Гормональний моніторинг функції жовтого тіла, трофобласта і плаценти при одноплідній вагітності в жінок із різними видами безплідності в анамнезі

Abstract

Purpose — to investigate hormonal monitoring of the function of the corpus luteum, trophoblast and placenta in pregnant women with a history of various types of infertility. Materials and methods. We have studied hormonal parameters from 8 to 14 weeks of pregnancy in 420 women. The study of hormonal parameters was carried out in three groups (six subgroups): Group I — pregnant women with a history of endocrine infertility: Ia — 50 patients after IVF, Ib — 50 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF; Group II — pregnant women with a history of inflammatory infertility: IIa — 100 patients after IVF, IIb — 100 patients who became pregnant independently after conservative and surgical treatment of inflammatory infertility, but without IVF; Group III — pregnant women with a history of combined infertility, inflammatory genesis with endocrine, IIIa — 30 patients after IVF, IIIb — 30 patients who became pregnant on their own after conservative and surgical treatment of combined infertility, but without IVF. A study of the content of placental hormones in the dynamics of pregnancy at 7–10 and 11–14 weeks was carried out: estradiol (E2), progesterone, human chorionic gonadotropin (β-hCG) and pregnancy-associated plasmoprotein (PAPP-A). Determination of E2, progesterone was carried out by the enzyme-linked immunosorbent assay using standard kits of the Delfia system on a 1420 Victor 2 analyzer from Perken Elmer (USA). β-hCG and PAPP-A were determined by the immunochemiluminescent method using test systems manufactured by Siemens. Results. We carried out hormonal monitoring of the corpus luteum and trophoblast function and analyzed the results of fetal biochemical markers in 276 pregnant women. The data obtained indicate that in the period of 7–10 weeks of pregnancy, the concentration of progesterone was significantly higher in women after IVF relative to the indicators of patients with natural conception. At this stage of pregnancy, the level of progesterone did not depend on the form of infertility. Similar changes were observed with respect to estradiol levels. So the level of estradiol in pregnant women of 7–10 weeks during natural pregnancy was ≈5.0 nmol/L, while the same level of estradiol in pregnant women with one fetus after IVF was 8.4±1.1 nmol/L. The progesterone/estradiol ratio was virtually the same across the groups. The level of estradiol and progesterone in the blood of women at 11–14 weeks of gestation also practically did not differ, and did not depend on the form of infertility and the method of conception. It should be especially noted that at 11–14 weeks there was a decrease in the progesterone/estradiol ratio, which represents a progressive pronounced relative progesterone deficiency and hyperestrogenism in women with infertility. The indicators were especially low in pregnant women of groups I and III, who had endocrine and combined infertility in the anamnesis. We also investigated the indicators of β-hCG and PAPP-A in pregnant women 11–14 weeks. by groups, as classic markers of screening for congenital malformations of the fetus and the risk of complications of pregnancy. So the level of PAPP-A in pregnant women did not significantly differ in groups, both from the method of conception and the type of infertility in the anamnesis. The level of β-hCG in pregnant women 11–14 weeks of singleton pregnancy after IVF is significantly higher than in women with natural conception. The highest rates were in the group after combined infertility. Conclusions. The level of hormones: estradiol and progesterone in pregnant women after IVF at 7–10 weeks was higher than in women with a history of infertility during natural conception. Already at 11–14 weeks, the same indicators in the same groups did not differ. After natural conception, the rate of increase in estradiol significantly outpaced the increase in progesterone levels in pregnant women with a history of infertility. The concentration of PAPP-A in the first trimester in pregnant women after IVF did not significantly differ from those in women with natural conception. The content of β-hCG at 11–14 weeks in groups of pregnant women after IVF was 1.5–2 times higher. The highest rates were in pregnant women with a history of concomitant infertility. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: estradiol, progesterone, β-hCG, PAPP-A, pregnancy after infertility.