THE DEVELOPMENT OF A COMPLEX APPROACH AIMING AT COMPLICATIONS DECREASE DURING IN VITRO FERTILIZATION

Abstract

The widespread usage of in vitro fertilization (IVF) in clinical practice not only helps to solve couples’ infertility problems, but can also be accompanied by severe complications that a woman may have.Purpose of the research. To develop a complex approach aimed at reducing the number of complications during in vitro fertilization and to evaluate its effectiveness.Materials and methods of the research. A retrospective analysis of the medical documentation of the reproductive medical center has been carried out before and after the implementation of the developed complex approach aimed at reducing the frequency of complications that happen during IVF. The developed measures included the usage of the IVF protocol with a controlled ovarian stimulation with antagonists of gonadotropin releasing hormone in the case of a high risk of ovarian hyper stimulation syndrome, taking into account the level of serum progesterone, the usage of gonadotropin-releasing hormone agonist as an ovulation trigger, the introduction of a synthetic analogue of vasopressin in the case of intraperitoneal bleeding, the selection of patients who can be transferred embryos in a fresh cycle or carry out cryopreservation and transfer not more than one or two embryos into the uterus.Results of the research. The implementation of the developed measures allowed to reduce the frequency of the ovarian hyper stimulation syndrome (from 10.5% to 5.0%, P<0.001), the relative risk reduction was 52.1% (95% CI 30.5-67.0%), which correlated to the clinically significant effect. There was not a single case of intra-abdominal hemorrhage. The decrease in the cases of ectopic pregnancy (from 2.5% to 0.7%, P=0.003) and the absence of heterotopic pregnancy have been recorded. The fact of the increase in the frequency of clinical pregnancies (from 28.8% to 38.3%, P<0.001), reduction of multiple pregnancies (from 28.2% to 6.8%, P<0.001) and, accordingly, reductions (from 8.0% to 2.1%, P=0.002) can be regarded as a beneficial one. The cases of favorable infertility treatment, which resulted in the birth of a live child (from 23.0% to 35.0%, P <0.001) have been increased, with a relative benefit in 52.4% (95% CI 30.0-78.7%), which correlated to a clinically significant effect.Conclusion. The developed complex of measures allows to reduce the cases of complications arising as a result of treatment of IVF, contributes to increasing the frequency of onset of clinical pregnancy and the birth of a live child.