RU2571236C2 - Method of treating infertility accompanying chronic endometritis with endometrial hypoplasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly gynaecology, and concerns treating infertility accompanying chronic endometritis with endometrical hypoplasia. A method involves an integrated therapy, which involves intrauterine administration of medicinal solutions and an endometrial exposure to low-frequency ultrasound (LFUS). The LFUS procedures are performed within three courses: the first course uses 0.05% chlorhexidine in the uterine cavity. The second and third courses provide using Imunofan in sterile normal saline in ratio 1/125. The therapeutic course involves performing procedures once a day, daily, from 5 to 10 procedures. The therapeutic courses are alternated with a treatment-free period of 2-3 menstrual cycles. The procedures in the therapeutic course start on the 5-9^th day of menstrual cycle. The procedure involves providing the continuous intrauterine circulation of the medicinal solution with maintaining the pressure less than atmospheric pressure. The procedure is performed at ultrasonic vibration frequency 25 kHz, LFUS wave guide vibration amplitude 60-120 mcm, medicinal solution flow 100-150 ml/min, exposure 3-5 min, amount of infusion 200-300 ml.

EFFECT: method provides complete uterine sanitation, activation of regeneration and active growth of the endometrium with improved treatment comfort and safety, minimum time and facilities required.

2 cl, 3 ex, 4 tbl, 3 dwg

Description

The invention relates to medicine, in particular to gynecology, and relates to methods and devices for treating inflammatory diseases of the uterus, namely chronic endometritis, using ultrasound devices for treating the uterine cavity with medicinal solutions.

It is known that in the intergravid period, acute persistent or chronic endomyometritis is often the cause of early habitual miscarriage - spontaneous miscarriages or an undeveloped pregnancy, which make up 10-15% of all clinically identified pregnancies. In Russia, about 1 million women annually suffer from inflammatory diseases of the uterus and appendages, of which 30% need treatment (see Infections in Obstetrics and Gynecology / Edited by O.V. Makarov, V.A. Aleshkina, T.N. Savchenko. - M.: MEDpress-inform, 2007 .-- 464 s). There is no tendency to decrease in the number of these patients, on the contrary, there is an increase and "rejuvenation" of this pathology. So, in 17-20% of patients, the acute process becomes chronic with the development of adhesions, persistent pain, impaired ovulation; 18% of them will sooner or later have an ectopic pregnancy and 15% subsequently suffer from infertility that requires treatment (see Buyanova S.N. Reproductive prognosis in patients with purulent inflammatory diseases of the pelvic organs: problems and solutions / S.N. Buyanova , N.A. Shchukin, A.V. Gorshilin // Russian Bulletin of the Obstetrician-Gynecologist. 2009. - No. 2. - Volume 9. - S. 65-68.).

The well-known "Method for the treatment of inflammatory diseases of the vagina and vaginal part of the cervix uteri" by administering a drug with subsequent exposure to the pathological focus by the energy of ultrasonic vibrations, in which, the exposure to energy of ultrasonic vibrations is carried out through a liquid drug at a frequency of ultrasonic vibrations of 26.5-44 kHz, an amplitude of 40-60 μm, a waveguide rotation speed of 30-60 rpm for 60-120 s, and then through a consistent drug (hydrocortisone ointment 1-2.5%; Konkova ointment etc.) by contact sounding at a frequency of 26-44 kHz, an amplitude of 20-40 microns for 10-15 s. At the same time, the ultrasonic input device is equipped with a trellis expander with a centralizer fixed to it with the help of spokes, inside of which a Teflon ring is pressed in for free placement of the waveguide tool in it (See A.S. No. 1101239, A61N 7/02; publ. 07.07 .1984).

This method allows you to get good results, but requires changing the drug for ultrasound processing and adjusting the frequency of ultrasonic radiation, which complicates the treatment, and the input device has a trellis expander that can create inconvenience for the patient, this method also does not allow for intrauterine processing.

There is also a method of treating inflammatory diseases of the female genital area and a device for its implementation (See Pat. RF No. 2086275 A61N 7/00. Publish. 08/10/1997). The method consists in introducing a medicinal solution into the uterine cavity (a solution of kanamycin 500 thousand ME and a solution of furatsilin 1: 5000), while initially expanding the cervical canal, filling the uterine cavity with a medicinal solution through the channel of the distal fibrous fiber endoscope inserted into the uterine cavity, under the control of which the mouths of the fallopian tubes are sealed with obturators, after which, instead of a fiber-optic endoscope, a trellis expander, coupled to the waveguide-tool, is introduced and circular sounding is performed along awns uterus through the drug solution frequency ultrasound energy at a frequency of 26.3 kHz ultrasonic vibrations and exposure for 2-3 minutes. However, this method has significant drawbacks, in particular, manipulations to expand the cervical canal increase the invasiveness and pain of the procedure, while the use of endoscopic equipment increases the cost of treatment, and the complexity of the procedure requires the involvement of highly qualified medical personnel and time-consuming procedures, which creates difficulties for its widespread use in clinics.

There is also known a “Method for the treatment of chronic endometritis”, in which 100 ME of a half-dan immunomodulator dissolved in 5 ml of a sterile solution for injection is injected into the uterine cavity and the endometrium is simultaneously voiced for 60 s, acting continuously with low-frequency ultrasound, with an oscillation frequency of 26 , 5 kHz, with an amplitude of 50 μm, exposure is carried out in the first phase of the menstrual cycle, once a day (see RF Patent No. 2342173, A61N 7/00).

However, this method of treatment requires manipulations to expand the cervical canal and probe the uterine cavity, which increases the complexity of the procedure, as well as its invasiveness and pain for the patient, increases the likelihood of complications, and reduces the time spent performing NCHU procedures (60 sec.) And a course of 5 procedures, it may not provide complete processing and stimulation of the endometrium, which may reduce the effectiveness of treatment, and this method is not aimed at stimulating the growth of hypoplastic endometrium.

The objective of the invention is to increase the effectiveness of the treatment of women with infertility, the cause of which is endometrial hypoplasia, to restore normal endometrial function and eliminate inflammatory processes while ensuring complete sanitation of the uterine cavity, activating the regeneration processes and active growth of the endometrium by local exposure of the endometrium to drug solutions, while increasing convenience and safety of procedures using ultrasound equipment of domestic production, allowing It is possible to restore the reproductive functions of women with minimal time and money.

The problem is solved by the fact that, against the background of individual complex therapy, patients undergo local exposure to the endometrium with a “voiced” drug solution, which is supplied to the uterine cavity in the form of a cavitating jet created by an ultrasonic delivery waveguide-instrument with an irrigation canal and a protective casing introduced through the cervical canal into the uterine cavity, and the treatment is carried out in three courses: in the first year for NCHUZ treatment use 0.05% aqueous solution of chlorhexidine; in the second and third courses using a solution of the immunomodulator "Imunofan" with sterile saline (0.9% NaCl) in a ratio of 1/125, while the procedures are carried out once a day, daily, the start of the procedures - 5-9 days of the menstrual cycle, the number of procedures in the course is from 5 to 10, and between the courses of treatment they take a break of 2-3 menstrual cycles, and this method of treatment is carried out at a frequency of ultrasonic vibrations of 25 kHz, the amplitude of the oscillations of the low-frequency waveguide instrument 60-120 microns, the flow rate of the drug solution 100 -150 ml / mi exposure of ultrasonic exposure 3-5 min, the infusion volume of 200-300 ml when using for the procedures of the domestic apparatus of ultrasonic therapy produced by LLC "Fotek" Ekaterinburg series AK100 "Fotek" containing an ultrasound generator, acoustic unit, waveguide instrument with an internal an irrigation channel for supplying a medicinal solution and a protective cover, an infusion system for supplying a medicinal solution, protected by a patent for PM No. 125853, A61 / 00. "A device for the local treatment of inflammatory diseases of the uterine cavity."

Moreover, the implementation of the method does not require anesthesia, preliminary sounding of the uterine cavity and expansion of the cervical canal and includes exposure to the walls of the uterus with a cavitating jet, supplemented by cavitation sparging of the drug solution in the uterus with a constant circulation of the solution inside the uterus without increasing the pressure in it above atmospheric.

The task is also achieved due to the fact that the device for the treatment of inflammatory diseases of the uterine cavity has an outer diameter of the working part of the casing (which is inserted into the cervical canal) 4.8 mm, the length of the working part of the casing is 4.5 cm. The above dimensions of the protective casing allow the use of this instrument in gynecological practice without additional manipulations to expand the cervical canal and preliminary sounding of the uterine cavity. To reduce the injury to the channel when introducing into it a feeding LFLM tool, the distal part of the casing narrows (rolls). Until the uterine cavity is filled with a medicinal product, the main active factor is the cavitating stream generated by the NCHU instrument. In the process of filling the cavity, this factor is supplemented by cavitation bubbling of fluid accumulated in the uterine cavity.

The pressure that determines this pressure is set by the height of the capacity of the drug solution relative to the uterine cavity.

The main parameters of the treatment method, such as the use of the Imunofan immunomodulator for a new purpose in a solution for NCHU treatment, the number of order and duration of treatment courses and procedures, breaks between treatment courses, the characteristics of NCHU and the volumes of drugs administered, were determined by the authors in practice after theoretical and laboratory research and testing and are recommended for use as giving in their complex a positive therapeutic result in the form of an increase in the thickness of the endometrium and the desired pregnancy nosti.

The inventive method using the apparatus of the series AK100 "Fotek" is as follows.

Procedures are carried out in the gynecologist's office or manipulation room. The patient is located on a gynecological chair. The vagina and cervix are exposed in the mirrors. A bimanual gynecological examination is performed to determine the location of the uterus.

Then, having prepared a therapeutic solution, ultrasonic treatment of the uterine cavity is performed. For this, an acoustic unit is connected to the ultrasonic generator, a system for supplying a drug solution is connected to the fitting of the acoustic unit. Through the cervical canal, a feed waveguide tool is inserted into the uterine cavity in a protective casing, while the conical base of the working part of the casing abuts against the external pharynx of the cervical canal, which prevents the possibility of accidental perforation of the uterus as a result of an excessively deep insertion of the instrument into the organ cavity. Next, using the regulator of the infusion system, establish a jet supply of a medicinal solution in the irrigation channel of an ultrasonic instrument. After that, ultrasonic vibrations are started and the uterine cavity is treated with a “voiced” drug solution for 3-5 minutes at an ultrasonic oscillation frequency of 25 kHz and an infusion rate of about 100-150 ml / min, with an average total infusion volume of 200-300 ml

The drug solution supplied through the channel of the ultrasonic instrument is transformed by means of ultrasonic vibrations into a directed jet of “voiced” (cavitating) liquid, which contains many cavitation bubbles filled with gas and / or steam. When processing the walls of the uterus with a cavitating jet, micromassage of tissues occurs, due to which microcirculation processes are enhanced, metabolic processes are accelerated, which contributes to the growth of the endometrium. After filling the treated cavity with a medicinal solution, the effect of the cavitating stream is supplemented by cavitation bubbling of the liquid. The effect of cavitation vesicles and other factors of low-frequency ultrasound on the infection site leads to mechanical destruction of bacteria, micromassage of the underlying tissues, stimulates the growth of the endometrium in the first phase of the menstrual cycle. Active chemicals formed in the "voiced" fluid have a bactericidal effect on the causative agents of infection and stimulate redox processes in the tissues.

In the process of ultrasonic treatment provides a constant outflow of contents from the uterine cavity. The spent fluid from the uterine cavity enters the space between the ultrasound instrument and the protective casing and flows out through the drainage holes in the casing. If the walls of the cervical canal do not tightly cover the protective casing, then the outflow of fluid also occurs along the walls of the cervical canal. At the same time, a medicinal solution is supplied from the infusion system to the uterine cavity through the internal irrigation channel of the ultrasound instrument.

After the procedure is completed, the ultrasonic oscillation generator is turned off, the drug solution is stopped from the infusion system, the ultrasound instrument in the protective casing is removed from the uterine cavity, the infusion system is disconnected from the acoustic unit.

For effective ultrasonic treatment according to the proposed method, therapeutic solutions of the following concentration are used:

- 0.05% aqueous solution of chlorhexidine;

- Imunofan immunomodulator solution with sterile physiological solution (0.9% NaCl) in a ratio of 1/125 (100 μg - 2 ampoules of 1 ml per 250 ml of physical solution). Imunofan (arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine) is an immunomodulatory agent. The drug has an immunoregulatory, detoxifying, hepatoprotective effect and causes the inactivation of free radical and peroxide compounds. Producer LLC Scientific-Production Enterprise "Bionox", e-mail: imunofan@mail.ru

Treatment includes from 2 to 3 courses of indications. As medicinal solutions are used:

on the 1st course of treatment - a solution of chlorhexidine,

on the 2nd course - a solution of the immunomodulator "Imunofan",

on the 3rd - a solution of the immunomodulator "Imunofana" (the concentration of the solutions indicated above).

The number of procedures in one course is on average from 5 to 10. Procedures are performed 1 time per day, daily. Beginning of procedures: 5-9 d.m. Between courses of treatment, a break - 2-3 menstrual cycles.

Moreover, the procedure is well tolerated, comfortable and safe for the patient, does not require large time and material costs for its implementation.

A clinical study of the proposed method of treatment was carried out on the basis of the Department of General Gynecology, MBU Central City Hospital No. 7, Yekaterinburg.

Criteria for inclusion in the study group: women with a diagnosis of infertility I or II, chronic endometritis, the diagnosis is histologically confirmed (aspirate with pipeliopsy or scraping with hysteroscopy).

Group characteristics: 28 women - average age M _E 29.5 (p ₂₅ 28-p ₇₅ 35.5), infertility I 11 women (39.29% ± 0.09), infertility II - in 17 (60.71% ± 0.09). The average experience of infertility is M _E 2.5 (p ₂₅ 1-p ₇₅ 4.25) years. The menarche age is M _E 13.5 (p ₂₅ 12.8-p ₇₅ 15), the duration of menstrual bleeding is on average 5 days (M _E 5 (p ₂₅ 3.25-p ₇₅ 5)), the menstrual cycle is on average 28 days (M _E 28 (p ₂₅ 28-p ₇₅ 30)). Beginning of sexual activity at the age of 18 (M _E 18 (p ₂₅ 17-p ₇₅ 20)). A history of childbirth in 7 women (25.0% ± 0.08), in 2 of them premature births with the death of children: after 3 weeks in one (premature birth in 30 weeks), after 8 months in the other (premature birth at 26 weeks). A summary of the group is presented in Table 1.

Table 1 Anamnestic data for the group Indicator Group n = 28 Regular menstrual cycle 25 89.29 ± 0.06 The volume of menstrual c / t meager 3 10.71 ± 0.06 moderate 21 75.00 ± 0.08 plentiful four 14.29 ± 0.07 algomenorrhea eleven 39.29 ± 0.09 Pregnancy childbirth 7 25.00 ± 0.08 before childbirth (26-31 weeks) 2 7.14 ± 0.05 abortions four 14.29 ± 0.07 miscarriages 7 25.00 ± 0.08 non-developing pregnancy 7 25.00 ± 0.08 cystic drift one 3.57 ± 0.04 Contraception without contraception 0 barrier method 19 50.00 ± 0.12 in / uterine contraception 0 hormonal 7 25.00 ± 0.08 interrupt n / act, calend. 2 7.14 ± 0.05

Hysteroscopy was carried out in 13 cases (46.43% ± 0.09), of which the hysteroscopic picture of chronic endometritis was confirmed in 8 cases (28.57% ± 0.09), in the remaining cases - visually without pathology. Histological confirmation of the diagnosis of chronic endometritis in 100% of cases. According to ultrasound diagnostics, all patients have endometrial hypoplasia.

All women for at least 6 months were treated with several courses of antibacterial therapy (fluoroquinolones (cipro- and levofloxacin), tetracycline drugs (doxycycline), protected penicillins (amoxiclav), hormone therapy (duphaston, proginova, divigel), immunomodulator therapy ( alokine - α, Imunofan by candlelight, polyoxidonium, longidase), physiotherapy (hirudotherapy, magnetic laser, mud therapy, gynecological massage).

All women previously underwent examination before the procedure: bacterial sowing from the cervical canal. In 90% - crops are sterile, in 10% - growth of UPF in a titer of less than 10 ⁴ Escherichia coli, Enterococcus faecalis, Staphylococcus aureus and others. After a course of procedures, in a week all 100% of the crops are sterile. The same picture before the 2nd and 3rd courses of procedures.

According to ultrasound, after the first course of procedures, the M-echo value significantly increases, while on the 2nd menstrual cycle after the 1st course of treatment, the M-echo value does not significantly change (relative to the M-echo value immediately after the 1st course of procedures) . After the 2nd course of treatment, the M-echo increases significantly, after the 3rd course the same effect (Table 2).

As a percentage, there is an increase in the endometrium (M-echo value) by 52 ± 0.12%, when considering the average indicator at the time of the start of the procedures and after 3 courses of the procedures (Table 3).

table 2 The characteristics of endometrial growth in women in the study group in absolute terms Indicator Averages credibility M-echo before procedures / M-echo at 13-15 dm.ts. immediately after the procedures M _E 4 (p ₂₅ 3,5-p ₇₅ 4,5) / M _E 6 (p ₂₅ 6-p ₇₅ 6,5) p≤0,05 M-echo at 13-15 dm.ts. immediately after the procedures / M-echo at 13-15 dm.ts. through the cycle after the 1st course M _E 6 (p ₂₅ 6-p ₇₅ 6.5) / M _E 6.6 (p ₂₅ 6-p ₇₅ 7) p> 0.05 M-echo at 13-15 dm.ts. immediately after the procedures / M-echo at 13-15 dm.ts. after 2nd year M _E 6 (p ₂₅ 6-p ₇₅ 6.5) / M _E 7.6 (p ₂₅ 7-p ₇₅ 7.8) p <0.05 M-echo at 13-15 dm.ts. after the 2nd course / M-echo at 13-15 dm.ts. after 3rd year M _E 7.6 (p ₂₅ 7-p ₇₅ 7.8) / M _E 8.4 (p ₂₅ 8.0-p ₇₅ 9.0) p <0.05

Table 3 The characteristic endometrial growth in women in the study group as a percentage Indicator Endometrial growth in% M-echo before procedures / M-echo at 13-15 dm.ts. immediately after the procedures 33.3 ± 0.11 M-echo before procedures / M-echo at 13-15 dm.ts. through the cycle 39.4 ± 0.12 M-echo before procedures / M-echo at 13-15 dm.ts. after 2nd year 47.4 ± 0.12 M-echo before procedures / M-echo at 13-15 dm.ts. after 3rd year 52.4 ± 0.12

Illustrative examples of the method of treatment are presented below.

Example 1

Patient M., 28 years old, with a diagnosis of Infertility 1-3 years, menstruation from 16 years old, irregular, scarce, painful. Sexual life since 18 years. From the age of 18, a woman has been observed by a gynecologist-endocrinologist, has taken COCs. Married 4 years, without contraception - 3. There were no pregnancies. The diagnosis was established - PCA. The diagnosis of chronic endometritis is established immunohistochemically.

Before courses NCHUZ (Low-frequency ultrasonic treatment) for the proposed method of treatment:

- 3 courses of antibacterial therapy - metronidazole (500 mg -2 t. * 2 r / d - 7 days), ciprofloxacin (500 mg * 2 r / d - 5 days), doxycycline 100 mg * 2 r / s - 7 days.

- 5 cycles - proginova at 2 mg * 1 r / d (from the 1st to the 15th day), duphaston at 10 mg * 2 r / d (from the 16th to the 25th).

- 2 courses of immunomodulators - polyaxidonium, imunolide.

- From physiotherapy - gynecological massage 2 courses, hirudotherapy - 1 course, mud therapy - 2 courses.

Ultrasound - the magnitude of the M-echo - an average of 4 at 13-15 dm.ts.

The first course of treatment is a chlorhexidine solution at 9 d.m. (from 13.02.2013) - 10 procedures with chlorhexidine 0.05% solution. During the course of NCHUZ - amoxiclav, divigel, duphaston, alokin-alpha.

The magnitude of the M-echo in the first menstrual cycle after the first course is 6.6 by 13 d.s. (an increase of 39.4 ± 0.47%).

The magnitude of the M-echo in the second menstrual cycle after the first course of treatment is 6 to 14 d.s.

Bakseeding is sterile before and after the procedures.

The second course of treatment is a solution of "Imunofan" at 9 d.m. (from 04/12/2013) - 5 procedures. Without concomitant antibacterial therapy, hormone replacement therapy is a divigel. Bakseeding is sterile before and after the procedures.

The magnitude of the M-echo in the same course is 7.6 at 13 d.s. (growth 47.4 ± 0.5%)

The third course of treatment is Imunofan solution at 6 d.m. (from 05/06/2013) - 5 procedures. Without concomitant antibacterial therapy, hormone replacement therapy is a divigel. Bakseeding is sterile before and after the procedures. M-echo in the next course of 8.4 mm. Total endometrial growth from the beginning of the procedures (1st year) is 52.4 ± 0.5%.

In July, the anovulatory cycle. After stimulation of ovulation - on 12/20/2013 - pregnancy of 18 weeks.

Example 2

Patient R., 28 years old, with a diagnosis of Infertility II - 1 year, menstruation from 14 years old, regular, moderate, painless. Sexual life since 23 years. Contraception - COC. Pregnancy 1, in 2011 - non-developing in the period of 5-6 weeks. The diagnosis of chronic endometritis based on hysteroscopy and histologically.

Before courses NCHUZ

- 2 courses of antibiotic therapy - metronidazole, doxycycline.

- 5 cycles - proginova (from the 1st to the 15th day), duphaston (from the 16th to the 2nd 5th).

- 2 courses of immunomodulators - polyaxidonium.

- From physiotherapy - gynecological massage 1 course, hirudotherapy - 1 course, mud therapy - 1 course.

Ultrasound - the magnitude of the M-echo - an average of 4.3 per 19 d.s.

The first course of treatment is a solution of chlorhexidine at 6 dm.ts. (from 01/23/2013) - 10 procedures.

During the course of NCHU3 - divigel, duphaston, alokin-alpha.

The magnitude of the M-echo is 6.6 by 13 d.s. (an increase of 34.8 ± 0.48%) in the first menstrual cycle after. And 6 on 14 dm.ts. - in the second cycle (decrease in effect), M-echo - 6.6 in the third cycle at 13 dm.ts.

Bakseeding is sterile before and after the procedures.

The second course of treatment is a solution of "Imunofan" at 9 d.m. (from 04/12/2013) - 5 procedures. Without concomitant antibacterial therapy, hormone replacement therapy is a divigel. Bakseeding is sterile before and after the procedures.

The magnitude of the M-echo in the same cycle is 7 per 13 d.s. (growth 38.6 ± 0.49%).

The third course of treatment is the Imunofan solution at 9 d.m. (from 05/06/2013) - 5 procedures. Without concomitant antibacterial therapy, hormone replacement therapy is a divigel. Tank. crops are sterile before and after the procedures. M-echo in the next cycle of 8 mm. Total endometrial growth from the beginning of the procedures (1st course) - 46.3 ± 0.5%.

On 12/20/13, pregnancy is 9-10 weeks.

Example 3

Patient DL, 32 years old, with a diagnosis of Infertility II - 2 years, menstruation from 12 years old, regular, moderate, painless. Sexual life since 18 years. A history of 3 pregnancies: 1 - urgent delivery, 2 spontaneous miscarriages up to 12 weeks. The diagnosis was made - Asherman's syndrome after the last curettage of the uterine cavity. In 2012 - hysteroscopy, dissection of intrauterine synechia.

Before courses NCHUZ:

- 5 cycles - proginova (from the 1st to the 15th day), duphaston (from the 16th to the 25th).

- 2 courses of immunomodulators - polyaxidonium, imunolide.

- From physiotherapy - gynecological massage 2 courses, hirudotherapy - 1 course, mud therapy - 2 courses.

Ultrasound - the magnitude of the M-echo - an average of 4 at 13-15 dm.ts.

The first course - from 13.01 to 9 d.s. - 10 procedures with chlorhexidine 0.05% solution. During the course NCHUZ - duphaston, progina.

The magnitude of the M-echo is 6 by 13 d.s. (an increase of 33.0 ± 0.47%) in the first menstrual cycle after. And 6 on 14 dm.ts. - in the second cycle (stabilization of the effect).

Bakseeding is sterile before and after the procedures.

The second course is a solution of "Imunofan" at 5 d.m. from 05.06. 5 treatments. Without concomitant antibacterial therapy, hormone replacement therapy is duphaston. Bakseeding is sterile before and after the procedures.

The magnitude of the M-echo in the same cycle is 7.1 per 13 d.s. (growth 43.7 ± 0.5%).

The third course is a solution of "Imunofan" at 6 d.m. from 03.07. 5 treatments. Without concomitant antibacterial therapy, hormone replacement therapy is duphaston. Bakseeding is sterile before and after the procedures. M-echo in the next cycle of 7.5 mm. Total endometrial growth from the beginning of the procedures (1st year) is 46.7 ± 0.5%.

On 12/20/13 - a pregnancy of 11 weeks.

Summary treatment results for patients 1; 2; 3 are shown in Table 4.

Table 4 The dynamics of the magnitude of the M-echo during treatment The magnitude of the M-echo (according to ultrasound data, made at 13-15 dm.ts.) one 2 3 four 5 before treatment in the 1st menstrual cycle after the 1st course of procedures in the 2nd menstrual cycle after the 1st course of procedures in the menstrual cycle during the 2nd course of procedures in the menstrual cycle after 3 courses of procedures Patient M four 6.6 6 7.6 8.4 Patient P 4.3 6.6 6 7 8 Sick DL four 6 6 7 7.5

In figure 1; 2; 3 graphically presents the results of treatment according to examples 1; 2; 3.

The novelty of the invention is the use of the known immunomodulator Imunofan preparation for ultrasound treatment of the uterine cavity for a new purpose and method of introducing patients with chronic endometritis into the treatment course, which leads to a significant increase in the endometrium in the first phase of the menstrual cycle, and this is not an obvious effect of the proposed method, leading to the restoration of childbearing functions in women with infertility in the presence of chronic endometritis.

Additional sanitation of the uterine cavity by the proposed device with the above exposure parameters allowed to increase the effectiveness of treatment, reduce the drug load on the patient, achieve restoration of the reproductive function of women and cure one of the main causes of infertility.

Thus, the application of the proposed method for the treatment of infertility against a background of chronic endometritis with endometrial hypoplasia is highly effective and promising, since highly effective rehabilitation of the uterine cavity and endometrial growth are carried out. This method is non-invasive, painless, easy to do and economically low cost.

The growth of the endometrium after 3 courses of procedures is from 23 to 46%, which is observed precisely after the application of NCHUZ. Longer courses of antibacterial, hormonal therapy, standard physiotherapy did not previously help these women. The main effect of NCHUZ - microvibration - a kind of micromassage of the endometrium of the uterine cavity, as a result of which microcirculation processes are strengthened, oxidation-reduction metabolism and reduction processes are accelerated and enhanced.

It should also be noted anti-inflammatory, analgesic, hyposensitizing effect, not only in the scoring area, but also beyond. It should be noted bactericidal effect of ultrasound. Due to all of the above, the processes of endometrial regeneration are activated and its active growth occurs (Table 2; 3; 4; Figure 1; 2; 3).

The work carried out indicates that it is thanks to the NCHP and selected therapeutic drugs according to the administration schedule that women are cured of almost "fatal", for pregnancy, pathology, which provides a solution to one of the main causes of infertility.

Claims (2)

1. A method for the treatment of infertility in the presence of chronic endometritis with endometrial hypoplasia in women, comprising complex therapy, which includes intrauterine administration of medicinal solutions with exposure to the endometrium of low-frequency ultrasound (NCHUZ), characterized in that the LCHU treatment procedures are carried out in three courses: the first year for NCHUZ treatment of the uterine cavity using a 0.05% aqueous solution of chlorhexidine; in the second and third courses using a solution of Imunofan in sterile saline in a ratio of 1/125, while in the course of treatment the procedures are performed once a day, daily, with the number of procedures from 5 to 10, 2-3 periods are taken between the courses of treatment , and the beginning of the procedures in the course is 5-9 days of the menstrual cycle, and during the procedure they provide a constant circulation of the drug solution inside the uterus without increasing the pressure in it above atmospheric pressure with a frequency of ultrasonic vibrations of 25 kHz, amp tude oscillations NCHUZ Tool waveguide 60 - 120 microns, a flow rate of drug solution to 100-150 ml / min, 3-5 minutes exposure, an infusion volume of 200-300 ml. 2. The method according to p. 1, characterized in that for carrying out LCHU procedures, an ultrasonic therapy apparatus of the AK100 series of the company Fotek is used in Yekaterinburg, which provides the supply of a medicinal solution through the inner channel of LCHUZ instrument, while the outer diameter of the working part introduced into the cervical canal the casing of the waveguide tool is 4.8 mm, and the length of the working part of the casing is 4.5 cm

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