Ефективність ембріологічного етапу екстракорпорального запліднення в пацієнток із прогнозованою слабкою відповіддю яєчників

Abstract

Purpose - to show the efficacy of the embryological stage of in vitro fertilisation (IVF) in women with infertility and predicted poor ovarian response to stimulation with various gonadotropins. Materials and methods. This article analyzes the embryological stage of IVF in 140 women with infertility and predicted poor ovarian response. The main clinical group included 75 women who underwent controlled ovarian superstimulation with urinary gonadotropins in the protocol along with gonadotropin-releasing hormone antagonist. Group II (comparison) included 65 women who underwent stimulation of superovulation as per the similar scheme with recombinant gonadotropins. Oocyte pickups, fertilization, cultivation, and embryo transfer were carried out as per standard techniques. Confirmation or exclusion of biochemical pregnancy was carried out by determining the level of total chorionic gonadotropin in the blood serum 14 days after embryo transfer. When calculating the results, the analysis applied methods that were adopted in medical and biological statistics and described in the Glantz Manual. Data were processed by means of StatSoft Statistica 8.0 software package. Results. Among female patients of Groups I and II - where duration of ovarian stimulation did not exceed 10 days - the average duration of using gonadotropins estimated 8.4±1.3 and 9.5±1.2 days respectively (p<0.05). In patients with a longer administration of drugs compared, the average duration of gonadotropin stimulation was definitely higher when using recombinant gonadotropins, i.e. 12.8±2.0 days versus 10.4±1.4 days (p<0.05). When evaluating the follicle-stimulating hormone (FSH) dose used as part of gonadotropin products compared, it was found that in female patients of Groups I and II - where duration of gonadotropin stimulation did not exceed 10 days - the FSH course dose averaged 2,700±300 IU respectively. With the gonadotropin stimulation lasting for more than 10 days, the FSH dose in Group I increased on average up to 3,000±300 IU; in Group II, it increased on average up to 3,300±300 IU (p<0.05). The number of viable embryos on Day 5-6 of cultivation - in the groups compared - averaged to 5.4±2.1, whereas 4.3±2.3 (p=0.014), and their percentage of the number of obtained zygotes reached 91.2±4.1% and 90.0±5.6% (p=0.041). On Day 5, the process of cultivating viable embryos in the groups decreased down to 4.2±1.5 and 3.6±1.7 (p=0.005), whereas their percentage of the number of obtained zygotes decreased down to 77.2±3.5% and 76.0±4.8% (p=0.012). When conducting the cytomorphological examination of embryos under cultivation, it was found that percentage of good quality embryos in the total pool of embryos aged 5 days was 60.4±13.6% and 54.6±14.2% (p=0.011) respectively, whereas in the total pool of embryos aged 6 days, the percentage was 72.6±14.7% and 68.7±16.4% (p=0.013). Conclusions. The conducted comparative study of the effects of human menopausal gonadotropin and the combination of recombinant FSF + recombinant luteinizing hormone at the pre-transfer stage in all examined female patients with expected poor response to gonadotropins showed that the administration of these drugs was accompanied by definitive differences within a number of parameters of stimulated cycles; in terms of statistics, significant are the conclusions as follows: reducing the stimulation period in women who had duration of gonadotropin for less than 10 days; decreasing the average dose of FSH if the gonadotropin stimulation period lasted less than and more than 10 days; improving the survival rate of embryos aged 5 and 6 days; increasing the percentage of good quality embryos among embryos aged 5 and 6 days. 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 author. Key words: infertility, assisted reproductive technologies, controlled ovarian stimulation, urinary gonadotropins, recombinant gonadotropins.