Эффективность прайминга мио-инозитолом у пациенток с «бедным» ответом в программе экстракорпорального оплодотворения

Abstract

Aim. To evaluate the effect of myo-inositol administration in the periconceptional period on the parameters of the stimulated cycle, embryological stage and reproductive outcomes of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) programs in patients with expected "poor" ovarian response. Design. Рrospective cohort study Materials and methods. The prospective cohort study included 98 women with low ovarian reserve, corresponding to groups 3 and 4 of the POSEIDON classification (number of antral follicles < 5; anti-Mullerian hormone level < 1.2 ng/ml), planning treatment in the IVF program. The participants were divided into two groups using the envelope method. Patients of group 1 (n = 47) took the drug Inofert Forte (ITALFARMACO, Italy) daily for three months before entering the IVF program, the daily dose of which contained 1200 mg of myo-inositol with alpha-lactalbumin and 400 μg of folic acid. Women in group 2 (n = 51) took 400 mcg of folic acid during preparation for the treatment protocol. Results. The total dose of gonadotropins (2250 (2025; 2287) IU) was significantly lower in group 1 patients taking myo-inositol compared to group 2 women (2400 (2250; 2662) IU), p = 0.017. There was a significant difference in the number of oocytes at metaphase II stage (2.61 ± 0.6 vs. 2.19 ± 0.7, p = 0.046), fertilization rate (79% vs. 70%, p = 0.043), and number of zygotes (1.95 ± 0.5 vs. 1.57 ± 0.6, p = 0.030) between group 1 and group 2 patients, respectively. The total number of blastocysts in women taking inositol-containing preparations was statistically significantly higher than in group 2 and amounted to 1.33 ± 0.6 vs. 1.0 ± 0.3 (p = 0.025), with an equal percentage of blastulation (69% and 67%). The number of class A blastocysts in group 1 amounted to 42% of their total number, while in group 2 women this indicator did not exceed 24% (p = 0.174). When analyzing the outcomes of IVF/ICSI programs, there was a tendency to increase the frequency of clinical and progressive pregnancy in the group of myo-inositol priming without achieving statistically significant results compared to the group with standard preparation for the IVF program. Conclusion. The using of myo-inositol in the periconceptional period may be one of the possible variants of the strategy to increase the effectiveness of ART programs in women with expected "poor" ovarian response to stimulation. Key words: in vitro fertilization, infertility, priming, myo-inositol, poor ovarian response.