Berestovyj O. Дисертаційна робота присвячена підвищення ефективності лікування безпліддя різного ґенезу у подружніх парах на основі вивчення нових аспектів патогенезу жіночого безпліддя, а також удосконалення та впровадження алгоритму діагностичних, лікувально-профілактичних та прогностичних заходів.

Dissertation work is devoted increase of efficiency of treatment of infertility of different genesis in married couple on the basis of study of new aspects of pathogeny of female infertility, and also improvement and introduction of algorithm of diagnostic, treatment-and-prophylactic and prognostic measures. The results of the conducted researches testify that at married couple with undifferentiated connective tissue dysplasia principal reasons of female infertility is: pipe peritoneal factor (54.7%); anovulation (32.0%) and endometriosis (13.3%). At the estimation of structure infertility prevails primary (72%) in comparing to the second (38%), and in 64% his duration makes more than 5 years. At the estimation of the psycho-emotional state at married couple it is set with undifferentiated connective tissue dysplasia, that the starting mechanism of high level of violations is treatment of infertility, and by basic displays: fear is before a negative result (62%); situation anxiety (more than 50 points); high level of alarm and depression (more than 10 points). Direct cross-correlation dependence of moderate relation (R=0.33; р<0.05) is thus set between duration of infertility and level of depression for women and men (R=0.28; р<0.05). At research of quality of life is set its decline anymore, as on 10 points in relation to married couple without undifferentiated connective tissue dysplasia. On every patient with infertility on a basis undifferentiated connective tissue dysplasia it will be 4,9 its signs, and on every man – 3,7 signs respectively. In 50% women found out pathology of sight, in 33,3% is a disease of the cardiovascular system; among men – in a 50% pathology of vessels, and in 34.6% is violation of the musculoskeletal system. The most widespread signs of undifferentiated connective tissue dysplasia for women with infertility is: dorsopathy (76%); deformation of spine (48%) and pathology of sight (46.6%); among men is an asthenic physique(60%); pathology of foot (34.6%) and deformation of spine (36.0%). On the measure of expressed an easy degree took place in 59.3% patients, and in 40.7% – middle; among men – 43.3 and 56.7% respectively. Women with unexplained infertility have frequent (50%) sexually transmitted diseases and inflammatory diseases of privy parts the characteristic features of anamnestic infor¬mation (45%). Average duration is 4.10.4 years; thus primary infertility prevails (77.5%) above the second (22.5%). In 55% patients it is not discovered pathological changes of organs of small pelvis, duration of treatment is 3.20.3 years. For women with unexplained infertility it is selected 4 syndromal of borderline mental disorders: neurosthenic (37.5%); phobic (25%); hysterical (20%) and anxiety-depressive (17.5%). 62.5% women have a high level of psycho-social stress (from 2 to 3 points). Frequency of presence of antibodies to the thyroid for women with unexplained infertility is 47.5%; to the phosphotides of cellular membranes – 42.5% respectively. 60% married couple with unexplained infertility have compatibility for to both classes of the system HLA. General amount of married couple which have 2 coinci¬dences for is 40% two classes, from them for I the class – 20% and for II – 20%. Frequency 3 and more coincidences for is 60% two classes of the system HLA, from which in I class – 10% and in II – 50% respectively. Results of immunohistochemical research to endometrium for women with unex¬plained infertility evidence about the followings changes: mionectic expression of leukemia-inhibiting factor in the epithelium of endometrium and pinopods (violation of receptivity of tissue and processes of implantation); mionectic expression of prospasal cytokine interleukin-1 in the epithelium of endometrium, pinopods and stroma (violation of processes of implantation); decline of expression of marker of angiogenesis vascular-endothelial grouth in the epithelium of endometrium, pinopods, stroma and endothelia of cells (vascular violations); an increase of expression of marker of apoptosis is in endometrium (strengthening of apoptosis of cages and violation of implantation). To the complex of examination of married couple with infertility it is necessary to include diagnostics of undifferentiated connective tissue dysplasia with determination of leading phenotypic signs (fat feet, expansion of veins, hypermobility of joints, gothic sky, pathology of organs of sight, deformation of thorax and spine, tensility and languor of skin and long thin fingers) and level of magnesium, zinc in the whey of blood and follicle liquid.