The dissertation presents a new solution to the scientific problem, consisting of theoretical synthesis of the results of the study of psychosocial disorders in women with infertility, optimization of the conditions of pregnancy and on this basis - pathogenetic substantiation and development of pathogenetically directed differentiated relative psychosocial disturbances of a complex of prognostic, diagnostic and therapeutic and prophylactic measures.
A number of significant medical-social and psychological factors of infertility treatment inferiority were established in order of decreasing significance: the age is over 35 years old (OR = 7.1), primary infertility (OR = 4.0), algostismnorea (HS = 3.7), vegetative syndrome dysfunction (OR = 3.6), endometriosis (OR = 3.1), endocrine diseases (OR = 3.1), increased stress (OR = 3.0), obesity (OR = 2.9), sleep disturbance (OR = 2.9), depression (OR = 2.9), which confirmed the essential significance of psychosomatic factors associated with infertility of tubal-peritoneal genesis and indicates the need for their diagnosis and correction during preparation for DRT cycles.
A pathogenetically grounded differentiated diagnostic-therapeutic complex for detected disturbances for patients with infertility and psychosomatic disorders has been developed. The diagnostic complex for assessing the risk of inefficiency of DRT involves: collecting anamnesis for the detection of comorbid states; psychological interview, psychodiagnostics (ITO Sotchik's technique, Wein questionnaire, Diagnosis of Wein's sleep disturbances, Holmes-Rage level assessment, Beck's depression); with disorders of sleep - level of melatonin; detection of prothrombotic states (APA level, hemostasis system); cytological evaluation of microbiocinosis for the detection of asymptomatic bacquanidosis (criteria of Njentha); detection of chronic pelvic pain, assessment of its intensity (verbal descriptor scale, level of perception of stress SPSS, neuromuscular stress Nachin); Detection of obesity (BMI, estimation of coping strategies in stressful situations, Dutch food interactions questionnaire DEBQ).
Therapeutic and prophylactic complex of increasing the effectiveness of DRT: psychological counseling, psychocorrection (a method of symbols-catalytic-imaging psychotherapy, music therapy, family and group therapy); observance of sleep hygiene, autotraining, melatonin preparations (sleep regulator and adaptogen); preparations L-arginine (glutargin - improvement of blood flow, metabolic regulator of metabolic processes, increase of adaptability); immunomodulators (accelerated treatment of inflammatory processes, with increased APA); probiotics in complex therapy of microbiocenosis disorders; cyclodinone in the treatment of dyshormonal disorders in the background of latent hyperprolactinemia, algotysmenorrhea, chronic pelvic pain; nebenzodiazepine anxiolytics Strezam at psycho-vegetative treatments, depressive states; Obesity - diet therapy, psychotherapy, focused on the formation of stress-resistance through the development of problem-oriented coping behavior.
Psychological support for patients with DRT programs is carried out in stages. The first stage is the reduction of anxiety, the second is the neutralization of negative experiences related to infertility and the past experience of treatment, the third is the correction of the motivation of pregnancy. the fourth is the achievement of a psychoemotional equilibrium in the period from the day of embryo transfer to the day of diagnosis of pregnancy.
The application of the proposed complex allows to improve the mental and general somatic state, to balance the hormonal background, to optimize the conditions of pregnancy, which allows to increase the efficiency of the DRT programs from 22.5 to 37.5%.
