ТHE IMPACT OF THE PROPOSED THERAPEUTIC AND PREVENTIVE COMPLEX ON THE HEMOSTASIS SYSTEM, ENDOTHELIAL, AND IMMUNE STATUS IN PREGNANT WOMEN FOLLOWING ASSISTED REPRODUCTIVE TECHNOLOGIES
DOI:
https://doi.org/10.11603/24116-4944.2024.2.14987Keywords:
pregnancy, miscarriage, childbirth, perinatal outcomes, endothelial dysfunction, assisted reproductive technologiesAbstract
The aim of the study – to determine the state of the hemostasis system and endothelial factors in women after the use of assisted reproductive technologies (ART) based on the proposed therapeutic and preventive complex.
Materials and Methods. A prospective study was conducted involving 299 pregnant women, categorized according to the type of infertility and management approach: Group I – 94 women with tubal-peritoneal infertility. Group II – 87 women with endocrine infertility. Group III – 68 women with male-factor infertility. Control group – 50 pregnant women with spontaneous conception and physiological pregnancy progression. Depending on the treatment approach, Subgroup A included pregnant women who received the proposed therapeutic complex, while Subgroup B – pregnant women treated according to standard obstetric care protocols. Therefore, Subgroup IA included 49 women, Subgroup IB – 45 women, Subgroup IIA – 48 women, Subgroup IIB – 39 women, Subgroup IIIA – 36 women, Subgroup IIIB – 32 women. Blood samples were taken from the cubital vein to assess homocysteine levels (ELISA, AXIS-SHIELD reagents, UK; Stat Fax 2100 analyzer, USA), coagulogram parameters (four-channel coagulation analyzer Coag 4D, Diagon, Hungary), Endothelin-1 (ELISA, Biomedica reagents, UK; Stat Fax 2100 analyzer, USA), VEGF levels (ELISA, Biotin Conc reagents, UK; Stat Fax 2100 analyzer, USA). The proposed therapeutic and preventive complex included progesterone support, magnesium supplementation, folic acid, L-arginine aspartate, omega-3 polyunsaturated fatty acids, long-term psychological correction.
Results and Discussion. The proposed therapeutic and diagnostic complex demonstrated positive effects by influencing:
- a) homocysteine concentration – a significant reduction in homocysteine levels in subgroup A compared to subgroup B (e.g., IA: 8.2±1.4 mmol/L vs. IB: 20.3±1.8 mmol/L, p<0.05). Reduction in miscarriage risk in Group I by 41.6% (Group I before treatment: 70.2%; subgroup IA: 28.6%, p<0.05). Decreased spontaneous miscarriage cases in Group I (subgroup IA: 28.6%, subgroup IB: 57.7%, p<0.05).
- b) coagulation hemostasis – normalization of fibrinogen levels (IA: 3.2±0.2 g/L, IB: 4.1±0.1 g/L, p<0.05), reduced D-dimer (IA: 241.5±11.6 ng/mL, IB: 517.3±12.1 ng/mL, p<0.05), decreased soluble fibrin monomer complexes (RFMK) (IA: 0.39±0.2, IB: 0.55±0.1, p<0.05).
- c) endothelial status – lower VEGF levels (e.g., IA: 38.4±6.1 pg/mL, IB: 321.8±14.6 pg/mL, p<0.05), reduced endothelin-1 levels (e.g., IA: 2.6±0.4 ng/mL, IB: 17.1±3.2 ng/mL, p<0.05).
- d) immune status – improved cellular homeostasis: reduced T-lymphocytes (IA: 0.39±0.04, IB: 0.70±0.13, p<0.05), decreased CD3+ levels (IA: 28.24±1.31, IB: 34.89±1.29, p<0.05), increased CD8+ levels (IA: 17.24±0.33, IB: 14.76±0.34, p<0.05). Enhanced humoral homeostasis: mnormalized B-lymphocyte levels (IA: 28.22±0.61, IB: 24.28±0.9, p<0.05), restored CD22+ cell levels (IA: 0.41±0.02×109/L, IB: 0.52±0.04×109/L, p<0.05).
Conclusions. The proposed therapeutic and diagnostic complex is an effective method for correcting endothelial, hemostatic, and immune status abnormalities in pregnant women after ART. It is recommended for practical use in this group of patients.
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