Kutsenko A. Micromanipulative methods for treatment of infertility in married couples with pathospermia in males

The Dissertation is dedicated to the improvement of the results of infertility renewal in married couple with male factor of infertility by means of assisted reproductive technologies (ART) on basis of the personified approach to the selected among them the optimal program and prophylaxis of its appearance due to the proposed principle of division into risk groups. The work has been performed at the Institute of Reproductive Medicine (Kyiv). There are analyzed the results of examination and treatment of 420 married couples with infertility caused by various reasons, under the Protocol. According to the ART programs, three groups were separated: first (140) - insemination by male sperm (IMS), second (180) - intracytoplasmatic sperm injection (ICSI), third (100) - intracytoplasmatic morphologically selected sperm injection (IMSI). It was stated that percentage of biochemical pregnancy on stimulated native cycle at IMSI was 50.0±5.0%, at ICSI - 42.8 ±3.6 (p>0.05), at both programs it was the same with oligoasthenoteratozoospermia and obstructive azoospermia (53.0± 6.9% and 53.4±9.4%; and 45.0±4.5% and 42.8±3.6, respectively) and reliably less with non-obstructive (28.6±9.8% and 31.8 ±9.9%, respectively). After the cryo-cycle the index was unreliably less. The reproductive loss was 7.9% and 5.2%, respectively. Birth to a live-born fetus was reached in 58.0 ±4.9% and 51.1± 3.7% (p>0.05, respectively). The determined peculiar results in dependence on pathospermia manifested higher value of indices in oligoasthenoteratozoospermia and obstructive azoospermia at IMSI (68.4± 4.6% and 60.7± 4.8% versus 54.2±4.5% and 55.3± 7.5% at ICSI, respectively, but p>0.05; they were practically the same reliably less in non-obstructive (28.6± 4.5% versus 27.3±9.0%. At IMS program, after 3 attempts the pregnancy and birth were successful in 17.0±1.8% and 15.0±1.8%, respectively. There were determined preconditions, risk factors (21) and their characteristics (51), were followed by cause-and-effect relations between them by the ART results. Having formed the groups out of them, it has been proved by the influence vector that the largest total risk belongs to the group with special medical factors (OR=24.38; CI:6.75-101.11), it is less at biologically/common clinical (OR=15.15; 95% CI:46-66.89) and then - social (OR=8.64; 95% CI:3.68-21.50). Besides, the prognosis chart was made on the basis of informative evaluation (in scores) of importance of the detected factors (characteristics). After its processing by calculation of normatively informative data for every characteristic with the help of mathematic analysis, it was determined as an integral coefficient the minimal and maximal possibility of an unfavorable result. On this basis three risk groups were singled out. All this became a key element for coming to a substantiated and objective decision in every case both for prophylaxis of male infertility and choice of the optimal ART program.