The dissertation is devoted to a comprehensive study of the impact of hormonal homeostasis disorders and extragenital diseases on the course of pregnancy achieved through assisted reproductive technologies (ART), as well as to the development of approaches for stratifying oncological and somatic risks in women prior to their inclusion in in vitro fertilization (IVF) protocols.
The study provides an integrated theoretical justification and proposes an innovative solution to the problem of improving the effectiveness of ART.
The paper presents the results of a retrospective analysis of 162 outpatient records of women divided into the main group (101 patients with infertility undergoing ART protocols) and the control group (61 practically healthy women).
Special attention is given to the analysis of the hormonal profile (AMH, FSH, LH, estradiol, progesterone, prolactin, and TSH) and its impact on ART outcomes. It was found that normal AMH levels are associated with a higher pregnancy rate, whereas elevated levels of FSH, LH, and prolactin, as well as decreased levels of estradiol and progesterone, represent unfavorable prognostic factors. The most pronounced negative impact on pregnancy progression was observed in cases of progesterone deficiency, hyperprolactinemia, and thyroid homeostasis disorders. Optimal TSH levels (0.5–2.5 mIU/L) ensured the highest rates of both pregnancy achievement and pregnancy progression in ART programs as well as in spontaneous conception.
The correlation between serum levels of vitamin D, ferritin, selenium, zinc, magnesium, vitamins B12 and B9, and clinical outcomes was analyzed. Vitamin D was identified as a critical prognostic factor for pregnancy continuation, as adequate levels ensure more than 92% successful pregnancy progression, whereas deficiency increases the risk of early reproductive loss by 2–3 times. It was determined that for successful implantation the target ferritin level should not be lower than 45–60 ng/mL. Essential trace elements (selenium and zinc) were found to be key “trigger mechanisms” for frozen embryo transfer protocols (group IA). Achieving normal zinc levels ensured a 100% probability of pregnancy progression after cryotransfer. Selenium deficiency reduced the chances of success from 81% to a critical 23%. Normalization of magnesium levels was shown to be a guarantee of embryo viability in the natural cycle (100% success).
The dissertation presents the results of a comprehensive examination of 77 women with infertility and thyroid nodules classified as TI-RADS 3 and TI-RADS 4. The main objective of this part of the study was to determine the prognostic value of ultrasound assessment and the necessity of morphological verification of thyroid nodules using fine-needle aspiration biopsy before initiating hormonal stimulation in IVF protocols. Based on morphological data, a three-level model for admission to ART programs was developed.
The study also analyzed the examination results of 88 patients with focal breast pathology. Based on the obtained data, a differentiated approach depending on the BI-RADS category was developed: risk of malignancy <2% (entry into ART programs is permitted after consultation with a mammologist with follow-up in 3–6 months); risk 2–50% (mandatory fine-needle aspiration biopsy or core biopsy, and admission to ART only after confirmation of a benign histological conclusion; if proliferation with atypia is detected, postponement for 1–3 months for surgical treatment is recommended); risk >50% (urgent core biopsy; if breast cancer is confirmed, this represents an absolute contraindication to standard ART protocols).
One of the sections presents the results of a comprehensive assessment of the vaginal microbiocenosis and microscopic markers of inflammation in women with infertility undergoing treatment with assisted reproductive technologies, taking into account various pathogenetic variants of endocrine and vitamin-mineral disorders, as well as the presence of benign lesions of the thyroid and mammary glands.
The obtained results substantiate the feasibility of mandatory comprehensive assessment of the hormonal profile (AMH, FSH, LH, estradiol, progesterone, prolactin, TSH) in women with infertility and extragenital pathology at the stage of preparation for assisted reproductive technology programs in order to predict treatment effectiveness and individualize patient management strategies.
The results obtained can be implemented in the clinical practice of reproductive medicine institutions in order to increase the effectiveness of ART programs, reduce the frequency of unsuccessful cycles and early reproductive losses through a personalized approach to patient preparation and management.
