RISK FACTORS AND PREVENTION OF EARLY PREGNANCY LOSSES AFTER IN VITRO FERTILIZATION

Abstract

The study was conducted in 2016 in four stages on the basis of the department of assisted reproductive technologies of the Moscow Regional Perinatal Center of Balashikha with the purpose to determine the tactics allowing increase of the number of patients who managed to successfully overcome the embryonic threshold after the In Vitro Fertilization (IVF) and embryo transfer (ET). Patients were divided in groups with early embryonic losses and the control group. At the following stage of the study determination of the effect of each unfavourable factor on gestation in the first and in the second groups of patients was done. It turned out that such factors as the amount of obtaine oocytes in the course of transvaginal puncture less and equal to 7 (r k = 0,42, р = 0,005); chronic endometritis supported by histological findings (r k = 0,74, р = 0,005); disturbance of the receptor status of endometrium (r k = 0,71, р = 0,005); coincidence with the spouse by HLA system 3 and higher (r k = 0,26, р = 0,03); circulation of AB to β -HCG, weakly positive and positive result of the test by the ELISA method statistically significantly affect the early embryonic losses if the patient refused from the proposed correction before IVF (r k = 0,31, р = 0,005). And on embryonic – innate trombophilias (r k = 0,78, р = 0,00); acquired thrombophilias (r k = 032, р = 0,003); chronic endometritis confirmed by histological findings (r k = 0,64, р = 0,033); circulation failure in the small pelvis by results of the uterine vessel dopplerometry (r k = 0,66, р = 0,00). Comparison of effectiveness of IVF and ET programs in 2016 was conducted in patients who had and didn’t have the risk factors statistically significantly affecting the outcome. The first two groups of patients were subject to specialized therapy depending on the detected unfavourable factors affecting the outcome of the pregnancy after IVF provided that it was possible to correct this factor with subsequent evaluation of effectiveness of repeated attempts of IVF and ET in patients after correction of unfavourable factors as compared to the control group. The tactics of minute detection of patients with statistically significant risk factors of early embryonic and embryonic losses, as well as complex preparation of such patients by modern methods allows increasing the number of patients who managed to safely overcome the embryonic threshold after IVF and ET by 20% and finally to positively affect the take baby home indicator.