НОВЫЕ ДОСТИЖЕНИЯ В ЛЕЧЕНИИ ТОНКОГО ЭНДОМЕТРИЯ (ОБЗОР ЛИТЕРАТУРЫ)

Abstract

Thin endometrium (TE) is a clinical condition in which endometrial thickness before embryo transfer or during the presumed “window of implantation” remains insufficient, and this is associated with impaired implantation and reduced pregnancy outcomes in assisted reproductive technology (ART) programs. In clinical practice, a threshold of <7 mm is most commonly used (especially in frozen–thawed embryo transfer cycles), although studies report ranges of ≤6–8 mm, and no universally accepted diagnostic criterion exists. The pathogenesis of TE is multifactorial and includes the consequences of intrauterine interventions and inflammatory conditions (e.g., chronic endometritis), impaired angiogenesis and endometrial perfusion (high vascular resistance), as well as dysregulation of hormonal responses and molecular markers of endometrial receptivity. Clinically, TE is associated with reduced clinical pregnancy and live birth rates, as well as an increased risk of adverse obstetric outcomes in certain cohorts. Current treatment strategies for TE include optimization of estrogen–progestin preparation (different routes of administration and duration), pharmacological approaches aimed at improving blood flow/endometrial perfusion (e.g., sildenafil, pentoxifylline plus vitamin E, low-dose acetylsalicylic acid—supported by conflicting evidence), intrauterine infusion of growth factors/biological agents (G-CSF, PRP), and regenerative approaches (mesenchymal stem cells and their extracellular vesicles/exosomes). [6–12] Despite the growing number of studies, many interventions are limited by small sample sizes, heterogeneity of TE definitions and outcome measures; for some treatments, variable efficacy and a lack of impact on “hard” outcomes (live birth) have been reported in individual studies.