Медико-соціальні особливості пацієнток пізнього репродуктивного віку зі зниженим оваріальним резервом

Abstract

Purpose - to determine medical and social features of patients of late reproductive age with reduced ovarian reserve. Materials and methods. 130 patients with assisted reproductive technologies (ART) programs were divided into groups according to POSEIDON criteria. The main group of 80 patients of older reproductive age (35 years and older) is divided into 2 subgroups according to the POSEIDON criteria. Subgroup 1 consisted of 34 women with a predicted poor response to controlled ovarian stimulation (COS) - group 4 according to POSEIDON. Subgroup 2 - 46 patients with a predicted normal response to COS (POSEIDON group 2). The comparison group consisted of 50 patients under 35 years of age with a predicted normal response to COS (POSEIDON group 1). The quality of life was assessed according to the FertiQoL questionnaire, the presence and degree of depression according to the method of V. Zung. Results. The share of women aged 40 and older among patients with ART programs with a predicted poor response to COS is 3 times higher than the predicted normal respondents (32.4% vs. 10.9%), which reflects the decisive role of women’s age in reducing ovarian reserve. A significant proportion of women in this category report such a bad habit as smoking (17.6%), the third - a sedentary lifestyle (32.4%) and stress (29.4%), 26.5% - a violation of the daily routine and work. Problems with reproduction affect the quality of life of women and cause psychological changes. More than a third of women (35.3%) rate their health as poor and very poor, and more than half (53.0%) are dissatisfied with their quality of life. The emotional sphere suffers the most from fertility problems (score - 45.3±2.2), and the assessment of mental and physical health and social functioning is reduced. Although patients appreciate the quality of treatment, its tolerability is worse in these women. At the same time, the psychological state of half of women is assessed as subdepressive or masked depression (52.9%), and depression was diagnosed in 14.7% of respondents. Conclusions. Established medical and social characteristics of women of late reproductive age with reduced ovarian reserve (smoking, daily and work disorders, sedentary lifestyle, stress, low quality of life, subdepressive and depressed state) indicate the need for additional inclusion in ART training programs lifestyle and methods of psychocorrection. 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 the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: infertility, older reproductive age, reduced ovarian reserve, assisted reproductive technologies, quality of life, depression.