Медико-соціальні особливості пацієнток пізнього репродуктивного віку зі зниженим оваріальним резервом

Мета - визначити медико-соціальні особливості пацієнток пізнього репродуктивного віку зі зниженим оваріальним резервом. Матеріали та методи. 130 пацієнток після застосування програм допоміжних репродуктивних технологій (ДРТ) розподілено на групи згідно з критеріями POSEIDON. Основну групу, яку становили 80 пацієнток старшого репродуктивного віку (від 35 років), розділено на 2 підгрупи згідно з критеріями POSEIDON. Підгрупу 1 становили 34 жінки з прогнозованою бідною відповіддю на контрольовану оваріальну стимуляцію (КОС) - група 4 за POSEIDON; підгрупу 2 - 46 пацієнток із прогнозованою нормальною відповіддю на КОС  - група 2 за POSEIDON. Групу порівняння становили 50 пацієнток віком до 35 років із прогнозованою нормальною відповіддю на КОС - група 1 за POSEIDON. Оцінено якість життя за опитувальником «FertiQoL», наявність і ступінь депресії - за методикою В. Зунга. Результати. Частка жінок віком від 40 років серед пацієнток після застосування програм ДРТ з прогнозовано поганою відповіддю на КОС у 3 рази більша порівняно з прогнозовано нормальними відповідачами (32,4% проти 10,9%), що відображає визначальну роль віку жінки в зниженні оваріального резерву. Значна частка жінок цієї категорії відмічає таку шкідливу звичку, як куріння (17,6%), третина - малорухливий спосіб життя (32,4%) та стреси (29,4%), а 26,5% - порушення режиму дня і праці. Проблеми з репродукцією позначаються на якості життя жінок та обумовлюють психологічні зміни. Понад третина (35,3%) жінок оцінює стан власного здоров’я як поганий і дуже поганий, а більшість (53,0%) незадоволена якістю життя. Найбільше від проблем із фертильністю страждає емоційна сфера (оцінка - 45,3±2,2), знижена й оцінка психічного та фізичного здоров’я, а також соціального функціонування. Хоча пацієнтки досить високо оцінюють якість наданого лікування, однак його переносимість у цих жінок гірша. При цьому психологічний стан половини жінок оцінюється як субдепресивний або маскована депресія (52,9%), а депресія діагностована в 14,7% респонденток. Висновки. Встановлені медико-соціальні особливості жінок пізнього репродуктивного віку зі зниженим оваріальним резервом (куріння, порушення режиму дня та праці, малорухливий спосіб життя, стреси, низька якість життя, субдепресивний та депресивний стани) вказують на необхідність додаткового введення заходів із корекції способу життя та методик психокорекції до програм підготовки до ДРТ. Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано інформовану згоду пацієнток. Автори заявляють про відсутність конфлікту інтересів

Risk factors for the ineffectiveness of assisted reproductive technology programs after a woman’s illness with COVID-19

Purpose - to determine the risk factors for the ineffectiveness of ART programs after a woman’s illness with COVID-19. Materials and methods. In the group of 80 examined patients with symptoms of “long-COVID” who applied to the reproductive technology clinic for infertility treatment, 2 subgroups were distinguished: the Subgroup 1: 64 patients in whom assisted reproductive technologies (ART) was unsuccessful (cancellation of transfer, non-occurrence of pregnancy or its loss) and the Subgroup 2: 16 women with successful ART (live birth). Results. Significant differences were found among patients with unsuccessful use of ART in terms of the frequency of the main symptoms of “long-COVID”, the following symptoms stand out: “depression, anxiety” (54.7% vs. 18.8%, p<0.05) and “sleep disturbances” (59.4% vs. 31.3%, p<0.05). A significant difference was also found in social and household factors: the presence of stress (35.9% vs. 12.5%, p<0.05), especially in everyday life (31.3% vs. 6.3%, p<0.05), the presence of bad habits (21.9% vs. 6.3%, p<0.05). A significantly higher frequency of decreased ovarian reserve (32.8% vs. 12.5%, p<0.05) and corresponding hormonal disorders: increased follicle-stimulating hormone (21.9% vs. 6.3%, p<0.05) and decreased anti-Müllerian hormone (25.0% vs. 6.3%, p<0.05). Among somatic pathology, endocrine pathology stands out (45.3% vs. 12.5%, p<0.05), in particular metabolic disorders (34.4% vs. 12.5%, p<0.05). A significant difference was also established in the frequency of liver diseases (21.9% vs. 6.3%, p<0.05) and gastrointestinal tract (23.4% vs. 12.5%, p<0.05). There is a higher frequency of menstrual disorders, namely a decrease in the duration of menstruation (20.3% vs. 6.3%) or, conversely, prolonged menstruation (17.2% vs. 6.3%), an irregular cycle (25.0% vs. 6.3%, p<0.05) and luteal phase insufficiency (21.9% vs. 6.3%, p<0.05). Urogenital infections were noted in 43.8% of patients (vs. 12.5%, p<0.05). Conclusions. Risk factors for the ineffectiveness of ART programs have been established, among which stress, depression and anxiety, bad habits, endocrine pathology, metabolic disorders, liver pathology, menstrual cycle disorders, and urogenital infections are especially highlighted. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors

Genetic-epigenetic aspects of infertility in women with long-COVID-19

The aim of the study is to determine the genetic and epigenetic features of infertile patients with long-term COVID-19 in order to clarify the risk factors for the failure of assisted reproductive technologies (ART) use. Materials and methods. The MTHFR (C677T, A1298С), RFC-1 (G80A) and BHMT (G742A) gene polymorphisms and the methylation of ESR1 gene was performed. 40 patients (main group) with infertility due to long-term COVID-19 were examined: the subgroup 1 - 25 women in whom the use of ART was ineffective, the subgroup 2 - 15 patients with effective use of ART. The control was taken from literary sources: for RFC (G80A), MTHFR (C677T) and MTHFR (A1298C) polymorphisms - 35 Ukrainian women without infertility and reproductive losses; for BHMT (G742A) - 60 people of the Ukrainian population. The methods of variational statistics were used, in particular the Fisher test with a significance level of p<0.05. Results. Patients of the main group have a higher frequency of the homozygous genotype of the MTHFR gene polymorphism (C677T) on the mutant T allele (20.0% vs. 3.2%; p<0.05). When ART is unsuccessful, the TT genotype is 4 times greater (28.0% vs. 6.7%; p<0.05). A study by genotypes of MTHFR polymorphism (A1298C) did not reveal a significant difference. Patients of the main group `have a higher frequency of the mutant allele A of the RFC gene (G80A) (80.0% vs. 51.4%; p<0.05). No significant difference was found depending on the success rate of ART. The frequency of BHMT gene polymorphism (G742A) in the main group did not differ from that in the Ukrainian population, however, in the case of unsuccessful ART, it was observed less often and only in the heterozygous variant (40.0% vs. 66.6%; p<0.05). The analysis of pairwise intergenic interaction revealed the highest frequency of the combination of AAGA for the MTHFR (A1298C)+BHMT (G742A) pair - 35.0% and GAAA for the RFC (G80A)+MTHFR (A1298C) pair - 30.0% in the main group. Hypermethylation of the promoter region of the ESR1 gene is observed in 20 (50.0%) patients of the main group: in 17 (68.0%) women of the subgroup 1 versus 3 (20.0%) women of the subgroup 2 (p<0.05). Conclusions. The genetic and epigenetic conditioning of the success of ART programs in infertility associated with long-term COVID-19 has been revealed, which opens up new diagnostic and therapeutic opportunities for identifying factors predisposing to unsuccessful ART treatment and increasing the effectiveness of such treatment by correcting disorders of folic acid metabolism, hyperhomocysteinemia and the estrogens receptor apparatus. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. The authors declare no conflict of interest

The influence of neurovegetative and psychological characteristics of infertile patients with long-term COVID-19 on the effectiveness of assisted reproductive technologies

The connection of the long-COVID-19 symptom with violations of various systemic factors, in particular with the female reproductive system, is considered, but the number of such studies is not large. The purpose of the study is the influence of neurovegetative and psychological characteristics of infertile patients with long-term COVID-19 on the effectiveness of assisted reproductive technologies (ART). Materials and methods. The main group consisted of 80 women with infertility and "long-COVID", the comparison group - 40 patients without a history of COVID-19. In the main group, 2 subgroups were distinguished: 1 - 64 women with unsuccessful ART and 2 - 16 patients in whom ART was successful (a live birth was obtained). Socio-economic status and stress factors (questionnaire), fear of stress-19 (FCV-19S scale), autonomic dysfunction were assessed using the O.M. questionnaire. Wayne (1998), Anxiety and Depression Levels on the Hospital Anxiety and Depression Scale (HADS). The used methods of variational statistics using the Student's t-test and Fisher's angular transformation with a critical significance level of p<0.05 were used to calculate the odds ratio (OR) and its confidence interval (CI). Results. Women with infertility and "long-COVID-19" are characterized by a relatively low level of socio-economic status: a lower level of income, a smaller share of entrepreneurs and housewives, not comfortable enough living conditions. These patients have a higher level of stressogenic load: comorbidity with chronic somatic pathology (58.8%), conflict situations in the family (31.3%), dissatisfaction with their sexual relationships (58.7%), a significantly higher level of fear of COVID -19 (29.73±1.31 points). Vegetative dysfunction is diagnosed in 82.5% of patients. Symptoms that are typical for "long-COVID-19" are most often noted: reduced work capacity/fatigue (82.5%), attack-like headaches (72.5%), difficulty breathing (47.5%), sleep disturbances (47 .5%). Unfavorable medico-social and psychological risk factors for the failure of ART programs in patients with "long-COVID-19" can be a point assessment of the autonomic dysfunction syndrome above 25 (OR=5.80, CI 1.22-27.64), anxiety (OR=5.80, CI 1.56-21.62), presence of depression (OR=4.20, CI 1.27-13.89), chronic somatic disease (OR=4.20, CI 1.30-13.62), conflict situations (OR=3.86, CI 1.24-12.04). Conclusions. Women with infertility and "long-COVID-19" need additional examinations to assess the medical and social status, vegetative function and psychological state, correction of detected violations. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors