Infertile marriage is a complex socio-economic problem; the frequency of infertility in Ukraine is 17-20%, which prompts further study of its mechanisms, including immune ones, in order to develop appropriate methods of correction. Purpose - to characterize the phenotypic features of T-cells and their subpopulation of T-helpers (CD3+CD4+) with the expression of intracellular cytokines in women with a history of infertility at different stages of pregnancy. Materials and methods. Relative levels of immunocompetent cells (cl) of blood, including intracellular expression of cytokines CD3+CD4+cells, in 436 non-pregnant (the reference group n) and 514 pregnant women with infertility at the first trimester and the second trimester of pregnancy were determined using a cellular cytofluorimeter and the corresponding test systems. Characteristics of indicators in pregnant women at the different terms in groups were analyzed: a - 4-7 weeks (140 women); b - 8-9 weeks (163 women); c - 10-12 weeks (133 women); d - 13-18 weeks (63 women); e - 19-28 weeks (15 women) compared to the group n and among themselves. Results. The first 12 weeks of pregnancy in women with a history of infertility are characterized by high blood levels of T-helpers (CD3+CD4+-cl), and their activation according to the expression of markers CD25 and HLA-DR, and for 18 weeks - intracellular secretion of pro-inflammatory cytokines IFN-γ + and TNF-α, high expression of anti-inflammatory IL-4 was observed throughout the 27 weeks of follow-up. The percentage of women with high levels in the blood of CD3+CD4+IFN-γ+- and CD3+CD4+TNF-α+-L is the highest during the first 12 weeks, from 13th week these indicators for TNF-α, and with 20th - for IFN-γ do not differ from non-pregnant ones. Since the beginning of pregnancy, the relative number of women with low expression of IL-4 and IL-10 T-helpers has significantly decreased; within 13-18 weeks, the percentage of such pregnant women is significantly increased to the reference group, and such women are the most vulnerable due to the possible weak reaction of the anti-inflammatory link to the state of tolerance. Conclusions. The characteristics of peripheral blood immune system cell levels according to their CD phenotypes and intracellular cytokine expression indicate their participation in pregnancy mechanisms at different stages and individual analysis allows for negative predictions and improvement of pregnancy course in women with a history of infertility. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: CD-phenotype of immunocompetent cells, intracellular cytokines, pregnant women, history of infertility.

The purpose - to substantiate the principles of prevention and treatment of major gestational complications in women with a history of combined infertility. Materials and methods. The patients were divided into the groups, depending on the prescribed treatment regimen: the group 1 - 52 pregnant women with a history of combined infertility who received basic therapy with a positive urinary test for pregnancy (dydrogesterone 10 mg 2 times a day for up to 12 weeks, folic acid - 400 mcg per day up to 14 weeks of pregnancy). The group 2 - 50 pregnant women with combined infertility who received our improved regimen (5-methyltetrahydrofolate - 600 mg, iodine - 200 mcg, micronized progesterone - 200 mg, cardioaspirin - 150 mg, calcium with vitamin D3, omega-3, -6, -9 polyunsaturated fatty acids - 1000 mg, magnesium with vitamin В6). Statistical processing of data was performed by the methods of variation statistics. Results. More often, gestational complications in the trimester II were in pregnant women of the group 1, who took the basic treatment regimen, than in patients of the group 2, who used the therapeutic complex improved by us. Thus, polyhydramnios was detected almost 2.5 times more often in patients of the group 1 (11.5%) versus 4% of pregnant women of the group 2; and oligohydramnios was confirmed 3 times more often in women of the group 1 (7.7%), while in pregnant women of the group 2 only in 2%. Isthmic-cervical insufficiency developed in every 5 women (21.2%) in the group 1 and almost three times less often - in 8% of women in the group 2. Anomalies of placental attachment, namely: placenta previa and its low location occurred 2.5 times more often in women of the group 1 (15.4%) compared with pregnant women of the group 2 (in 6%). Premature maturation of the placenta, which was manifested by structural changes in it on ultrasound, was manifested almost three times more often in women of the group 1 - in 17.3% versus 6% of pregnant women in the group 2. Gestational anemia was found in women of the group 1 (19.2%), which is half as often as in the group 2 (12%). Gestational diabetes was also half as common in women of the group 1 (30.8%) compared to the group 2 (20%). Exacerbation of chronic pyelonephritis was almost twice as common in women of the group 1 (7.7%) compared with the group 2 (4%). But pregnant women of the group 1 (23.1%) had vaginitis 4 times more often than the group 2 (6%). Conclusions. The use of the monitoring algorithm developed by us and a set of therapeutic and preventive measures in women with a history of infertility has significantly improved the results of their pregnancies. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

No abstract

Висока частота метаболічних порушень у жінок з ендокринною безплідністю пояснюється наявністю таких факторів ризику, як вік від 30 років, метаболічний синдром, ожиріння, інсулінорезистентність. Мета -з'ясувати глибину обмінно метаболічних порушень та удосконалити комплекс прегравідарної підготовки в жінок з ендокринною безплідністю. Пацієнти та методи. Обстежено 102 пацієнтки з ендокринним безпліддям, яким призначено різні курси прегравідарної підготовки протягом 3 місяців. Для дослідження відібрано пацієнток із синдромом полікістозних яєчників (СПКЯ) і метаболічним синдромом. Пацієнток розподілено на групи залежно від схеми лікування: І група -35 жінок з ендокринною безплідністю, які отримували для прегравідарної підготовки Доменорм Максі в поєднанні з дієтою; ІІ група -37 пацієнток з ендокринною безплідністю, які отримували для прегравідарної підготовки Метформін у поєднанні з дієтою; ІІІ група -30 пацієнток з ендокринною безплідністю, які отримували для прегравідарної підготовки Доменорм Максі, Метформін у поєднанні з дієтою. Усім жінкам до та після лікування проведено вимірювання артеріального тиску (АТ) й окружності талії (ОТ); у крові визначено рівень глюкози та індекс HOMA, тригліцеридів (ТГ) і ліпопротеїдів високої щільності (ЛПВЩ). Результати. У ІІІ групі жінок з ендокринною безплідністю, які застосовували Доменорм Максі, Метформін і дієту, встановлено найкращі результати щодо нормалізації метаболічних порушень: зниження АТ -83,3%, нормалізація рівня глюкози крові -90%, індексу HOMA -93,3%, зниження ЛПВЩ і ТГ -90%, зменшення ОТ -73,3%. У І та ІІ групах дещо різнилися дані щодо ефективності залежно від впливу на ту чи іншу ланку патогенезу метаболічного синдрому. Але обидві схеми довели ефективність. У І групі прегравідарна підготовка (Доменорм Максі та дієта) була досить ефективною: зниження АТ -71,4%, нормалізація рівня глюкози крові -57,1%, індексу HOMA -62,9%, ЛПВЩ -71,4%, ТГ -74,3%, зменшення ОТ -28,6%. У ІІІ групі жінок застосування Метформіну та дієти для прегравідарної виявило слабкий ефект у зниженні АТ (18,7%). При цьому ОТ зменшилася у 48,6%, ЛПВЩ знизилися у 73,3%, ТГ -у 78,4% пацієнток, рівень глюкози крові нормалізувався у 81%, індекс HOMA -у 78,4% пацієнток. Висновки. З'ясовано глибину обмінно метаболічних порушень у жінок із СПКЯ та можливість корекції цих порушень за допомогою багатофакторного підходу до комплексної терапії прегравідарної підготовки. Дослідження виконано згідно з принципами Гельсінської Декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначених у роботі установи. На проведення досліджень отримано інформовану згоду жінок. Автор заявляє про відсутність конфлікту інтересів. Ключові слова: метаболічний синдром, СПКЯ, ендокринна безплідність в анамнезі, Доменорм Максі, Метформін.

Purpose — to study the indicators of quality of life in pregnant women with a history of different types of infertility. Materials and methods. The study of quality of life indicators was carried out in 127 women aged 20 to 49 years, 97 of whom had a history of infertility of various origins and 30 pregnant women who had it. The distribution of pregnant women into groups was based on the factor of infertility: Group I — 35 pregnant women with a history of endocrine infertility, Group II — 37 pregnant women with a history of inflammatory infertility, Group III — 25 pregnant women with a history of combined infertility of inflammatory genesis with endocrine, Group IV (control) — 30 healthy pregnant women who did not have a history of infertility. The method of assessing quality of life was the WHOQOL-BREF Short Questionnaire. Results. The indicators of quality of life and general health, according to the subjective assessment of the patients, were the lowest in group III — 2.5±0.10 points and 2.1±0.05 points. In group I patients, the score was 3.1±0.15 points and 3.2±0.20 points and in group II — 3.2±0.10 points and 3.3±0.07 points, respectively. It should be noted that the most positive assessment of these indicators took place in the control group of pregnant women — 5.0±0.3 points. Thus, the physical functioning was assessed by the patients of group III at 16.7±1.1 points, and self+perception — at 20.5±1.6 points. A patient of groups I and II with a history of infertility assessed these indicators — 18.2±1.3 points; 23.4±1.5 points and 19.5±1.4 points; 22.6±1.6 points, respectively. The women in the control group had higher scores — 24.7±1.8 points; 25.7±1.7 points. Microsocial support in groups I, II, III was assessed 8.2±0.3 points; 9.3±0.5 points; 7.7±0.2 points, but in the control group — 13.7±0.1 points. The indicators of social well+being were 22.4±1.8 points; 23.5±1.9 points; 20.6±1.5 in groups I, II, III, and in the control group — 36.4±2.1 points. Conclusions. In women who became pregnant after long-term treatment of infertility in anamnesis, there was a significant deterioration in quality of life indicators compared with healthy women, which is explained by the high incidence of obstetric complications in them. Determination of quality of life indicators in women with a history of infertility is an integral part of monitoring during pregnancy, which allows adequate assessment and timely correction of physical, social and psycho-emotional functions in the interests of the mother and the fetus. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: short WHO questionnaire, quality of life assessment, pregnancy after infertility.