Vorobei-Vykhivska V. The role of hemostasis in effectiveness of assisted reproductive technology programs

The work deals with improving the consequences of assisted reproductive technology programs through evaluation and correction of the hemostatic system of women suffering from infertility. The main risk factors of adverse outcomes of assisted reproductive technology programs related to impairments of the hemostasis system were defined, namely burdened personal and family thrombotic history, burdened obstetric and gynecological history, the presence of polymorphisms of genes of plasminogen activator inhibitor (PAI-1: -675 5G> 4G), fibrinogen (FGB: -455 G> A), A2 integrin (ITG A2: 807 C> T) and coagulation factor XIII (F13A1: 9G> T), as well as combinations of three or more of these and other hemostatic gene polymorphisms. It was established that adverse prognostic factor regarding outcome of ART program is a deviation of coagulation parameters towards hypercoagulation over the period from the start of controlled ovarian stimulation until the day of transvaginal ovarian puncture. For the first time, based on the study carried out, a pathogenetically reasonable complex of prevention and correction of trombophilic states in the treatment of infertility using assisted reproductive technologies was developed including heparinoids, low molecular weight heparins, antiplatelet agents and NO donator under the control of dynamic parameters of the hemostatic system. A new clinical approach to identification of causes of failure in IVF programs allows to expand opportunities of preparing and medical support of such programs and to achieve higher pregnancy rate. The proposed algorithm for diagnosis, prevention and correction of infringements of the hemostatic system made it possible to increase the effectiveness of ART programs.