Современные методы оценки рецептивности эндометрия при экстракорпоральном оплодотворении: прогностическая ценность и клиническая применимость

Рецептивность эндометрия является ключевым фактором успешной имплантации эмбриона и одним из наиболее сложных для оценки параметров в репродуктивной медицине. Несмотря на широкий спектр диагностических подходов, их клиническая эффективность остается предметом дискуссии. Настоящий нарративный обзор основан на анализе публикаций, индексированных в PubMed/MEDLINE, Scopus и Web of Science, с акцентом на систематические обзоры, рандомизированные исследования, проспективные и ретроспективные когортные работы, посвященные оценке рецептивности эндометрия в программах экстракорпорального оплодотворения. В обзоре проанализированы морфологические, функциональные, молекулярные и интегративные подходы, а также сопоставлена их клиническая ценность в отношении исходов имплантации, клинической беременности и живорождения. Показано, что морфологические и ультразвуковые параметры характеризуются ограниченной прогностической ценностью и высокой межиндивидуальной вариабельностью. Функциональные методы, включая оценку кровотока и перистальтической активности матки, демонстрируют более тесную связь с исходами имплантации, при этом их результаты остаются неоднородными. Молекулярные и клеточные маркеры в ряде исследований показывают более высокую диагностическую точность, но это не сопровождается убедимым улучшением частоты живорождения. Наиболее изученные транскриптомные тесты рецептивности эндометрия не демонстрируют преимуществ по сравнению со стандартным временем переноса эмбрионов в общей популяции пациенток. Следовательно, ни один из существующих методов не обладает достаточной прогностической точностью для самостоятельного клинического применения. Перспективным направлением является разработка интегративных диагностических моделей, объединяющих клинические, функциональные и молекулярные параметры, с последующей валидацией в крупных проспективных исследованиях.

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