Тактика підготовки ендометрію пацієнток у проґрамі допоміжних репродуктивних технолоґій для підвищення ефективності лікування

A brief description of immune subfertility, caused by antibodies directed against sperm-specific glycoproteins in the sperm membrane, is given. Observations during the last few years have indicated that this immune disease is primarily caused by anti-sperm antibodies of the IgA class, and recent results from vasovasostomized men lend further support to this theory. Detection of anti-sperm antibodies should therefore include characterization of the immunoglobulin class of antibodies. In male patients this can be achieved by direct mixed anti-globulin reaction test or immunobead-binding test on the patients' spermatozoa, and in female patients cervical mucus can be tested by indirect versions of the same tests.

Objective: To detect Antisperm antibodies in Patient’s with unexplained infertility. Method: This study was undertaken in 50 patient of unexplained infertility who were admitted in the indoor ward and those attending outpatient Department of obs and Gynae of M.L.N Medical College, Prayagraj. fifty couples with no organic cause for infertility were selected for this study.25.58% of couples with primary unexplained infertility showed positive ASA while only 14.42% of couples with secondary unexplained infertility showed positive results.No correlation was present between the presence of ASA and duration of infertility,socio economic status and ethnic group. Result: Antisperm antibody has a high predictive value for the patient with unexplained infertility. Presence of antisperm antibody was a more accurate predictor of Unexplained infertility than other historical risk factors. The serological test is rapid and non-invasive, and our data suggests that it would be useful in investigation of infertility. Conclusion: Antisperm antibody is a Sensitive, specific, easy, non-invasive and reliable test for diagnosis of Unexplained infertility

Since it was found that anti-sperm antibodies could impair in vitro development of fertilized eggs in the presence of complement in rats, the effects of sperm immobilizing antibodies on human pregnancy were examined in infertile women treated with IVF-ET. The pregnancy outcomes of 143 ET cycles in 58 infertile women with sperm immobilizing antibodies and 363 ET cycles in patients with tubal infertility as control were compared. Diagnosis of chemical pregnancy was done when the urinary hCG level had risen over 50 IU/L but a gestational sac could not be demonstrated later. Antibody titers of sperm immobilizing antibodies (SI50 units) were measured by a quantitative sperm immobilization test. 33 (23.1%) of 143 cycles in the patients with sperm immobilizing antibodies and 56 (15.4%) of 363 cycles in the control patients were diagnosed as pregnancy. The pregnancy rates were significantly higher in the former than in the latter (P < 0.05). In the patients with sperm immobilizing antibodies, 12 (36.4%) were chemical pregnancies, 5 (15.2%) were clinical abortions, and 16 (48.5%) had deliveries. In the control group, 18 (32.1%) were chemical pregnancies, 10 (17.9%) were clinical abortions including ectopic pregnancies and 28 (50.0%) had deliveries. There was no significant differences in each category. When the SI50 titers at the time of conception were considered, chemical pregnancy rates were 22.2% (4/18) in patients with SI50 titers below 10 units, but those in patients with SI50 titers above 10 were 50.0% (5/10) and above 100 were 60.0% (3/5), respectively, (P > 0.05). In four of five patients who had both chemical and clinical pregnancies, the SI50 titers at the time of conception were higher in the chemical pregnancy cycles than in the clinical pregnancy cycles. Though the pregnancy rates were significantly higher in the patients with sperm immobilizing antibodies as compared to those with tubal infertility, chemical pregnancy rates were also higher in the patients with higher sperm immobilizing antibody titers. These results suggest that sperm immobilizing antibodies may cause the damage of early development of human embryos in vivo in the small number of patients with a high titer of the antibodies.

The incidence of male reproductive failure leading to infertility, whether due to delayed parenthood, environmental issues, genetic factors, drugs, etc., is increasing throughout the world. The diagnosis and prognosis of male subfertility have become a challenge. While the basic semen assessment has been performed for many years, a number of studies question the value of the traditional semen characteristics. This is partly due to inadequate methods and standardization, limited knowledge of technical requirements for quality assurance, and an incomplete understanding of what clinical information a semen assessment can provide. Laboratories currently performing semen and endocrine assessment show great variability. The World Health Organization (WHO) manual for the evaluation of semen has been the core of andrology and fertility evaluation that has helped in further development of this field over many years. These include the physical appearance of the ejaculate, assessments of sperm count, motility, vitality, morphology, and functional aspects of the sperm and semen sample. These tests also include male endocrine profile, biochemical evaluation of the semen, detection of antisperm antibodies in serum, the use of computer-aided sperm analysis (CASA), sperm DNA integrity, and its damage due to oxidative stress. Assisted reproductive techniques (e.g., IVF, ICSI) have shown great success but are too expensive. Further development in this field with newer techniques and extensive training/instructions can improve accuracy and reduce variability, thus maintaining the quality and standards of such an evaluation. There is an urgent need to have standardized training centers and increased awareness in this area of men's health for reproductive success.

Antisperm Antibodies Detection and Management

The etiology and pathogenesis of hyperplastic processes of the endometrium (HPE) are currently unclear, some aspects of the pathogenesis remain controversial and debatable. The objective: was to evaluate the microbiota of the reproductive mucosa in patients with subfertility on the background of endometrial hyperplasia combined with chronic endometritis, and to develop an optimized treatment and rehabilitation program. Materials and methods. A comprehensive clinical and laboratory examination of 54 patients of reproductive age with subfertility on the background of endometrial hyperplasia and chronic endometritis was performed. Two groups were formed to evaluate the effectiveness: the main group - 30 patients who received an optimized program of treatment and rehabilitation options, the comparison group – 24 patients who received classic conventional therapy. The endometrium of 20 gynecologically healthy women was used for control clinical-laboratory and morphological examinations. The personalized program of postoperative support is offered: basic antibiotic therapy, supplemented with bacteriophage therapy, antiviral therapy, immunomodulatory, angioprotective and venotonizing agents, correction of ischemia, correction of metabolic disorders, restoration of morphofunctional potential of endometrial tissue with the use of individualized hormone therapy was proposed. Results. HPE became the prerogative of all patients in the study group, and in 19 (35.2%) endometrial polyps were registered, in 35 (64.8%) a combination of hyperplasia and polyps. The results of bacteriological research showed a significant proportion of abnormalities in vaginal biocinosis, which is manifested by a significant reduction in the frequency of secretions of major acid-forming lactobacilli compared with healthy patients. After using the proposed treatment program to improve well-being, reduce pain and reduce hypersecretory abnormalities were noted by all patients, the results of control pipelle biopsy with microbiological examination of the endometrium 3 months after the end of treatment showed sterile cultures in 97% of samples. During the year of observation, spontaneous pregnancy out of 30 people who received pre-pregnancy training in the main group occurred in 14 (46.7% of cases), and of the 16 women enrolled in the ART program, 7 (43.7%) became pregnant. Conclusions. A comprehensive study of the microbiocenosis of the mucous membranes of the reproductive tract showed that in women with endometrial hyperplasia combined with CE, microbiological parameters are characterized by a high frequency of viral and viral-bacterial associations, a significant proportion of dysbiotic disorders. Carrying out pregravid preparation along with optimizing the antibacterial therapy program using rational antimicrobial agents, modern enzyme preparations to reduce the intensity of stroma fibrosis, individualized hormonal correction, agents that improve the effects of ischemia and changes in mucosal microbiota, allow to restore morphofunctional disorders in the endometrium.

Sperm antibodies in couples with recurrent spontaneous abortion

The influence of antisperm antibodies in the female serum on fertilization and pregnancy rate in patients undergoing GIFT was assessed. A study group of 52 couples (69 cycles) with significant levels of antisperm antibodies in the female serum were compared to a control group of 749 couples (1185 cycles). Maternal serum or donor serum was used as growth medium supplement. The TAT test was performed for the detection of antisperm antibodies in the serum. Antisperm-antibody presence in female serum was associated with similar fertilization and pregnancy rates in a GIFT program compared to the control group. The type of serum used as growth medium supplement did not affect statistically the fertilization or pregnancy rate.

To verify the proposed relationship between recurrent spontaneous abortions and the presence of maternal antisperm antibodies (ASA) in women as detected by a sensitive and reliable method. The presence of maternal antipaternal immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies were determined against three different paternal antigens comprising T, B lymphocytes and semen cells by a sensitive flow cytometric crossmatch method to examine their possible correlation with pregnancy outcome. Group 1 consisted of sera obtained from 24 women with a history of abortion, and lymphocytes and semen samples collected from their husbands at the same time of visiting the in vitro fertilization (IVF) Clinic at King Faisal Specialist Hospital and Research Center. Sera, lymphocytes and semen samples were also collected from six couples with no history of abortion who served as controls (Group 2). Using a sensitive flow cytometric assay to analyse the samples, without knowledge of clinical status, elevated levels of both IgG and IgM were detected in Group 1. However, no significant association was found when compared with normal females who had healthy pregnancies. Flow cytometry is a highly sensitive and specific tool for the detection of alloantibodies in human sera from patients with rejected transplanted organs. Our findings suggest that maternal antipaternal antibodies with respect to IgG and IgM classes do not play a major role in women with a history of recurrent abortions, despite the presence of increased levels of antibodies against three different sources of paternal antigens.

The objective: optimization of tactic of conduct of women of reproductive age is after the delete of endometrial polyps on the basis of study of antioxidant status of organism and uterine blood flow.Materials and methods. 165 women of reproductive age took part in research. From them – 150 with endometrial polyps and 15 practically healthy women of reproductive age with regular ovulatory by a menstrual cycle, which did not have gynaecological diseases in anamnesis, and made a control group. The criteria of exception of patients from research were: malignant pathological process in the organs of the reproductive system or other localization, hormone-producing ovarian tumour, uterine fibroids and adenomyosis, and also pregnancy and lactation.A complex clinical-and-laboratory inspection which included a echographic inspection was conducted all women, Doppler, coloured Doppler mapping organs of small pelvis, hysteroscopy with the separate diagnostic scraping off of cervical canal and cavity of uterus, morphological research of remote polyps and determination of parameters of antioxidant status.Results. Ultrasonic research of organs of small pelvis in combination with coloured Doppler mapping and enables the curves of speeds of blood flow nono-invasive to estimate the change of indexes of blood flow to myo- endometrium in case of occurring of endometrial polyps. For patients with endometrial polyps as compared to the women of control group in the follicle phase of menstrual cycle for certain the low values of resistance index were determined only in radial and basale arteries (in radial arteries – 0,58±0,01 and 0,66±0,01, respectively; p&lt;0,01; in basale arteries – 0,50±0,01 and 0,57±0,01, respectively; p&lt;0,01). Reliable decline of vascular resistance for patients with endometrial polyps in radial and basale arteries and, respectively, vasodilatation of vessels of uterus, obviously, it can explain enhanceable maintenance of estrogen and estrogen receptors. From our data, in arcuate arteries at glandular polyps an arterial blood flow appeared in 93,8%, and at glandular-fibrotic polyps – in 61,2%, in radial arteries – 89,2% and 45,9% respectively, in basale arteries 81,5% and 35,3%, respectively. Research results rotined that stromal fibrosis mainly had met for patients which have glandular-fibrotic endometrial polyps. Leykocyte-histiocytic infiltration was characteristic to the glandular polyps, and lymphocytic infiltration – glandular-fibrotic to the endometrial polyps. Both glandular and glandular-fibrotic polyps were characterized by the thick-walled vessels. Vessels with the sclerosis of walls met only in glandular-fibrotic polyps in 17,4% cases. Found out by us considerable violations in antioxidant status for patients in the first days after operative interference as compared to analogical indexes for patients with the endometrial polyps to the operation conditioned by operating stress.Conclusions. For prognostication of possible risk of relapse of endometrial polyps after their operative delete it is suggested to conduct the Doppler monitoring with the use of method of coloured Doppler mapping in the basale and radial arteries of uterus in a postoperative period in a dynamics. With a purpose to normalization of antioxidant status is expedient and grounded in quality the mean of antirecurrent therapy to use the algorithm in methodology of which stopped up naturally evolutional the formed models developed by us, one of which there is co-operation of water-reducing and fatty components of the antioxidant system and, in particular, glutathione, ascorbic acid and tocopherol. Other natural model which an organism produced as a result of phylogenesis and protracted natural selection is a non-invasive electronic satiation of organism with the purpose of suppression freely radical to activity, neutralization and detoxication of tissue.A positive therapeutic effect is got after the algorithm which includes the complex use of antioxidant preparations (thioctic and ascorbic acid, alfa-tocopherol and indole-3-carbinol) in combination with the non-invasive satiation of tissue by electrons developed by us, can allow to revise some traditional going near treatment of hyperplastic processes of reproductive organs for women, that, no doubt, requires the modern methodological and methodical approaches scientifically grounded.Keyword: endometrial polyps, relapse, antioxidant status, uterine blood flow.