OPTIMIZATION OF INFERTILITY PRE-TREATMENT AND PROTOCOLS OF CONTROLLED OVULATION INDUCTION IN FEMALE PATIENTS WITH POLYCYSTIC OVARY SYNDROME IN IVF PROGRAMS

Abstract

Infertility is one of the pressing issues of modern worldwide medicine, despite of the success achieved in reproductive medicine in recent decades. This issue has not only medical but also socio-economic importance, as it leads to a deterioration of the demographic situation in the country. The level of infertility in our country is 1–20 % of the total number of couples. It should be noted that 40 % of infertility pairs are seeking to solve the problem from 5 to 25 years, and 30–35 % require assisted reproductive technologies (ART). The causes of infertility growth are the deterioration of reproductive health of the population, an increase in the incidence of endometriosis, uterine fibroids, ovarian cysts, endocrine disorders, inflammatory diseases of the pelvic organs, widespread use of contraceptives, late first pregnancy, as well as an important role is played by the deterioration of the ecological and economic situation in the country. It should be noted that polycystic ovary syndrome (PCOS) greatly contributes to the problem of infertility. This polycystic syndrome disease is one of the most common endocrinological pathologies in women of reproductive age. According to the literature, PCOS is diagnosed in almost 50 % of women with disorders of menstrual and ovulatory functions, and more than in 40 % is the cause of anovulatory infertility.

The aim of the study – to increase the effectiveness of infertility treatment by using integration pre-treatment in patients with PCOS before controlled ovulation induction in IVF protocols.

Materials and Methods. 150 women were diagnosed with PCOS. Patients were divided into 2 groups. In the group 1 there were 72 women who took folic acid (400 micrograms) daily for 2–3 months before ovulation induction, and in the IVF protocol. The group 2 consisted of 78 patients with PCOS, who received combined therapy of vitamin complex FT 500-Plus and vitamin D3 supplement Aquadetrim. In both groups, superovulation induction with recombinant gonadotropin corifollitropin-alfa – ELONVA was performed. On the 5–7th day of the protocol, antagonist-GnRH (ant-GnRH) Orgalutran (0.25 mg/daily) was administered. On the 8th day since ELONVA was administrated, recombinant-FSH (r-FSH) Puregon was used until the maturation of the oocytes, and as a trigger agonist-GnRH (a-GnRH) Dyferelin was used. The size of the ovaries and the state of the follicular apparatus was  evaluated by the ultrasound examination, as well as the presence of pathological lesions .

Results and Discussion. According to our own research, it was found out that in patients who used the preconception FT-500 Plus (inositol, folic acid, glutathione, lutein, zinc, vitamin C, vitamin E, selenium) and Vit.D3 pre-treatment and during all of the IVF protocol period there were significantly higher oocyte quality indices, a lower incidence of immature and degenerate cells and a higher percentage of blastocyst cleavage. The use of an agonist-GnRH as an ovulation trigger reduces the manifestations of OHSS.

Conclusions. The use of a combination of vitamin complexes in patients with PCOS helps to obtain oocytes of better quality, reduces the percentage of immature and degenerate eggs, increases the incidence of pregnancy. The use of the short protocol with the GnRH antagonist and the GnRH agonist trigger in this group of patients is more physiological and reduces the risk of complications.