4 курс / Акушерство и гинекология / Роль_протеина_ALK5_в_профиле_ранних_репродуктивных

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Note: * – significance of values at p<0.001, ** – significance of values at p<0.05.

The obtained data showed that statistically significant factors of early reproductive losses in SG women included vaginal inflammatory processes (36.67% in the SG and 11.67% in the CG, p < 0.001), endometriosis (15% in the SG and 6.67% in the CG, p < 0.001), uterine myoma (11.67% in the SG and 5% in the CG, < 0.05) and cervical pathology (30% in the SG and 11.67% in the CG, p < 0.001).

Thecombinationoftheseadversefactorshasanegativeeffectontherealization of reproductive function and significantly increases the risks of such serious complications as placental dysfunction, delayed intrauterine development of the fetus, and postpartum hemorrhage [5]. It is likely that the presence of latent foci of chronic infections associated with inflammatory processes of the female genitalia and untreated cervical pathology significantly increases the risk of immune

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Note: * – significance of values at p<0.001, ** – significance of values at p<0.05.

According to medical records,surgeries for pelvic adhesionswere3 times more common in the SG versus the CG (p<0.001). It is worth noting that surgical interventions were twice as frequent in older women as in younger patients and only sporadic cases were observed in the control group (p<0.05).

It is obvious that adhesion disease, disturbance of blood supply to the appendages after the fallopian tubes operations, as well as surgical trauma of the ovarian tissue,undoubtedly,have their damaging effect on the parameters ofovarian reserve and steroidogenesis,which indirectly changed thehormonal background and conditions for the physiological formation of endometrial implantation potential in some SG women.

During the analysis of anamnestic data on somatic pathology, attention was paid to the diseases that may have a direct and indirect effect on the formation and functioning of the reproductive system. Analysis of the nature and pattern of extragenital pathology in post-ART women provided an opportunity to identify a group of chronic inflammatory diseases of the urinary system with a latent course, which significantly influences the increased risk of early reproductive losses (Table 8).

Table 8 Distribution of women who were included in the retrospective clinical and

statistical analysis by the structure and rate of extragenital pathology

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Analysisoftheprenatal medical cardsofpregnantwomenshowedthatthemost common forms of diseases of the urinary system were asymptomatic bacteriuria, chronic pyelonephritis, and recurrent cystitis.

All forms of the above extragenital pathology had a subclinical course, and pregnant women had no complaints at the time ofadmission to the obstetric hospital.

The presence of concomitant extragenital pathology was confirmed by the examinations performed by related specialists during routine counseling of pregnant women, and the patients reported their existence during anamnestic data collection.

To clarify the nature of extragenital pathology, additional methods of investigation were used, depending on the pathology profile of each patient.

Thepeculiarity of thelast years is the increasein the share ofcombined somatic pathology and the increasing spread of extragenital disease, the so-called metabolic syndrome with clinical signs of a well-defined symptom complex.

It is worth noting that a disorder of fat metabolism, which is manifested by excessive or insufficient body weight in women enrolled in the ART program, was found in 16.67% of cases. The revealed data undoubtedly indicate a significant influence of a burdened gynecological and somatic anamnesis on the indicators of reproductive losses.

The analysis of the data from the prenatal medical records revealed the leading factors of infertility in the population of women included in the study. Table 9 presents the absolute and percentage numbers of the leading infertility factors in the patients who underwent effective treatment with the latest ART technologies, which resulted in clinical pregnancy.

Thus, the statistical analysis of the primary records of the patients revealed the fact that the main reason for using ART in the examined women was the combined factor of infertility – 44.2% (45% in SG women and 43.3% in CG women), the second place among the causes of fertility loss belongs to the tubal-peritoneal factor

– 30.8% (33.3% in SG women and 28.3% in CG women) and 25% (21.67% in SG women and 28.3% in CG women) is endocrine infertility.

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Note: * – significance of values in the study group in comparison with the control group at p<0.001.

The proportion of infertility up to 2 years was 3.3% in the SG group, whereas in the CG, infertility up to 2 years was detected in 11.67%. The proportion of infertility period of 6–9 years was 30% in the SG, whereas in the CG, an infertility period of 6–9 years was detected in 33.3%. The proportion of the infertility period of more than 10 years was 20% in the SG group, whereas in the CG, an infertility period of more than 10 years was detected in 11.67%.

The average statistical value of the infertility period in the SG was 6.8±3.5 years, in the CG – 6.0±2.9 years. The analysis of anamnesis data showed a correlation between the risk of early reproductive losses and the duration of infertility in women in the SG (p < 0.05) whose pregnancies occurred after ART treatment programs, as compared to women whose pregnancies occurred without any complications. At the same time, the higher was the duration of infertility, the higher was the probability of the risk of early reproductive losses.

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Table 12

Pregnancy outcome in women with secondary infertility

Note: * – significance of values in the study group in comparison with the control group at p<0.001.

The share of artificially induced abortions (11.67% in the SG versus 3.33% in the CG, p<0.001) was larger in women with a poor reproductive history in the SG.

It is likely that the risk of early reproductive loss also depends to some extent on the method of ART (Table 13) that was chosen to treat infertility and the number of previous ineffective treatment cycles in the protocols.

Table 13

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