Assisted Reproductive Technology Program Research Articles

Management strategies for POSEIDON patients with poor ovarian response to ovarian stimulation: а literature review

A poor ovarian response to ovarian stimulation is a factor that significantly reduces the effectiveness of in vitro fertilization programs. Managing these patients remains an unresolved issue in assisted reproductive technology programs. The difficulties are largely determined by the heterogeneity of groups of patients with a poor ovarian response and the need for a personalized approach to ovarian stimulation. This review covers the data from the global literature on the management tactics of patients with a poor ovarian response according to the POSEIDON classification, with the aim of increasing the quantity and quality of retrieved oocytes and clinical pregnancy rates.

On the issue of repeated implantation failures with assisted reproductive technologies

Embryo implantation is the first key step of a successful pregnancy, but implantation failures in patients undergoing assisted reproductive technology (ART) programs remains quite common. The main known factors of repeated implantation failures (RIF) in patients undergoing ART are unhealthy lifestyle, genetic factor, uterus pathology, endometriosis and adenomyosis, thrombophilia, and also male factor and embryonic factors. RIF factors and ways to overcome them receive much attention from researchers. However, although many possible RIF causes have been identified, much remains unknown regarding the etiology and management of this condition. In clinical practice, studies and interventions are often used without clear scientific rationale or convincing evidence of their effectiveness due to the lack of standardization of diagnostic and treatment methods. An effective strategy for treating RIF risk factors is necessary to increase the chances of successful pregnancy in assisted reproductive technology programs.

Gonadotropins in assisted reproductive technology programs: A review

Reproductive medicine is actively developing, and new methods, drugs, and protocols are being developed and introduced for the treatment of infertility. Assisted reproductive technologies (ART) are the most effective methods. In ART protocols, ovarian stimulation (OS) is based on gonadotropin use. The choice of the starting dose of gonadotropin is a critical factor in the successful OS and the effectiveness of ART programs. The article describes the development history of gonadotropins and provides current data on their use in ART programs. The use of biosimilars of follitropin alfa in OS is discussed, and the effectiveness of its Russian biosimilar is also addressed. TRANSLATE with x English Arabic Hebrew Polish Bulgarian Hindi Portuguese Catalan Hmong Daw Romanian Chinese Simplified Hungarian Russian Chinese Traditional Indonesian Slovak Czech Italian Slovenian Danish Japanese Spanish Dutch Klingon Swedish English Korean Thai Estonian Latvian Turkish Finnish Lithuanian Ukrainian French Malay Urdu German Maltese Vietnamese Greek Norwegian Welsh Haitian Creole Persian TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Back

Treatment of mares with the non-steroidal anti-inflammatory drug (NSAID) phenylbutazone transiently affects in vitro maturation of equine oocytes and blastocyst development after Intracytoplasmic Sperm Injection (ICSI)

Mares enrolled in assisted reproductive technologies (ARTs) programs are often treated with non-steroidal anti-inflammatory drugs (NSAIDs), particularly phenylbutazone (Bute), due to chronic lameness. The current study was performed to determine the effect of Bute administration on the developmental competence of in vitro-matured equine oocytes subjected to Intracytoplasmic Sperm Injection (ICSI). In a Preliminary Study, immature cumulus-oocyte complexes (COCs) recovered by post-mortem ovary harvested from two healthy mares (n = 2) treated for 10 days with Bute (4.4 mg/kg, PO, BID), and four non-treated healthy mares (n = 4), were matured in vitro and subjected to Piezo-driven ICSI. Lower oocyte in vitro maturation [Bute: 25% (3/12) vs. Control: 61% (28/46)] and blastocyst rates [Bute: 0% (0/12) vs. Control: 18% (5/28)] were observed in the Bute-treated when compared to the Control mares (P < 0.05). In the Main Experiment, a group of healthy mares (n = 9) received a daily dose of Bute (4.4 mg/kg, orally, SID) for 10 days. A control group of mares (n = 10) was treated with an equal volume of placebo. Mares in both groups were subjected to ultrasound-guided transvaginal oocyte aspiration (TVA) on days 3, 33, and 77 following the last dose of Bute (PT). Recovered COCs from both mare groups were matured in vitro and subjected to Piezo-driven ICSI. By day-3 PT, oocyte in vitro maturation rate was similar between mare groups [Bute: 65% (36/55) vs. Control: 67% (78/116); P > 0.05], while oocyte recovery [Bute: 53% (55/103) vs. Control: 70% (116/166)], cleavage [Bute: 31% (11/36) vs. Control: 62% (48/78)] and blastocyst rates [Bute: [0%] (0/36) vs. Control: 28% (22/78)] were significantly different (P < 0.05). By day 33 PT and 77 PT, differences on oocyte recovery, in vitro maturation, cleavage, and blastocyst rates were not observed between mare groups. In summary, the administration of Bute for 10 consecutive days (4.4 mg/kg, PO, SID, or BID) is associated with a decrease in the ability of immature equine oocytes to undergo in vitro-maturation (Preliminary Study) and develop to the blastocyst stage following ICSI (Preliminary Study and Main Experiment). This negative effect appeared to be transient, as 30- and 77-days post-treatment, no differences on in vitro maturation, cleavage or blastocyst rates were observed.

DETERMINATION OF IL-1β mRNA GENE EXPRESSION AND HMGB-1 mRNA GENE EXPRESSION IN WOMEN WITH GENITAL ENDOMETRIOSIS ASSOCIATED WITH INFERTILITY AT THE STAGE OF PREPARATION FOR ASSISTED REPRODUCTIVE TECHNOLOGIES

Despite the large number of studies on the identification and search for noninvasive early diagnostic markers of genital endometriosis, this problem remains relevant today. It is important to introduce early diagnosis of genital endometriosis for the purpose of timely prevention and treatment.Objective: to study the expression levels of IL-1β and HMGB-1 mRNA genes in women with genital endometriosis associated with infertility, and to evaluate the effect of our proposed preparation for assisted reproductive technologies on the level of IL-1β and HMGB-1 mRNA gene expression.Material and methods. To analyze gene expression IL-1β and HMGB-1 and determine relative normalized mRNA expression IL-1β and HMGB-1, the polymerase chain reaction method was used with real-time reverse transcription(RT-PCR. The object of molecular genetic studies using the RT-PCR method was the fraction of mononuclear cells isolated from the whole blood of patients with endometriosis. In this study, we performed a retrospective analysis of the medical records of 30 women with infertility undergoing an assisted reproductive technology program. The main group consisted of 20 women diagnosed with external genital endometriosis who underwent assisted reproductive technologies. Women in the main group, in addition to standard training for assisted reproductive technologies, received a probiotic containing Lactobacilli 1010 manufactured by Unic Biotech Ltd, India. They took one pill twice a day for one month as part of a general treatment before undergoing assisted reproductive technologies. We determined the expression level of IL-1β and HMGB-1 before and after this preparation stage. The control group consisted of 10 women who had tubal infertility due to a previous inflammatory disease, but according to the results of a comprehensive clinical and laboratory examination, they were compared to healthy women. These women, aged 21 to 42 years, with a mean age of 29,75 years, did not receive our proposed preparation with the inclusion of a probiotic. This study was conducted at the Bukovyna State Medical University and the clinic "Yuzko medical center".Results. In the main group, the IL-1β mRNA gene expression level before training was (26,7877±0,01), which was significantly higher than the level after training (0,1610±0,01*). Consequently, the use of the probiotic led to a dramatic reduction in elevated mesothelin levels, underscoring its efficacy and potential application in assisted reproductive technology training programs. Also, a high level of expression of mRNA genes can be noted HMGB-1in whole blood of women of the main group before preparation for assisted reproductive technologies (table 2). Expression level of mRNA genes HMGB-1in whole blood of women of the main group before preparation for assisted reproductive technologies was (11,9198±0,01). After our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic, the mRNA gene expression level HMGB-1in the whole blood of women of the main group was (0,2821±0,01*). Therefore, our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic is quite effective, since the expression levels of IL-1β mRNA genes and HMGB-1sharply decreased.Conclusions. Extremely high expression of mRNA genes IL-1β and HMGB-1 indicates a close connection between the pathogenesis of endometriosis and inflammation. The inclusion of probiotics in the complex scheme of preparation for assisted reproductive technologies leads to a noticeable improvement in the well-being of the patient and a significant decrease in the expression of IL-1β and HMGB-1 mRNA genes. Therefore, we recommend our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic.

Evaluation of renal function in patients with type 1 diabetes mellitus implementing reproductive function in assisted reproductive technology protocols

The prevalence of type 1 diabetes mellitus has increased significantly among women of reproductive age over the past two decades. Despite improved glycemic control and intensified insulin therapy, patients with diabetes still suffer from many reproductive problems, which often makes this group of patients potential participants in assisted reproductive technology programs under certain conditions. Diabetic nephropathy is one of the most serious complications of type 1 diabetes mellitus. It ranks first in the structure of chronic kidney disease and is a common cause of end-stage renal failure, disability, and mortality. Early diagnosis and identification of specific markers of diabetic nephropathy will allow for timely initiation of nephroprotective therapy to slow the progression of diabetic kidney damage.&#x0D; This review article is based on the results of the PubMed, Frontiers, and ResearchGate search queries from 2016 to 2023. We analyzed worldwide and domestic data on the impact of type 1 diabetes mellitus on kidney function, the influence of sex hormones on diabetic nephropathy, and the importance of the personalized approach to this group of patients at the pre-pregnancy stage, especially those planning treatment within assisted reproductive technology programs.

Overcoming poor ovarian response in assisted reproductive technology programs in patients of late reproductive age

Objective: to increase the effectiveness of in vitro fertilization in patients of late reproductive age by optimizing prepregnancy preparation for the IVF program.Materials and methods: The study included 67 patients of late reproductive age with a history of unsuccessful IVF attempts, divided into two groups at the second stage of the study, depending on the volume of prepregnancy preparation: group 1 (33 patients), group 2 (34 patients). The control group (50 patients) were healthy women of reproductive age. Immunohistochemical examination of the endometrium and microbiological examination of the uterine cavity, hormonal status of peripheral blood, study of the concentration of melatonin in peripheral blood and follicular fluid, antioxidant status of follicular fluid, expression of leukemia inhibitory factor (LIF) in the cervical secretion were performed.Results: in patients with age-related dysregulation of the hypothalamic-pituitary-ovarian axis and impaired fertile function, a systemic and local (in follicles) decrease in melatonin levels was revealed. The studied effects of melatonin suggested that its use in patients of late reproductive age with reduced follicular reserve and a "poor" response to ovarian stimulation may increase the effectiveness of in vitro fertilization (IVF).Conclusions: The inclusion in the pre-gravidar preparation of a complex of water-soluble polypeptide fractions of the epiphysis, stimulating the production of endogenous melatonin, made it possible to increase the effectiveness of IVF in patients by an average of 3.1 times according to the criterion of "clinical pregnancy" and 4.1 times according to the criterion of "live birth".

The influence of neurovegetative and psychological characteristics of infertile patients with long-term COVID-19 on the effectiveness of assisted reproductive technologies

The connection of the long-COVID-19 symptom with violations of various systemic factors, in particular with the female reproductive system, is considered, but the number of such studies is not large. The purpose of the study is the influence of neurovegetative and psychological characteristics of infertile patients with long-term COVID-19 on the effectiveness of assisted reproductive technologies (ART). Materials and methods. The main group consisted of 80 women with infertility and "long-COVID", the comparison group - 40 patients without a history of COVID-19. In the main group, 2 subgroups were distinguished: 1 - 64 women with unsuccessful ART and 2 - 16 patients in whom ART was successful (a live birth was obtained). Socio-economic status and stress factors (questionnaire), fear of stress-19 (FCV-19S scale), autonomic dysfunction were assessed using the O.M. questionnaire. Wayne (1998), Anxiety and Depression Levels on the Hospital Anxiety and Depression Scale (HADS). The used methods of variational statistics using the Student's t-test and Fisher's angular transformation with a critical significance level of p&lt;0.05 were used to calculate the odds ratio (OR) and its confidence interval (CI). Results. Women with infertility and "long-COVID-19" are characterized by a relatively low level of socio-economic status: a lower level of income, a smaller share of entrepreneurs and housewives, not comfortable enough living conditions. These patients have a higher level of stressogenic load: comorbidity with chronic somatic pathology (58.8%), conflict situations in the family (31.3%), dissatisfaction with their sexual relationships (58.7%), a significantly higher level of fear of COVID -19 (29.73±1.31 points). Vegetative dysfunction is diagnosed in 82.5% of patients. Symptoms that are typical for "long-COVID-19" are most often noted: reduced work capacity/fatigue (82.5%), attack-like headaches (72.5%), difficulty breathing (47.5%), sleep disturbances (47 .5%). Unfavorable medico-social and psychological risk factors for the failure of ART programs in patients with "long-COVID-19" can be a point assessment of the autonomic dysfunction syndrome above 25 (OR=5.80, CI 1.22-27.64), anxiety (OR=5.80, CI 1.56-21.62), presence of depression (OR=4.20, CI 1.27-13.89), chronic somatic disease (OR=4.20, CI 1.30-13.62), conflict situations (OR=3.86, CI 1.24-12.04). Conclusions. Women with infertility and "long-COVID-19" need additional examinations to assess the medical and social status, vegetative function and psychological state, correction of detected violations. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors.

Lay understanding and experience of sexual intercourse among couples with infertility undergoing an assisted reproduction technology program: A qualitative study

AimTo explore the perception and lay understanding of sexual intercourse and sexual life experiences among infertile couples before, during, and after undergoing an assisted reproduction technology (ART) program. MethodThe participants of this descriptive qualitative study were Indonesian couples with infertility who underwent an ART program. Semi-structured interviews were conducted between September and December 2022, and the participants' responses were recorded. Data were analyzed using a step-by-step analysis based on Braun's qualitative analysis. The study was reported based on the Consolidated Criteria for Reporting a Qualitative Research (COREQ) Checklist. ResultsFifty participants were included, and five themes were developed before and two themes during or after the ART program. The couples’ knowledge varied as they experienced sexual intercourse at different periods, such as before, during, and after the ART program. Many participants reported that ART affected their emotions and mood, leading to decreased desire to engage in sexual intercourse. However, some used sexual intercourse as a basis for creating optimism and confidence in having offspring. Furthermore, couples perceived that the purpose of sexual intercourse is not only to have offspring but also to improve communication, promote intimacy, and express affection. In contrast, some perceived the ART program as time consuming, preventing them from engaging in sexual activities. However, not all couples considered sexual activity solely as a means of procreation. They concluded that sexual behavior is not only determined by genetics. ConclusionCouples who underwent the ART program regardless of its effectiveness were aware that sexual interaction is not only for having children but also for preserving harmony and familial connection.

Evaluation of the effect of mitoquinone on functional parameters, DNA structure, and genes expression related to the apoptotic and antioxidants of human sperm after freezing-thawing.

Sperm freezing is considered as an effective way in assisted reproductive technology (ART) programs, it has detrimental effects on sperm function, due to the production of reactive oxygen species (ROS). This study aimed to investigate the potential of Mitoquinone (MitoQ) in inhibiting the production of mitochondrial ROS during sperm freezing. A total of 20 human normozoosperm samples were collected for this study. The samples were divided into four groups, each containing different concentrations of MitoQ (0, 0.2, 2, and 20 nM), and then subjected to the freezing process. After thawing, the sperm suspensions were evaluated for parameters including motility, morphology, acrosome integrity, adenosine triphosphate (ATP) level, intracellular ROS, viability, chromatin packaging, DNA denaturation, DNA fragmentation, as well as the expression of antioxidants (GPX, SOD) and apoptotic (Bax, Bcl2) genes. The results showed that total and progressive mobility of sperms significantly increased in the 2 nM group, while significantly decreased in the 20 nM group (p ≤ 0.05). Sperm morphology did not significantly improve across all the tested concentrations (p ≥ 0.05). Intracellular ROS levels showed a significant decrease and increase in the concentrations of 2 and 20 nM, respectively (p ≤ 0.05). Furthermore, a significant increase was observed in viability, ATP, acrosome integrity, chromatin packaging, and non-denatured and non-fragmented DNA after treatment with 2 nM of MitoQ, compared with the control group (p ≤ 0.05). Regarding gene expressions, the relative expressions of oxidative stress genes were increased in the 2 nM group and decreased in the 20 nM group (p ≤ 0.05), while no significant difference was observed in the expressions of apoptotic genes compared with the control group (p ≥ 0.05). All the comparisons were made with respect to the control group. Adding the optimal concentration of MitoQ (2 nM) to the sperm freezing medium not only improves sperm functional parameters and reduces DNA damages, but also stimulates the expression of antioxidant genes, leading to even greater benefits for sperm cryopreservation.

Prediction of a poor ovarian response in assisted reproductive technology programs in patients after surgical interventions on the ovaries

Prediction of a poor ovarian response in assisted reproductive technology programs in patients after surgical interventions on the ovaries

ЗАСТОСУВАННЯ ПРОГРАМ ДОПОМІЖНИХ РЕПРОДУКТИВНИХ ТЕХНОЛОГІЙ В УКРАЇНІ: УПРАВЛІНСЬКІ АСПЕКТИ

The article discusses managerial aspects of the use of assisted reproductive technology programs in Ukraine. It was noted that it is now critically important for the natural recovery of the population of Ukraine to do everything possible to expand access to treatment, diagnosis and prevention of infertility, in particular with the help of programs of assisted reproductive technologies. It was determined that currently in Ukraine the most active subjects are service providers who determine the direction of development of management relations in the field of application of assisted reproductive technologies. The need to intensify the activities of the authorities regarding their role as a regulator of social relations within their competence is emphasized. Attention is focused on the development of a balanced regulatory toolkit of management, i.e. regulatory and legal acts of different legal force, follows organically from this. Attention was also drawn to the broad context of management in the field of application of assisted reproductive technologies. It is argued that within the scope of determining the priority directions for improvement of management in the field of application of assisted reproductive technology programs in Ukraine, it is expedient to develop not only medical, but also socio-humanitarian and socio-economic research on the evidence of certain reproductive health management practices. It is emphasized that in modern realities, the context of post-war reconstruction should also be taken into account in order to determine the ways of development of management in the field of application of assisted reproductive technologies. It was concluded that in order to ensure the high-quality functioning of the health care sector in the current realities, several options for solving the most acute problems are proposed: strengthening decentralization; expanding the space of freedom for autonomous work of doctors; establishment of coordination of activities between all links of medical care; introduction of new roles in the system of health care services; mental health as priorities for state funding.

Histological changes in the endometrium during intrauterine use of platelet-rich plasma (PRP) in assisted reproductive technology programs

Histological changes in the endometrium during intrauterine use of platelet-rich plasma (PRP) in assisted reproductive technology programs

ЕФЕКТИВНІСТЬ УПРАВЛІННЯ У СФЕРІ ЗАСТОСУВАННЯ ПРОГРАМ ДОПОМІЖНИХ РЕПРОДУКТИВНИХ ТЕХНОЛОГІЙ

The article substantiates the directions for increasing the efficiency of management in the field of application of assisted reproductive technology programs in Ukraine. It was noted that for the successful implementation of new approaches to the management of the DRT sphere, the government, all management bodies and society in general should investigate in more detail the complex of management measures in order to increase the efficiency of the functioning of this system. It is emphasized that the management of the field of DRT is closely related to the management of risks arising from globalization and modernization, which requires management participants to have the skills and ability to recognize and solve problems both in the field of health care and in other areas where risks arise. Attention is focused on the fact that in the process of studying the issues of the effectiveness of DRT management, it is worth focusing on specific Sustainable Development Goals: Goal 3 "Strong health and well-being" and Goal 17 "Partnership for sustainable development". Performance evaluation criteria are proposed, which will contribute to the improvement of the quality of management in the field of application of DRT programs at the current stage of the development of the Ukrainian state. This list of criteria can be further expanded and improved, because these proposals contain those performance indicators that are absolutely necessary at today's stage of development of management relations in the field of DRT application, when the sector is given over to self-regulation, programmatic and regulatory documents are not adopted for years. It is concluded that in order to achieve the maximum effectiveness of management in the field of application of DRT, it is advisable to implement the following principles of health management, which are combined in the general societal and national approaches: management through cooperation; management by involving citizens; management through a combination of regulation and persuasion; management through independent agencies and expert bodies; management through adaptive policies, sustainable structures and forecasting results.

The effectiveness of assisted reproductive technologies immunological prediction

The high frequency of infertility is a significant medical and social problem in many countries of the world; assisted reproductive technologies (ART) are actively used to solve it. Given that immune responses play an important role in the development and maintenance of pregnancy, the study of changes in immune parameters is relevant in different trimesters of pregnancy, as well as at the stage of preconception preparation. It is believed that the maternal-fetal relationship is not limited to the development of maternal tolerance to fetal antigens, but is complemented by complex cytokine interactions that control selective immune regulation, control of adhesion and vascularization processes during embryo implantation and pregnancy. The purpose of the review was to analyze the available scientific data on the use of immune parameters to predict the effectiveness of ART. A review of Russian and foreign scientific papers on prevalence, immunopathogenetic mechanisms, and infertility diagnostics was carried out. A multi-criteria search was carried out for inventions, abstracts of patent documents on immunological prediction of the effectiveness of ART. As predictors, immunocompetent cells (CD3+-, CD4+-, CD3-CD16+56+-venous blood lymphocytes, CD95+ macrophages of endometrial biopsy), cytokines, pregnancy glycoproteins, autoantibodies, immunogenetic markers are presented. The study of the quantitative level of cytokines in blood serum, ovarian follicular fluid and endometrium as mediators of intercellular and intertissue interactions is of undoubted scientific and practical interest in terms of establishing their discriminatory levels specific to different trimesters of a normal pregnancy, the threat of miscarriage, and infertility. There was an association with non-occurrence of pregnancy due to in vitro fertilization of an increased content of interleukin (IL)-2 and interferon (IFN)-γ in the follicular fluid, and a soluble receptor IL-2-α, IL-8 and lactoferrin in the blood serum. The immunosuppressive effects of pregnancy-associated α2-glycoprotein, trophoblastic β1-glycoprotein, α-fetoprotein, α2-macroglobulin contribute to the development and maintenance of pregnancy, but their prognostic value is not unambiguous. The study of the content of immunoglobulins G to α2-macroglobulin, lactoferrin, progesterone, estradiol, cardiolipin in the follicular fluid and blood serum makes it possible to predict the result of ART. Conclusion. The study of immune parameters, especially in combination with sex hormones and characteristics of the state of the embryo, in infertile women has diagnostic value and prognostic significance, and can contribute to the timely correction of therapy and the ART program.

Risk factors for the ineffectiveness of assisted reproductive technology programs after a woman’s illness with COVID-19

Purpose - to determine the risk factors for the ineffectiveness of ART programs after a woman’s illness with COVID-19. Materials and methods. In the group of 80 examined patients with symptoms of “long-COVID” who applied to the reproductive technology clinic for infertility treatment, 2 subgroups were distinguished: the Subgroup 1: 64 patients in whom assisted reproductive technologies (ART) was unsuccessful (cancellation of transfer, non-occurrence of pregnancy or its loss) and the Subgroup 2: 16 women with successful ART (live birth). Results. Significant differences were found among patients with unsuccessful use of ART in terms of the frequency of the main symptoms of “long-COVID”, the following symptoms stand out: “depression, anxiety” (54.7% vs. 18.8%, p&lt;0.05) and “sleep disturbances” (59.4% vs. 31.3%, p&lt;0.05). A significant difference was also found in social and household factors: the presence of stress (35.9% vs. 12.5%, p&lt;0.05), especially in everyday life (31.3% vs. 6.3%, p&lt;0.05), the presence of bad habits (21.9% vs. 6.3%, p&lt;0.05). A significantly higher frequency of decreased ovarian reserve (32.8% vs. 12.5%, p&lt;0.05) and corresponding hormonal disorders: increased follicle-stimulating hormone (21.9% vs. 6.3%, p&lt;0.05) and decreased anti-Müllerian hormone (25.0% vs. 6.3%, p&lt;0.05). Among somatic pathology, endocrine pathology stands out (45.3% vs. 12.5%, p&lt;0.05), in particular metabolic disorders (34.4% vs. 12.5%, p&lt;0.05). A significant difference was also established in the frequency of liver diseases (21.9% vs. 6.3%, p&lt;0.05) and gastrointestinal tract (23.4% vs. 12.5%, p&lt;0.05). There is a higher frequency of menstrual disorders, namely a decrease in the duration of menstruation (20.3% vs. 6.3%) or, conversely, prolonged menstruation (17.2% vs. 6.3%), an irregular cycle (25.0% vs. 6.3%, p&lt;0.05) and luteal phase insufficiency (21.9% vs. 6.3%, p&lt;0.05). Urogenital infections were noted in 43.8% of patients (vs. 12.5%, p&lt;0.05). Conclusions. Risk factors for the ineffectiveness of ART programs have been established, among which stress, depression and anxiety, bad habits, endocrine pathology, metabolic disorders, liver pathology, menstrual cycle disorders, and urogenital infections are especially highlighted. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors.

CLINICAL RESULTS IN PATIENTS WITH REDUCED OVARIAN RESERVE IN PROTOCOLS OF ASSISTED REPRODUCTIVE TECHNOLOGIES

Introduction. The issues of infertility treatment remain relevant, even in light of significant advances in reproductive medicine. Among the primary factors contributing to reproductive function disorders in women, age stands out prominently. The trend of women delaying pregnancy planning due to their emphasis on social fulfillment and financial stability has been steadily increasing. The aim of this study is to assess the effectiveness of protocols of controlled ovarian stimulation using pre-gravid preparation in patients with reduced ovarian reserve when using assisted reproductive technologies. Participants and methods. This study involved 112 women experiencing infertility due to reduced ovarian reserve and tubal infertility factors. These women underwent a brief ovulation stimulation protocol as part of an assisted reproductive technologies program. The participants were categorized into three groups: the first group comprised 43 women with infertility due to reduced ovarian reserve; prior to controlled ovarian stimulation (COS) and follicular puncture, this group received a combined treatment, which included a vitamin complex containing inositol ("FT500 plus"), a dietary supplement based on alpha-lipoic acid and magnesium ("Pelvidol"), dehydroepiandrosterone (DHEA), and growth hormone ("Zomacton"); the second group consisted of 38 women with infertility associated with reduced ovarian reserve who did not receive any pre-conception preparation; the third group, serving as the control, consisted of 31 women with infertility resulting from tubal factors, and they did not undergo any pre-conception preparation. The clinical outcomes of the women in both research groups and the control group were analyzed based on their treatment tactics within the ovulation stimulation protocols in assisted reproductive technologies programs. Results and discussion. The average number of oocytes obtained from patients with infertility under reduced ovarian reserve who underwent pre-gravid preparation with the medications "FT500 plus" and "Pelvidol" is statistically higher compared to the group of women with reduced ovarian reserve who did not undergo pre-gravid preparation for COS. Clinical results also indicate positive dynamics regarding proper fertilization, blastulation of embryos and subsequent pregnancy in women, who underwent pre-gravid preparation with an inositol-based pharmaceutical "FT500plus" and the dietary supplement "Pelvidol", dehydroepiandrosterone (DHEA) and "Zomacton" (growth hormone).Conclusion. The results of this clinical study demonstrate the effectiveness of pre-conception preparation for patients with reduced ovarian reserve (poor response). This preparation positively impacts the number of oocytes and embryos obtained, the controlled stimulation of oocytes, and the subsequent implantation of the embryo, leading to successful pregnancies.

Deep machine learning applied to support clinical decision-making in the treatment of infertility using assisted reproductive technologies

Introduction. Machine learning (ML) applied to data analysis allows to more accurately and targetedly determine the most significant correctable and non-correctable predictors of onset of pregnancy in assisted reproductive technology (ART) programs in patients of different age groups. Analysis of data using various techniques and comparison of results obtained via two models will determine the most significant factors for onset of pregnancy in the ART program.Aim. To determine the most significant clinical and embryological predictors of onset of pregnancy using standard regression analysis and a decision tree algorithm to predict pregnancy in the ART program.Materials and methods. A total of 1,021 married couples were included in the retrospective study. The study analysed clinical and laboratory test findings and stimulated cycle parameters depending on the effectiveness of the ART program. A regression analysis was carried out and a decision tree algorithm was built using the Gini criterion to determine the most significant factors.Results. We identified “general” signs that require further validation on other models, including ML: the presence/absence of a history of pregnancies, stimulated cycle parameters (oocyte cumulus complex, number of metaphase II (MII) oocytes, number of zygotes), spermogram indicators on the day of puncture, number of high and good quality embryos, as well as the embryo grading.Conclusion. rFSH (follitropin-alpha, Gonal-f) gives a significant result in two of the five available age groups, follitropin-beta, corifollitropin alfa – in one of the five groups only. Building a model that includes not only the couple’s medical history data, but also molecular markers using machine learning methods will not only allow us to most accurately determine the most promising groups of patients for in vitro fertilization (IVF) programs, but also increase the efficiency of ART programs by selecting the highest quality embryo to be transferred.

RETROSPECTIVE ANALYSIS OF THE CLINICAL PICTURE OF PATIENTS WITH REDUCED OVARIAN RESERVE DURING LONG AND SHORT PROTOCOLS OF OVULATION STIMULATION IN THE PROGRAMS OF ASSISTED REPRODUCTIVE TECHNOLOGIES

Abstract. The purpose of the study is to analyze the clinical and anamnestic picture medical cards of patients with reduced ovarian reserve to compare the effectiveness of ovulation stimulation protocols (short and long).&#x0D; Materials and methods. In accordance with the aim of our study, the general clinical data of of one hundred and thirty-seven women with infertility against the background of reduced ovarian reserve with long and short ovulation stimulation protocols and the control group in the programs of assisted reproductive technologies were retrospectively analyzed. The medical records of the patients were divided into three separate groups. The first group consisted of fifty-five women with reduced ovarian reserve, who underwent controlled ovarian stimulation according to a short protocol with gonadotropin-releasing hormone antagonists (anti-GnRH). The second group consisted of fifty-two patients with reduced ovarian reserve who underwent controlled ovarian stimulation according to a long protocol with gonadotropin-releasing hormone agonist (a-GnRH). The third comparison group (control) consisted of of thirty women with tubal factor infertility.&#x0D; Research results and their discussion. A retrospective analysis of medical records, anamnestic data, and general clinical indicators of women with reduced ovarian reserve who underwent ovulation stimulation using short and long protocols and control patients with tubal factor infertility was performed. The clinical and anamnestic picture of women with a reduced ovarian reserve showed a predominance of primary infertility, both in all parts of the study and in groups of women with a reduced ovarian reserve. The average age of women included in the retrospective medical analysis varied from thirty to forty-two years. These research groups (first and second) are characterized by an older reproductive age. During the analysis of the hormonal profile of the patients of the studied groups, features characteristic of women with a reduced ovarian reserve were also revealed. When analyzing the level of antimüllerian hormone, it was found that level of anti-Müllerian hormone was significantly reduced while level of follicle-stimulating hormone was correspondingly increased. These both features are primarily the basic reasons for the decrease in the ovarian reserve. It was analyzed that there was no significant difference in menstrual function between the women of the experimental group and the women of the control group (by the tubal factor of infertility). The body mass index (BMI) in the three groups when compared did not have a pronounced statistical difference, and fluctuated within the normal range in the experimental groups and ranged from eighteen integers and five tenths to to twenty-four integers and nine tenths kg/m2. When analyzing the frequency of surgical interventions in women of reproductive age with a reduced ovarian reserve, it was found that surgical interventions on the organs of the small pelvis also affect a woman's ovarian reserve.&#x0D; Conclusions. The results of of our research indicate characteristic clinical and anamnestic differences in patients with reduced ovarian reserve compared to patients with infertility which is caused by tubal factor. Risk factors for the occurrence of infertility against the background of a reduced ovarian reserve include a history of surgical interventions, older reproductive age, several unsuccessful attempts at assisted reproductive technologies, bad habits, hereditary factors, etc.

Pathology of cervical epithelium in women with various forms of infertility

Failure to conceive in a couple, that does not prevent fertilization for 12 months or more, is defined as infertility. This diagnosis is special one both because of the social component and of the involvement of two persons in it, as well as because of polyetiological factors. Pathology of the cervical epithelium is a common problem among women of reproductive age. In patients with infertility, it has its own significance as a factor for fertility disorders. In addition, there is a possible influence of different methods of treatment of pathology of the cervical canal on the course of pregnancy that occurred after treatment.The objective: to study the prevalence of cervical pathology in patients with various types of infertility.Materials and methods. The results of liquid cytology and human papillomavirus (HPV) testing were analyzed in 416 women, who were divided into four groups: I group included 108 patients with infertility associated with anovulation, II group – 101 patients with infertility of tubal origin, III group – 102 women with a male infertility factor in marriage, IV group – 105 women who applied for a preventive examination.Results. The general frequency of early cervical lesions of severity various degrees was differed significantly in the groups of the examined persons – from the lowest 25.9% in the group of patients with infertility associated with anovulation, and 35.2% in the group of women who applied for a preventive examination, to 50.9 % among women with infertility of tubal origin and 52.4% – in the group with a male infertility factor.In the last two mentioned groups, the frequency of severe intraepithelial lesions (7.8% and 7.9%, respectively) was higher than in the other groups, where it was established at a level of no more than 1.5%. A higher rate of HPV infection was also established in the groups infertility of tubal origin – 68.6%, male infertility – 63.4%, while in the group of patients with anovulation infertility its prevalence was at the level of 35.1%, which does not exceed the rate of healthy women in control group – 25.7%.Conclusions. 1. Patients with infertility of tubal origin and male factor infertility have a higher frequency of early cervical changes (50.9% and 52.9%, respectively) than healthy women of reproductive age (35.2%). 2. In cases of tubal and male factor infertility, the frequency of HPV infection is higher than the rate of the cervical epithelium lesions detected by the cytological method (68.6% and 63.4%, respectively), which allows us to recommend the HPV test to include in the list of mandatory examinations during preparation for the program of assisted reproductive technologies.