CLINICAL CHARACTERISTICS OF PATIENTS WITH INFERTILITY ON THE BACKGROUND OF POLYCYSTIC OVARY SYNDROME USING STANDARD PROTECTION PROTOCOL
About the author:
Khmil M. S., Khmil S. V.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age with infertility. Given the multifactority of PCOS, which determines the search for fundamentally different ways of correction of this pathology, a differentiated approach to choosing a way to restore reproductive function in women of this category is relevant. Aim of the study. To analyze the clinical features of infertile patients with PCOS in standard programs of assisted reproductive technology, depending on the method of embryo transfer. Object and methods. 100 women aged 25-39 years with infertility on a background of PCOS, who were being treated at the “Professor S. Khmil Clinic Medical Center”, were studied. Infertility in PCOS was diagnosed according to Rotterdam criteria. Women who had complaints of psychological distress used the Hospital Anxiety and Depression Scale (HADS) to assess their anxiety / depression level. The patients were divided into 2 groups – group 1 consisted of 22 patients who had embryotransfer to the uterine cavity for 5 days after puncture (fresh embryotransfer), group 2 – 78 patients who had embryo transfer in cryocycles. The distribution of women into groups was performed based on the degree of risk of ovarian hyperstimulation syndrome (OHS) developing. Controlled ovarian stimulation was performed according to a long protocol from 19-21 days of the previous menstrual cycle, was administered agonist-GnRG Decapeptil-Depot at a dose of 3.75 mg – tryptorelin («Decapeptyl», Ferring, Germany). Results of research. Analyzing the statistics obtained on the age of patients in the experimental groups revealed a similar age structure, however, in the group of women who had fresh embryotransfer, persons 30-34 years prevailed, while in the group of women who underwent embryo transfer in cryocycles 25-29 year olds persons prevailed. The distribution of patients into study groups revealed no significant differences in the structure of infertility duration among women with different embryo transfer methods. It should be noted that in the total population of women, primary infertility prevailed (80 people), whereas secondary was diagnosed in only 20 patients. The study of the structure of concomitant somatic diseases showed that patients with PCOS and infertility are dominated by metabolic syndrome (31 persons) and gynecological surgeries (41 persons). It should be noted that several patients have several associated pathologies. An analysis of the hospital anxiety / depression scale results of 19 women with infertility and PCOS who had complaints of psychological distress showed subclinical anxiety / depression in 63.2% and clinically expressed anxiety / depression in 36.8% of patients. In 92.00% of women with PCOS infertility were diagnosed OHS. At the same time, in the group of women who have fresh embryotransfer, the mild degree of OHS (54.55%) is predominant, while in women who perform embryo transfer in cryocycles, the average degree of OHS is 39.74%. Conclusion. The effectiveness of controlled ovarian stimulation over a long protocol in women with infertility in the background of PCOS is evidenced by the number of mature oocytes, fertilized normal cells and the number of blastocytes. In the women with PCOS infertility, which were diagnosed grade 3 of OHS, which is a contraindication to fresh transfer, the number of follicles is statistically higher relative to the data of grade 1 OSH (19.5%), respectively, the number of oocytes is higher by 22.2% (p>0.05).
polycystic ovary syndrome, infertility, controlled ovulation induction, general characteristics of patients, type of embryotransfer.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 238-245 pages, index UDK 618.2-059:618.11-006.2:618.177-089.888.11