4 курс / Акушерство и гинекология / Роль_протеина_ALK5_в_профиле_ранних_репродуктивных

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Distribution of women who were included in the retrospective clinical and statistical analysis by the method of ART

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

The retrospective analysis of the therapeutic techniques to restore fertility in the women who were included in the study revealed a probable link between the risk of early reproductive losses and the ICSI technique. The data showed that 58.33% of SG women who had early reproductive losses became pregnant after the

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Table 14 shows that 8 (13.3%) SG women had a history of one cycle of ART, while 18 (30%) patients had two previous unsuccessful cycles, 28 (46.67%) had three cycles, and 6 (10%) women had over four unsuccessful cycles. It is noteworthy that more than half of the women diagnosed with early reproductive losses had a history of three or more ART cycles. Among SG pregnant women, 24 (40%) women had one cycle of ART in medical history, while 19 (31.67%) patients had two previous unsuccessful cycles, 15 (25%) had three cycles, and 2 (3.3%) women had over four unsuccessful cycles. [230].

The obtained clinical and anamnestic data were used to assess the significance of the leading factors and predict the risk ofearly reproductive losses in women after ART (Table 15).

The clinical and anamnestic analysis in the group of women with early reproductive losses after ART revealed several medical factors that might have provoked pregnancy failure and allowed predicting the risk of a complicated course of the first trimester of gestation.

Table 15 Prognostic assessment of the history and course of induced pregnancy in

women with early reproductive losses

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secondary development (r=0.366, p<0.001), artificial abortion (r=0.327, p<0.001) and a history of spontaneous abortion (r=0.217, p<0.001), and 3 or more unsuccessful ART cycles (r=0.357, p<0.001), most frequently performed with ICSI (r=0.222, p<0.001) .

The mentioned factors suggest that early reproductive losses after ART are a consequence of a large number of pathological causes with the realization of a variety of often crossing pathophysiological pathways, so it is not always possible to identify a dominant etiological factor by existing diagnostic methods. In most cases, it is a combination of several causes that may act simultaneously or sequentially.

The most significant combinations of the leading factors for the probable developmentofearlyreproductivelossesafterARTwere establishedinthiscategory of patients. They included the combination of infertility duration and infertility factor (r=0.459), as well as the number of ART cycles (r=0.297); the type of infertility and the outcome of previous pregnancies (r=0.873).

In addition, RRL, a large share of intrauterine interventions (hysteroscopy, medical and instrumental abortions), and internal endometriosis increased the risk of early reproductive losses. A high body mass index and a history of over three unsuccessful ART cycles increased the risk of early reproductive losses. A combination of late reproductive age with over 10 years of infertility, over three unsuccessful ART cycles, and pelvic surgeries increased the risk of early reproductive loss.

3.2. Immunohistochemical study of the decidual tissue of aborted material in early reproductive losses for the detection of ALK5 protein expression

We were the first to perform an immunohistochemical study of the decidual tissue of aborted material in early reproductive losses to detect ALK5 protein expression. Decidual tissue obtained after an induced abortion during a normal pregnancy was used as a control. Tissue samples were obtained from medication-

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an Arias-Stella reaction were observed in the uterine cavity scrapings. The AriasStella reaction is a hormone-related atypical endometrial change characterized by hypertrophyandvacuolizationofglandularepithelialcellsassociatedwithexpressed nuclear pleomorphism, enlargement, and hyperchromasia.

Fig. 2 Manifested expression of TGFBR1 in a trophoblast of chorionic villi, x400

Characteristic histological features of the Arias-Stella reaction include large cells with abundant eosinophilic or vacuolized cytoplasm, nuclear enlargement, and hyperchromasia. The appearance of hypertrophic nuclei can vary widely from round or ovoid nuclei with a vesicular chromatin pattern to irregular nuclei with a compact pycnotic pattern. Some variants show prominent intranuclear cytoplasmic invaginations or pseudoinclusions. The nuclei may protrude into the lumen of the gland, creating a “spike” appearance. Loss of cell polarity with the appearance of papillary protrusions and swellings of epithelium is possible. Mitotic activity is usually absent [50; 51].

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in the epithelium of endometrial glands, from 24.31±7.25 to 30.75±7.46 per FOV; and in endometrial stromal cells, from 3.63±2.73 to 6.06±3.19 per FOV (Table 16).

Table 16 Comparison of TGFBR1 positive expression levels in decidual tissue in normal

pregnancy and early spontaneous abortion

Immunohistochemical positive expression of TGFBR1 in normal pregnancy was 48.5±12.4 to 59.77±14.3 per FOV in decidual cells; 52±12.4 to 59.77±14.3 in syncytiotrophoblast cells; 13±7.9 to 63.52±10.14 per FOV; in endometrial gland epithelium from 38.4±5.66 to 41.51±8.14 per FOV; and in endometrial stromal cells from 34.31±8.5 to 40.52±10.7 per FOV (Figs. 4–7).