THE ROLE OF COMPLEX TREATMENT OF UTERINE FIBROIDS IN WOMEN WITH INFERTILITY AND RECOVERY OF THE REPRODUCTIVE FUNCTION

A nation's reproductive health is an important medical and public indicator. A significant decrease in the birth rate has put Ukraine on the list of Top 8 European countries with the lowest birth rate. Uterine fibroids are one of the most widely spread gynecological diseases, which ranks the 2nd place 12 «Art of Medicine» 4 (16) жовтень-грудень, 2020 ISSN 2521-1455 (Print) ISSN 2523-4250 (Online) after the inflammatory processes of the small pelvis organs and affects from 20 to 30% of women above 30 years. In 13.3 to 27% of cases, uterine fibroids are observed in the reproductive age. In recent years, there has been a steady increase in the number of young women affected by the tumor. Uterine fibroids remain a serious issue and are one of the main causes of miscarriage and infertility, especially in women above 30 years [1, 2, 3]. The treatment of uterine fibroids remains a disputable issue. The slow development of the disease, without obvious clinical manifestations, has long been the reason for passive observation of patients, until the onset of symptoms requiring surgical treatment. The clinical manifestations of the disease, which are observed in every second patient affected by uterine fibroids, require a more active strategy of management of such patients. One of the factors impeding effective organ preservation treatment of fibroids is the lack of information about the mechanisms of the tumor development. As it is known, the progression of any tumor is directly dependent on it blood supply [4, 5]. So far, radical treatment (hysterectomy) remains the main method of treatment of uterine fibroids and is applied in 75 - 83% of cases. However, such radicalism is not justified in the majority of patients as new treatment methods come into being, which inhibit tumor growth and lead to the regression of the disease symptoms. According to various authors, the percentage of fibroidectomy in the total number of surgeries is lower than 1%, which is unreasonably low. The main advantage of fibroidectomy is the preservation of fertility, the main disadvantage – is the high risk of disease recurrence – from 15 to 20% [6]. There has been more and more debate recently about the issue of interrelation of uterine fibroids, the results of assisted reproductive technologies and embryo transfer. The improvement of results of ART after fibroidectomy encourages the broadening of indications for such surgeries in patients with symptomless fibroids. Drug therapy also makes it possible to preserve the reproductive function but, in contrast to surgical treatment, it does not mean the risk of intra- and postoperative complications. The combination of drug therapy and organ preservation surgeries reduces the risk of complications related to surgical treatment and contributes to the preservation of fertility. The use of complex rehabilitation measures with hormone therapy improves the results of surgical treatment, reduces the risk of recurrence of uterine fibroids and contributes to a more favorable postoperative course. At present, there are no clear criteria for managing patients after organ preservation surgeries on the uterus; at the outpatient stage, there are few effective approaches aimed at the recovery of fertility and the rehabilitation of such patients. Thus, the recovery and preservation of the reproductive function is one of the priorities in the development of medicine in Ukraine.