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UDC 618.177-089.888.11
PREDICTORS OF IVF PROGRAM FAILURES IN PATIENTS INFERTILITY AND BODY WEIGHT SURPLUS
1 Altai State Medical University, Barnaul
2Siberian Institute of Human Reproduction and Genetics, Barnaul T.V. Zhuk1, S.D. Yavorskaya1, V.V. Vostrikov2
In order to identify the predictors of failures in IVF programs in patients with body weight surplus, a retrospective analysis of 145 histories and protocols of superovulation stimulation for 135 factors was conducted. During the study, two comparison groups were formed. The first group (n = 99) is patients whose pregnancy has not occurred. The second group (n = 46) is patients whose pregnancy has occurred. The comparative analysis of the two groups showed no significant statistical differences, with the exception of the tubal peritoneal infertility factor (82.8% and 65.2% p = 0.03), which prevailed in the group of patients with an unsuccessful outcome in the IVF program. On the grounds of the work carried out, it can be concluded that it is necessary to further search for predictors of failures in this group of patients. Key words: overweight, obesity, IVF, infertility, pregnancy.
In conditions of modern socio-economical situation one of the key priorities of Russian state policy is the strengthening of the institution of the family and increase of birth rate. This socially important priorities are settled by the Presidential Decree №1351 of 9th October, 2007 [1]. In Altai Krai, in terms of realization of the program on the increase of birth rate in 2016 medical help regarding infertility implying assisted reproductive technologies (ART) was provided to 1215 couples, pregnancy happened in 30% of cases [2]. One of the socially significant problems of modern time is the problem of excess weight. Obesity is not only the risk of cardio-vascular pathology and oncology, but also the risk of infertility, maternal and perinatal incidence and lethality [3, 4]. It is reported that patients with weight surplus are included into the risk group of ART inefficiency [5]. However, for a number of female patients excessive weight is not a barrier for the realization of reproductive function in IVF programs. It is not strictly stated yet which factors in patients with weight surplus determine the effectiveness of ART programs and which are predictors of failure.
Research objective: to determine the factors conditioning the outcome of ART (IVF) in patients with weight surplus and obesity.
Materials and methods
To solve the stated goal there was conducted a retrospective analysis of 145 medical histories and protocols of superovulation stimulation. The research was conducted on the basis of Siberian Institute of Human Reproduction and Genetics (Head physician, Candidate of Medical Science Vostrikov V.V.). Criteria of inclusion: overweight and obesity (BMI>25), age from 18 to 35, infertility of endocrine, tuboperitoneal, idiopathic or mixed genesis, 1 trial of IVF. Criteria of exclusion: female
patients of elder reproductive age, necessity of other types of ART (use of donated ovocytes, surrogate maternity), male infertility factor, reduction of ovarian reserve, congenital disorder or acquired uterine cavity deformities, endometriosis of 3-4 stage, uterine myoma of large size, heavy forms of extragenital pathology, cancellation of embryo transfer.
In terms of study, there were formed two groups of comparison. First group (n=99) - patients in which pregnancy did not occur. Second group (n=46) - patients in which pregnancy did occur. There were assessed 135 factors including social characteristics, somatic and gynecological anamnesis, data of protocols of superovulation stimulation, evaluation of endometrium and embryos for transfer, and also the outcomes of occurred pregnancies.
The statistical processing of obtained results was conducted on the personal computer by means of Statistica 10.0 program package. In cases of normal distribution and also the equality of dispersion by F-criterion, there was used Student t-test to compare the mean values. In case of distributions not corresponding to the normal law and also by the inequality of dispersions, there was implied the non-parametric Mann-Whitney U-test. For the comparison of qualitative features, there was used x2 criterion with Yates' correction.
Results and discussion
Patients of the comparison groups were comparable by age, region of residence, social status, somatic load and BMI. In both groups of comparison there dominated secondary infertility (63,6% and 65,2%; p=0,99). However, the tuboperitone-al factor of infertility was registered much rarer in patients with negative result of IVF program (82,8% and 65,2% % p=0,03). The rate of occurrence of infertility of endocrine (46,5% and 58,7%; p=0,23),
mixed (39,4% and 32,6%; p=0,54) and idiopathic (2% and 4,3%; p=0,8) genesis in the compared groups did not differ significantly. The assessment of gynecological anamnesis showed that in the 1st group of patients (ineffective IVF), the frequency of spontaneous miscarriage (21,2% and 13%; p=0,34) and extra-uterine pregnancy (40,4% and 26,1%; p=0,13) was higher than in the second group (effective IVF). The same group of patients was characterized by more frequent occurrence of such diagnoses as polycystic ovarian syndrome (21,2% and 15,2%; p=0,53), pelvic inflammatory diseases (82,8% and 73,9%; p=0,3), uterine myoma (19,2% and 10,9%; p=0,31), adenomyosis (8,1% and 2,2%; p=0,31). The presence of Chlamydial infection in the anamnesis was associated with the IVF failure (20,2% and 6,5% p=0,064).
In the majority of cases (75,8% and 76,1%; p=0,86) in two groups of comparison there was used the long protocol. The protocol with antagonists held the second position (21,2% and 21,7%; p=0,88), the short protocol of ovulation stimulation was rarely used (3% and 2%; p=0,80). The average duration of stimulation in two groups was averagely identical (12,5±0,2 and 12,2±0,3). Upon the end of stimulation protocol there were calculated the follicles suitable for puncture. The average rate of follicles with diameter over 16 mm in the first group constituted 11,1±0,8, in the second group - 8,5±0,7. The evaluation of embryos quality for transfer was characterized by the following indicators: embryos of perfect quality (57,6% h 56,5%: p=0,95), embryos of good quality (57,6% and 56,5%: p=0,95), embryos of satisfactory quality (15,2% h 6,5%; p=0,23). The thickness of endome-trium for transfer averagely constituted 12±0,5 mm in both groups. A dangerous complication of ovulation stimulation program is the Ovarian Hyperstimulation Syndrome. In terms of this criterion there were no significant differences stated (15,2% and 10,9%; p=0,66).
Occurrence of pregnancy is not the solvation of infertility problem. The analysis of outcomes of occurred pregnancies in patients of the second group showed that term births took place only in 55,3% of cases. The rate of early losses constituted 18,4%, preterm deliveries - 26,3%, which exceeds the overall population indexes.
Conclusion
The assessment of groups of female patients with weight surplus for 135 factors did not show significant difference, except for the prevalence of tubo-peritoneal factor of infertility in patients with IVF failure. According to the obtained data, it is possible to conclude that it is necessary to search for further factors associated with IVF failures in patients with weight surplus and obesity.
References
1. On the approval of concept of demographic policy of the Russian Federation by 2025: Decree of the President of the RF of 0910-2007 №1351. Available at: http://www. kremlin.ru/acts/bank/26299 Accessed 26.05.2017.
2. "The resume of realization of measures for the increase of birth rate n Altai Krai in 2016". Available at: http://www.altaire-gion22.ru/region_news/podvedeny-ito-gi-realizatsii-meropriyatii-po-povysheni-yu-rozhdaemosti-v-2016-godu_572468. html Accessed 26.05.2017.
3. Sim K.A. Does weight loss in overweight or obese women improve fertility treatment outcomes? A systematic review/ Partridge, Sainsbury A. Obesity reviews. 2014; 15: 839850.
4. Lutsiv O. The effects of morbid obesity on maternal and neonatal health outcomes: a systematic review and meta-analyses. Obesity reviews. 2015; 16: 531-546.
5. Shah D.K. Effect of obesity on oocyte and embryo quality in women undergoing in vitro fertilization. Obstet Gynecol. 2011; 118: 63-70.
Contacts:
Corresponding author - Yavorskaya Svetlana Dmi-triyevna, Doctor of Medical Sciences, Associate Professor of the Department of obstetrics and gy-necology with the course of further vocational education of Altai State Medical University, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 368587. Email: l2001@bk.ru
