ASSESSMENT OF CAUSES OF EARLY PREGNANCY LOSS IN WOMEN WITH INFERTILITY INCLUDED IN THE PROGRAM OF ASSISTED REPRODUCTIVE TECHNOLOGIES.
DOI:
https://doi.org/10.11603/24116-4944.2017.1.7371Keywords:
infertility, miscarriage, subchorionic hematoma, assisted reproductive technologies, risk factors.Abstract
The aim of the study was to evaluate the course of the first trimester of pregnancy in patients with infertility, included in the program of assisted reproductive technologies and to identify the principal etiological factors leading to the development of local non-progressive Chorionic detachment and early reproductive loss.
Materials and methods. A retrospective analysis of 1864 medical charts of patients with threatening miscarriages and diagnosed primary spontaneous abortion had been carried out. These women had been treated at the Gynaecological Department of the City Maternity Hospital (Ivano-Frankivsk), and in the Gynaecological Department of Pre-Carpathian Centre for Human Reproduction for the period of 2011–2016. The control group consisted of 100 healthy pregnant women. In 698 cases, the patients were included in the program of assisted reproductive technologies. In 542 cases (37.44 %) patients suffered from subchorionic hematoma, 196 of them (36.16 %) (principal group) were fertilized in vitro; in 346 cases (comparison group) pregnancy occurred in physiological cycle.
Results and discussion. The obtained data on the patients’ age in the study groups made possible to assume the risk of subchorionic hematoma more often in young patients and women over the age of 30 years; the parity of pregnancies was also of great significance. The results of clinical and anamnestic analysis showed the prevalence of gestational losses in terms of 5–7 weeks of pregnancy (63.41 %). Among the causes of early abortions – anatomical factors accounted for 18.08 %, hormonal disorders – 36.53 %, congenital and acquired thrombophilic states (including autoimmune and genetic disorders) were observed in 27.30 %, peculiarities of couple karyotype – in 10.33 % of cases, infectious inflammatory factor – in 63.83 % of patients. A significant role of infectious factor in the genesis of reproductive losses was proved: histological examination revealed morphological signs of chronic endometritis (62.19 %), rising infectious lesions of fertilized eggs (54.87 %), endometrial hypoplasia (20.91 %).One of the important factors of subchorionic hematoma development in women with treated infertility can be endocrine imbalance, diagnosed in this category of patients, which manifests itself as growing proportion of surgical interventions on the pelvic organs, a high percentage of neuroendocrine disorders, such as menstrual disorders, ovarian dysfunction, luteal phase deficiency and hypoestrogenic endocrine profile in women of this category.
Conclusions. Basing on the analysis, we can summarize that miscarriages in the first trimester in women with treated infertility is a very serious pathology, the seriousness of which is obvious in the case of treated infertility and applying of assisted reproductive technologies, which requires a meticulous examination of patients for revealing probable causes of early reproductive losses and opens a prospect for further research.
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