Current interpretation of the etiology and pathogenesis of the syndrome fetal loss (literature review)

In this review discussed current interpretation the problems of the etiology, pathogenesis and therapy of the syndrome of the loss of pregnancy. The infectious aspects of miscarriage and the impact of impaired mutual regulation of the maternal endocrine and immune systems are considered in detail.В обзоре представлен современный взгляд на проблемы этиологии, патогенеза, и терапии синдрома потери плода. Подробно рассматриваются инфекционные аспекты невынашивания, а также влияние на течение гестации нарушений взаиморегуляции эндокринной и иммунной систем организма матери

OOCYTE FINAL MATURATION TRIGGERS IN IVF PROGRAMS

A trigger is a firing key (Lat. trigger). A luteinizing hormone is this trigger – a trigger of ovulation at a certain cycle of the ovarial cycle. Understanding of the trigger problem in the artificially cycles of IVF programs requires recollection of certain theoretical issues of follicle growth and maturation as well as the ovulation process in the natural ovarian cycle [1, 2]

RISK FACTORS AND PREVENTION OF EARLY PREGNANCY LOSSES AFTER IN VITRO FERTILIZATION

The study was conducted in 2016 in four stages on the basis of the department of assisted reproductive technologies of the Moscow Regional Perinatal Center of Balashikha with the purpose to determine the tactics allowing increase of the number of patients who managed to successfully overcome the embryonic threshold after the In Vitro Fertilization  (IVF) and embryo transfer  (ET). Patients were divided in groups with early embryonic losses and the control group. At the following stage of the study determination of the effect of each unfavourable factor on gestation in the first and in the second groups of patients was done. It turned out that such factors as the amount of obtaine oocytes in the course of transvaginal puncture less and equal to 7 (rk = 0,42, р = 0,005); chronic endometritis supported by histological findings (rk = 0,74, р = 0,005); disturbance of the receptor status of endometrium  (rk = 0,71, р = 0,005); coincidence with the spouse by HLA system 3 and higher (rk = 0,26, р = 0,03); circulation of AB to β-HCG, weakly positive and positive result of the test by the ELISA method statistically significantly affect the early embryonic losses if the patient refused from the proposed correction before IVF (rk = 0,31, р = 0,005). And on embryonic – innate trombophilias (rk = 0,78, р = 0,00); acquired thrombophilias (rk = 032, р = 0,003); chronic endometritis confirmed by histological findings (rk = 0,64, р = 0,033); circulation failure in the small pelvis by results of the uterine vessel dopplerometry (rk = 0,66, р = 0,00). Comparison of effectiveness of IVF and ET programs in 2016 was conducted in patients who had and didn’t have the risk factors statistically significantly affecting the outcome. The first two groups of patients were subject to specialized therapy depending on the detected unfavourable factors affecting the outcome of the pregnancy after IVF provided that it was possible to correct this factor with subsequent evaluation of effectiveness of repeated attempts of IVF and ET  in patients after correction of unfavourable factors as compared to the control group. The tactics of minute detection of patients with statistically significant risk factors of early embryonic and embryonic losses, as well as complex preparation of such patients by modern methods allows increasing the number of patients who managed to safely overcome the embryonic threshold after IVF and ET by 20% and finally to positively affect the take baby home indicator

Is it possible to help patients of older reproductive age implement their reproductive function within the framework of IVF and PE programs backed by state support?

The effectiveness of the basic in vitro fertilization (IVF) and embryo transfer (PE) programs that were state funded using the funds of the Mandatory Health Insurance Fund (MHIF) was compared with the comprehensive programs that were co-financed (along with the funds of the MHIF, the parallel payment of donor oocytes (DO), donor embryos (DE) (or a donor program from own funds)) in patients of older reproductive age with low ovarian reserve and the forecast of “poor” and reduced ovarian response to controlled ovarian hyperstimulation (COH) on the basis of the Assisted Reproductive Technology (ART) Department of the Moscow Regional Perinatal Center (MRPC). We analysed the outcomes of the programs that have been implemented using the funds of the MHIF on the basis of the ART Department for 2015 and 2016 in patients, who were divided into 2 groups. Group 1 consisted of 69 patients who underwent a basic IVF and PE program in 2015, Group 2 included 60 patients who underwent the basic and comprehensive IVF and PE programs in 2016. In addition, Subgroup 2 has been singled out from Group 2 and included 26 patients out of 60 who underwent the comprehensive IVF and PE programs. The groups were comparable by the main indicators of the ovarian reserve, the average age and the anamnestic data. The embryos were cultivated up to 5 days, their quality was assessed according to the Gardner scale. The number of oocytes obtained (of which mature ones per 1 patient) was (p< 0.05): in Group 1 - 3.7 ± 1.1/2.7 ± 1.8, in Group 2 - 4.7 ± 2.2 / 4.1 ± 1.2, in Group 2a - 7.7 ± 3.4 / 5.7 ± 2.4. The number of embryos received per patient (of which, the highest quality embryos) (p< 0.05): in Group 1 - 2.1 ± 1.1/1.1 ± 0,4, in Group 2 - 2.9 ± 1.4/1.8 ± 0,8; in Group 2a, 4.4 ± 1.8/2.7 ± 1.2. In all patients, the embryos were transferred on Day 5 of the cultivation. In the course of the comprehensive programs, two embryos were transferred: one embryo was obtained by fertilizing the patient’s oocytes with the husband’s semen (of medium or low quality), the other embryo was obtained from a donor by fertilizing with the husband’s sperm (of high quality). In the absence of their own embryos, two high quality DE or embryos obtained by fertilization with the husband’s semen were transferred. The effectiveness of the IVF program (frequency of pregnancy) was as follows: Group 1 - 11.6% per IVF cycle; Group 2 - 21.6% per cycle (13), Group 2a - 38.4% per cycle

Outcomes of in vitro fertilization as a multifactorial clinical problem or reproductive medicine

The study was conducted during the years 2013--2014 by the assisted reproductive technology (ART) department of the Moscow Regional Perinatal Center in Balashikha. We analyzed 384 IVF and ET cases using clinical and embryological criteria. It was found that the outcome of induced pregnancy is associated with such factors as patient age, body mass index, polycystic ovary syndrome, hyperandrogenism, congenital thrombophilia, endometrial pathology, miscarriage history, total dose of HT per COS cycle, number of best quality embryos in ovarian cohort, level of serum hCG on day 14 after embryo transfer. "Best quality embryo in ovarian cohort" factor is of great interest due to high reliability and few studies in this area. Quality distribution of embryos does not occur randomly or as part of an isolated in vitro process; it follows a certain pattern that directly affects the outcome of pregnancy

The maternal factors of failures and defects of implantation after IVF

Introduction. Failures and defects of implantation after IVF are to high extent determined by maternal factors, which are manageable. However, until now, medical tactics have not been clearly defined in identifying the most significant of them among patients who have failures and defects in implantation in previous IVF programs.Objective. To summarize research literature and results of many years of our own research to determine medical tactics in patients with failures and defects in implantation in previous IVF programs when identifying significant maternal risk factors.Material and methods. The analysis and collation of data have been performed on the basis of 80 literature sources with a focus on the papers of domestic authors, including publications with regard to their own study results.Results. The most significant maternal risk factors for failures and defects of implantation after IVF were identified: chronic endomyometritis and thrombophilia. The pregravid preparation algorithm has been determined in patients with chronic endometritis and with previous failures and defects in implantation after IVF, including the use of antibacterial, antiviral, anti-inflammatory, immunomodulating and physiotherapy. We show the necessity for the prescription of low molecular weight heparins in patients with thrombophilia since the establishment of pregnancy after IVF has been shown.Conclusion. Carrying out pregravid preparation in patients with chronic endometritis and prescribing low molecular weight hepa-rins from early pregnancy in patients with thrombophilia can increase the percentage of women who have become pregnant after IVF and have passed the embryonic threshold

KOZHEVNIKOV–RASMUSSEN’S ENCEPHALITIS. A CASE REPORT

Kozhevnikov–Rasmussen's encephalitis (KRE) is a rare inflammatory brain disease characterized by severe intractable epilepsy and unilateralprogressive motor defect associated with controlateral hemispheric atrophy. Authors described clinical features, electroencephalography and magnetic resonance tomography data and course of the disease during 12 years of patient with adult onset KRE