Tarawneh D. Pathogenetic substantiation of endometrial preparation in vitro fertilization programs in patients with thrombophilia

The work is devoted to increasing the effectiveness of assisted reproductive technologies programs by studying the main pathogenetic characteristics of failed IVF attempts in women with thrombophilia. The dissectant studied hemodynamic and molecular factors of endometrial receptivity, as predictors of the onset of pregnancy in IVF programs in patients with thrombophilia. In this dissertation work the indicate the role of the immune system and hormonal status in IVF in women with thrombophilia and their definite influence on the state of the endometrium. The study of structural and functional characteristics, as well as analysis of morphofunctional and immunohistochemical changes in the endometrium was carried out. The author has determined the most significant parameters for assessing the state of the endometrium in IVF in women with thrombophilia. The degree of severity of lesions in the stroma and in the glands of endometrioid tissue is shown, depending on the factor of infertility. It has been revealed that the morphologically unchanged endometrium in carriers of hereditary thrombophilia genes does not have a of full value functional activity able of fully provide the implantation and development of the embryo, in connection with the violation of the receptivity of the endometrium. In the dissertation suggests non-invasive methods for the evaluation of markers that determine the receptivity of the endometrium, the need for their determination before the IVF program in patients with thrombophilia. The main ultrasound and dopplerometric criteria of blood flow in the uterine vessels characterizing the receptivity of the endometrium are identified and their relationship to the effectiveness of IVF programs is determined. The relationship between the expression of LIF, TGF-?1, VEGF-A in the endometrium of women in the period of the supposed "implantation window", which is correlated with the effectiveness of IVF programs, has been elucidated. The role of expression of the protein proliferation factor Ki67 and PCNA, which regulate the cell cycle in the endometrium in patients with thrombophilia, was investigated. The algorithm is proposed and the effectiveness of the examination and treatment of patients with thrombophilia suggested by the author is estimated. The dynamics of changes in the state of the endometrial receptor apparatus in women with thrombophilia is shown on the background of the therapy. Based on the introduction of a new approach to the treatment and preparation of the endometrium before the IVF, it was possible to significantly improve the effectiveness of pregnancy in women with unsuccessful attempts of pregnancy.