Рецептивность эндометрия у молодых женщин с хроническим эндометритом и женщин позднего репродуктивного возраста с признаками функционального старения: роль персонализированной подготовки

Relevance: Endometrial receptivity plays a key role in successful embryo implantation and the effectiveness of assisted reproductive technology programs. One of the main molecular markers of receptivity is leukemia inhibitory factor (LIF), reduced expression of which is associated with impaired implantation. At the same time, chronic endometritis in young women is not always accompanied by impaired receptivity when LIF expression is preserved. In contrast, age-associated changes in the endometrium in women of advanced reproductive age lead to reduced LIF expression and implantation potential. The study aimed to evaluate the effectiveness of personalized endometrial preparation in women of advanced reproductive age with signs of functional aging and reduced LIF expression compared with young women with chronic endometritis and preserved endometrial receptivity. Materials and Methods: The patients were divided into two groups according to age and LIF expression level. Group 1 included women aged <38 years with chronic endometritis and preserved endometrial receptivity; endometrial preparation was performed according to the standard protocol. Group 2 included women aged ≥38 years with reduced LIF expression who underwent personalized preparation comprising hormonal correction, senolytic support, and local treatment with tissue biomodulators. A single euploid blastocyst was transferred in all participants. Effectiveness was assessed based on the clinical pregnancy rate. Results: The clinical characteristics of the patients, including infertility duration, body mass index, reproductive history, and the number of implantation failures, were comparable between the groups. Endometrial thickness, estradiol level, and the day of embryo transfer did not differ significantly. LIF expression levels were similar between the groups (p=0.658), reflecting the effectiveness of personalized preparation in older patients. The clinical pregnancy rates were 55.6% and 63.6% in the respective groups (p=0.43). Conclusion: A personalized endometrial preparation protocol in women of advanced reproductive age with signs of functional aging and reduced LIF expression makes it possible to achieve a clinical pregnancy rate comparable to that observed in younger patients, despite age-related molecular changes. In women aged <38 years, chronic endometritis does not reduce endometrial receptivity when LIF expression is normal, confirming the need to assess molecular markers when selecting an implantation preparation strategy.