Maslij Y. Etiopathogenetic mechanisms and methods of poor ovarian response syndrome correction in IVF programs.

The work is devoted to the study of etiopathogenetic mechanisms of poor ovarian response syndrome (PORS), methods of its prognosis and correction. On the basis of anamnesis information study, clinical, laboratory researches, data of sonography and endoscopy, genetic researches it is determined that age factor and adnexal surgery play basic role (70% of cases) in the pathogenesis of PORS, in the part of cases (about 4%) these patients have high risk allele and FMR1 gene premutation. On the basis of hormonal researches (follicle-stimulating hormone (FSH), antimullerian hormone (AMG)), 2D- and 3D sonography with Doppler it is found out that biochemical markers serve as prognostic signs of PORS: concentration of FSH and AMG in peripheral blood in early proliferative phase of menstrual cycle, 3D and Doppler indexes of ovarian reserve: amount of primordial follicles, 3D ovarian volume, vascularization index. Depending on the etiopathogenetic factor of origin of PORS, differentiated treatment modality is elaborated. For patients with operations in anamnesis it is appropriate to use modified protocol of controlled ovarian hyperstimulation: short protocol with agonists and antagonists of gonadotropin-releasing hormone, for women without operations in anamnesis - long lutein protocol with agonists of gonadotropin-releasing hormone. For all categories of patients with PORS the use of IVF in natural cycle is proposed that allows to get acceptable for this category of patients pregnancy rate with less financial and physical loadings. The treatment algorithm developed in the work allowed to increase pregnancy rate for women younger 35 years up to 33,3%, for women of 36 years and older to 16,6 %.