center of reproductive medicine and genetics “Nova Clinic”

врач акушер-гинеколог, репродуктолог ООО «МедИнСервис» – Центр репродукции и генетики “Nova Clinic”

shustova.vik@yandex.ruPeoples’ Friendship University of RussiaФГАОУ ВО «Российский университет дружбы народов»Research Institute of Human MorphologyГБНУ «Научно-исследовательский институт морфологии человека»Bauman State Clinical Hospital №29ГБУЗ «Государственная клиническая больница №29 им. Н.Э. Баумана»MedInService – Center for Reproduction and Genetics “Nova Clinic” (“MedInService”)ООО «МедИнСервис» – Центр репродукции и генетики «Nova Clinic» («МедИнСервис»)23112020225444931072020Copyright ©; 2020, Consilium MedicumCopyright ©; 2020, ООО "Консилиум Медикум"2020Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://gynecology.orscience.ru/2079-5831/article/view/41903

This review summarizes current understanding of the pathogenesis of one of the most common forms of external genital endometriosis – ovarian endometrioma’s. Due to their frequent occurrence in young women of reproductive age and extremely negative impact on the morphophysiological state of the ovaries, this disease makes a significant contribution to the structure of endometriosis-associated infertility. The main determinant of the negative effect of ovarian endometrioma’s on reproductive function is a decrease in ovarian reserve, which can occur either due to the direct gonadotoxic effect of the endometriod cyst itself, or due to the unintentional removal of healthy ovarian tissue during surgery or the use of aggressive methods of electrosurgery. Hence, the question of methods for achieving hemostasis during surgery in terms of iatrogenic effects on healthy ovarian tissue is debatable. The management strategy for patients with infertility associated with ovarian endometriosis consists of two components: surgical treatment and/or the use of assisted reproductive technologies. Laparoscopic cystectomy is indicated for cysts larger than 3 cm. Repeated surgical interventions in case of endometriosis do not improve fertility outcomes. Assisted reproductive technologies methods should be considered as a priority tactic in patients of older reproductive age with low ovarian reserve indicators or infertility duration of more than 2 years, as well as in cases of recurrent ovarian endometrioma’s. Management of such patients must be personalized and take into account the age, state of the ovarian reserve, duration of infertility, stage and number of surgical interventions for this disease.

В настоящем обзоре обобщены современные представления о патогенезе одной из самых распространенных форм наружного генитального эндометриоза – эндометриоидных кист яичников (ЭКЯ). Ввиду их частой встречаемости у молодых женщин репродуктивного возраста и крайне негативного влияния на морфофизиологическое состояние яичников данное заболевание вносит весомый вклад в структуру эндометриозассоциированного бесплодия. Основной детерминантой негативного влияния ЭКЯ на репродуктивную функцию является снижение овариального резерва, которое может происходить как из-за непосредственного гонадотоксического действия самой эндометриодной кисты, так и за счет непреднамеренного удаления здоровой овариальной ткани во время хирургического вмешательства или использования агрессивных методов электрохирургии. Отсюда дискутабельным является вопрос о методах достижения гемостаза во время операции с точки зрения ятрогенного влияния на здоровую овариальную ткань. Стратегия ведения пациенток с бесплодием, ассоциированным с эндометриозом яичников, складывается из двух составляющих: оперативное лечение и/или применение вспомогательных репродуктивных технологий. Лапароскопическая цистэктомия показана при размере кист более 3 см. Повторные оперативные вмешательcтва по поводу эндометриоза не улучшают исходы фертильности. Методы вспомогательных репродуктивных технологий следует рассматривать в качестве первоочередной тактики у пациенток старшего репродуктивного возраста с низкими показателями овариального резерва или длительностью бесплодия более 2 лет, а также при рецидивах ЭКЯ. Ведение таких пациенток обязательно должно быть персонализированным и учитывать возраст, состояние овариального резерва, длительность бесплодия, стадию и количество оперативных вмешательств по поводу данного заболевания.

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