Аналіз соматичного та репродуктивного анамнезу пацієнток із прогнозованою слабкою відповіддю яєчників на стимуляцію гонадотропінами.
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| Title: | Аналіз соматичного та репродуктивного анамнезу пацієнток із прогнозованою слабкою відповіддю яєчників на стимуляцію гонадотропінами. (Ukrainian) |
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| Alternate Title: | Analysis of somatic and reproductive history in patients with prognostically poor response of the testicles to gonadotropin stimulation. (English) Анализ соматического и репродуктивного анамнеза пациенток с прогнозируемым слабым ответом яичников на стимуляцию гонадотропинами. (Russian) |
| Authors: | Чайка, О. О. |
| Source: | Reproductive Health of Woman; 2021, Vol. 54/55 Issue 9/10, p42-47, 6p |
| Subject Terms: | DIAGNOSIS of endometriosis, PELVIC inflammatory disease diagnosis, MENSTRUAL cycle, TIME, INFERTILITY, GONADOTROPIN, OVARIAN reserve, OLIGOMENORRHEA, HUMAN reproductive technology, DESCRIPTIVE statistics, DATA analysis software, REPRODUCTIVE history |
| Abstract (English): | The objective: to conduct a clinical and statistical analysis of the somatic and reproductive history in women with infertility and a predictable poor ovarian response to stimulation with different gonadotropins. Materials and methods. We examined 140 infertile patients 21–42 years old with an increased risk of poor response. I group included 75 women who received gonadotropins of human pituitary origin in stimulated cycles, II group involved 65 patients who received recombinant gonadotropins in stimulated cycles. The analysis of the anamnestic data included an assessment of the menstrual cycle (age of menarche onset, parameters, duration, and regularity), characteristics of reproductive function (number of pregnancies, peculiarities of the course and outcomes of pregnancy), gynecological diseases, conservative and surgical treatment of infertility and its effectiveness. Somatic pathology in women was analyzed. Data processing was carried out using the Stat Soft Statistica 8.0 software package. Results. The average age of patients in the I group was 36.4±3.6 years, in the II group – 35.6±2.5 years. The normal menstrual cycle was in 89.3% of women in the I group and 92.3% – II. Menstrual cycle disorders of the type of oligomenorrhea were observed in 8 (10.7%) and 5 (7.7%) patients, respectively. Primary infertility was diagnosed in 21 (28.0%) persons in the I group and 18 (27.0%) – II group, secondary infertility – 54 (72.0%) and 47 (72.3%) women, respectively. The average duration of primary infertility was 6.2±2.1 years, secondary one – 5.8±3.8 years. The history of artificial abortion had 17 (22.7%) and 14 (21.5%) women, spontaneous abortion and missed pregnancy till 12 weeks of gestation were observed with the same frequency – 18 (24.0%) and 15 (22.0%) cases, respectively, ectopic tubal pregnancy – 9 (12.0%) and 7 (10.7%) cases. The rate of insufficient ovarian function was determined in 49 (65.3%) women in the I group and 42 (64.6%) – the II group; it was manifested by chronic anovulation in 89 women of both groups, which accounted for 63.5% of patients and insufficiency of the corpus luteum (38 (27.1%) of the examined persons). Pelvic inflammatory diseases were diagnosed in 41 (54.6%) and 36 (55.4%) patients, external genital endometriosis – 22 (29.3%) and 17 (26.1%) women, respectively. Ovarian resection was performed in 21 (28.0%) patients of the I group and 16 (24.6%) – II group, the indication for which in 57.1% and 56.3%, respectively, was a recurrent course of external genital endometriosis with the formation of endometrioid cyst. The pathological changes in the endometrium were detected in 39 (52.0%) and 31 (47.7%) patients of the I and II groups, respectively, among which 14 (18.6%) and 11 (16.9%) women had polyps, 11 (14.7%) and 9 (13.8%) – chronic endometritis. Conclusions. Thus, the predisposing factors for the development of a poor response in vitro fertilization programs were late reproductive age, a high frequency of surgical interventions on the pelvic organs and, as a result, a change in the blood circulation of the ovarian cortex, a decrease in the volume of the stroma and a reduction in the follicular reserve. According to the main clinical and anamnestic characteristics, there were no significant differences between patients who received human pituitary or recombinant gonadotropins in stimulated cycles. [ABSTRACT FROM AUTHOR] |
| Abstract (Russian): | Цель исследования: проведение клинико-статистического анализа соматического и репродуктивного анамнеза у женщин с бесплодием и с прогнозируемым слабым ответом яичников на стимуляцию различными гонадотропинами. Материалы и методы. Обследовано 140 пациенток с бесплодием в возрасте от 21 до 42 лет с повышенным риском слабого ответа. В I группу вошли 75 женщин, которые получали в стимулированных циклах гонадотропины человеческого гипофизарного происхождения, во ІІ группу – 65 больных, получавших в стимулированных циклах гонадотропины рекомбинантного происхождения. Анализ анамнестических данных включал оценку менструального цикла (возраст наступления менархе, характер, продолжительность, регулярность), характеристику репродуктивной функции (количество, особенности течения и исходы беременности), гинекологические заболевания, проведенное консервативное и оперативное лечение бесплодия и его результативность. Проанализирована соматическая патология у женщин. Обработку данных проводили с использованием программного пакета Stat Soft Statistica 8.0. Результаты. Средний возраст пациенток в І группе составил 36,4±3,6 года, во ІІ группе – 35,6±2,5 года. Нормальный менструальный цикл был у 89,3% женщин I группы и 92,3% – II группы. Расстройства менструального цикла по типу олигоменореи наблюдали у 8 (10,7%) и 5 (7,7%) пациенток соответственно. Первичное бесплодие диагностировано у 21 (28,0%) больной в I группе и у 18 (27,0%) – во ІІ группе, вторичное – у 54 (72,0%) и 47 (72,3%) женщин соответственно. Средняя продолжительность первичного бесплодия составила 6,2±2,1 года, вторичного – 5,8±3,8 года. В анамнезе артифициальный аборт установлен в 17 (22,7%) и 14 (21,5%) случаях, самопроизвольный аборт и неразвивающияся до 12 нед беременность наблюдались с одинаковой частотой – 18 (24,0%) и 15 (22,0%) случаев соответственно, эктопическая трубная беременность – 9 (12,0%) и 7 (10,7%) случаев. Частота недостаточной функции яичников составила 49 (65,3%) и 42 (64,6%) случая соответственно по группам; она проявлялась хронической ановуляцией у 89 женщин обеих групп, что составило 63,5% больных, и недостаточностью желтого тела – 38 (27,1%) обследованных женщин. Воспалительные заболевания органов малого таза выявлены у 41 (54,6%) и 36 (55,4%) пациенток, наружный генитальный эндометриоз – у 22 (29,3%) и 17 (26,1%) женщин соответственно. Резекция яичников выполнена у 21 (28,0%) больной I группы и у 16 (24,6%) – ІІ группы, показанием к которой у 57,1% и 56,3% соответственно было рецидивирующее течение наружного генитального эндометриоза с образованием эндометриоидных кист. Патологические изменения эндометрия выявлены у 39 (52,0%) и 31 (47,7%) больной I и II групп соответственно, среди которых у 14 (18,6%) и 11 (16,9%) больных отмечено наличие полипов, у 11 (14,7%) и 9 (13,8%) – хронического эндометрита. Заключение. Таким образом, предрасполагающими факторами для развития слабого ответа в программах экстракорпорального оплодотворения был поздний репродуктивный возраст, высокая частота оперативных вмешательств на органах малого таза и, как результат, изменение кровообращения коркового слоя яичников, уменьшение объема стромы и редукция фолликулярного запаса. По основным клинико-анамнестическим характеристикам достоверных различий между пациентками, которые получали в стимулированных циклах гонадотропины человеческого гипофизарного или рекомбинантного происхождения, обнаружено не было. [ABSTRACT FROM AUTHOR] |
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| Database: | Complementary Index |
Nájsť tento článok vo Web of Science | Abstract: | The objective: to conduct a clinical and statistical analysis of the somatic and reproductive history in women with infertility and a predictable poor ovarian response to stimulation with different gonadotropins. Materials and methods. We examined 140 infertile patients 21–42 years old with an increased risk of poor response. I group included 75 women who received gonadotropins of human pituitary origin in stimulated cycles, II group involved 65 patients who received recombinant gonadotropins in stimulated cycles. The analysis of the anamnestic data included an assessment of the menstrual cycle (age of menarche onset, parameters, duration, and regularity), characteristics of reproductive function (number of pregnancies, peculiarities of the course and outcomes of pregnancy), gynecological diseases, conservative and surgical treatment of infertility and its effectiveness. Somatic pathology in women was analyzed. Data processing was carried out using the Stat Soft Statistica 8.0 software package. Results. The average age of patients in the I group was 36.4±3.6 years, in the II group – 35.6±2.5 years. The normal menstrual cycle was in 89.3% of women in the I group and 92.3% – II. Menstrual cycle disorders of the type of oligomenorrhea were observed in 8 (10.7%) and 5 (7.7%) patients, respectively. Primary infertility was diagnosed in 21 (28.0%) persons in the I group and 18 (27.0%) – II group, secondary infertility – 54 (72.0%) and 47 (72.3%) women, respectively. The average duration of primary infertility was 6.2±2.1 years, secondary one – 5.8±3.8 years. The history of artificial abortion had 17 (22.7%) and 14 (21.5%) women, spontaneous abortion and missed pregnancy till 12 weeks of gestation were observed with the same frequency – 18 (24.0%) and 15 (22.0%) cases, respectively, ectopic tubal pregnancy – 9 (12.0%) and 7 (10.7%) cases. The rate of insufficient ovarian function was determined in 49 (65.3%) women in the I group and 42 (64.6%) – the II group; it was manifested by chronic anovulation in 89 women of both groups, which accounted for 63.5% of patients and insufficiency of the corpus luteum (38 (27.1%) of the examined persons). Pelvic inflammatory diseases were diagnosed in 41 (54.6%) and 36 (55.4%) patients, external genital endometriosis – 22 (29.3%) and 17 (26.1%) women, respectively. Ovarian resection was performed in 21 (28.0%) patients of the I group and 16 (24.6%) – II group, the indication for which in 57.1% and 56.3%, respectively, was a recurrent course of external genital endometriosis with the formation of endometrioid cyst. The pathological changes in the endometrium were detected in 39 (52.0%) and 31 (47.7%) patients of the I and II groups, respectively, among which 14 (18.6%) and 11 (16.9%) women had polyps, 11 (14.7%) and 9 (13.8%) – chronic endometritis. Conclusions. Thus, the predisposing factors for the development of a poor response in vitro fertilization programs were late reproductive age, a high frequency of surgical interventions on the pelvic organs and, as a result, a change in the blood circulation of the ovarian cortex, a decrease in the volume of the stroma and a reduction in the follicular reserve. According to the main clinical and anamnestic characteristics, there were no significant differences between patients who received human pituitary or recombinant gonadotropins in stimulated cycles. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 27088723 |
| DOI: | 10.30841/2708-8731.9-10.2021.252589 |