Analysis of somatic and reproductive history in patients with prognostically poor response of the testicles to gonadotropin stimulation

Abstract

The objective: to conduct a clinical and statistical analysis of the somatic and reproductive history in women with infertility and a predictable poor ovarian response to stimulation with different gonadotropins. Materials and methods. We examined 140 infertile patients 21–42 years old with an increased risk of poor response. I group included 75 women who received gonadotropins of human pituitary origin in stimulated cycles, II group involved 65 patients who received recombinant gonadotropins in stimulated cycles. The analysis of the anamnestic data included an assessment of the menstrual cycle (age of menarche onset, parameters, duration, and regularity), characteristics of reproductive function (number of pregnancies, peculiarities of the course and outcomes of pregnancy), gynecological diseases, conservative and surgical treatment of infertility and its effectiveness. Somatic pathology in women was analyzed. Data processing was carried out using the Stat Soft Statistica 8.0 software package.Results. The average age of patients in the I group was 36.4±3.6 years, in the II group – 35.6±2.5 years. The normal menstrual cycle was in 89.3% of women in the I group and 92.3% – II. Menstrual cycle disorders of the type of oligomenorrhea were observed in 8 (10.7%) and 5 (7.7%) patients, respectively. Primary infertility was diagnosed in 21 (28.0%) persons in the I group and 18  (27.0%) – II group, secondary infertility – 54 (72.0%) and 47 (72.3%) women, respectively. The average duration of primary infertility was 6.2±2.1 years, secondary one – 5.8±3.8 years. The history of artificial abortion had 17 (22.7%) and 14 (21.5%) women, spontaneous abortion and missed pregnancy till 12 weeks of gestation were observed with the same frequency – 18 (24.0%) and 15 (22.0%) cases, respectively, ectopic tubal pregnancy – 9 (12.0%) and 7 (10.7%) cases. The rate of insufficient ovarian function was determined in 49 (65.3%) women in the I group and 42 (64.6%) – the II group; it was manifested by chronic anovulation in 89 women of both groups, which accounted for 63.5% of patients and insufficiency of the corpus luteum (38 (27.1%) of the examined persons). Pelvic inflammatory diseases were diagnosed in 41 (54.6%) and 36 (55.4%) patients, external genital endometriosis – 22 (29.3%) and 17 (26.1%) women, respectively. Ovarian resection was performed in 21 (28.0%) patients of the I group and 16 (24.6%) – II group, the indication for which in 57.1% and 56.3%, respectively, was a recurrent course of external genital endometriosis with the formation of endometrioid cyst. The pathological changes in the endometrium were detected in 39 (52.0%) and 31 (47.7%) patients of the I and II groups, respectively, among which 14 (18.6%) and 11 (16.9%) women had polyps, 11 (14.7%) and 9 (13.8%) – chronic endometritis. Conclusions. Thus, the predisposing factors for the development of a poor response in vitro fertilization programs were late reproductive age, a high frequency of surgical interventions on the pelvic organs and, as a result, a change in the blood circulation of the ovarian cortex, a decrease in the volume of the stroma and a reduction in the follicular reserve. According to the main clinical and anamnestic characteristics, there were no significant differences between patients who received human pituitary or recombinant gonadotropins in stimulated cycles.