ARCHIVEOBSTETRICS AND GYNECOLOGY
International Medical Journal, Vol. 21., Iss. 4, 2015, P. 42−46.
AUXILIARY REPRODUCTIVE TECHNIQUES IN WOMEN WITH INFERTILITY FOLLOWING SURGERY FOR TUBAL PREGNANCY
Kharkiv Medical Academy of Postgraduate Education, Ukraine
The frequency of abdominal pregnancy in Ukraine amounts to 15.4 per 1,000 pregnancies. 47 % of patients urgently admitted to hospital are patients with abdominal pregnancy. Tubal pregnancies amount 93−98.5 % of all abdominal pregnancies. Pregnancy in intramural portion of the uterine tube amounts 2−4 %, in the isthmian portion 12−13.4 %, in the ampullar portion 78−83.6 %. Tubal pregnancy in both fallopian tubes occurs with a frequency of 1:20000. In 50−82 % of cases, women with infertility have a combination of several types; herewith they have tubal−peritoneal infertility in 43−60 %, endocrine in 30−40 %, endometriosis in 25 % of cases. One of the causes of combined (tubal and peritoneal−endocrine) infertility, present in 32−80 % of patients operated due to tubal pregnancy, is removal of the fallopian tubes, performed in 61.3 % of surgeries; it leads to poor blood supply of the ovaries with the development of deficiency syndrome. 7−27 % of patients with a history of tubal pregnancy have its relapse. Women who were removed both fallopian tubes have ovary deficiency syndrome and severe depression aggravating the quality of life. The effectiveness of ART applied to women with combined infertility who had tubal pregnancy is 30 %. Despite the improvement of assisted reproduction techniques, gametal cells and embryos produced during IVF are subject to influence of ROS (reactive oxygen species), reducing the effectiveness of ART. The use of modified CBS schemes with melatonin allows increase of the number of oocytes, improvement of the degree of their maturity and quality and increase of the rate of clinical pregnancies among women with infertility and ovaries deficiency syndrome by 55.3 %. Application of cryoextract of placenta in patients with combined infertility after surgical treatment of tubal pregnancy using IVF programs is quite promising. Since correction with melatonin is not effective in 100 % of cases, a promising method is the use of cryoextracts of placenta for its correction in ART programs in patients with combined (tubal peritoneal and endocrine) infertility after surgical treatment for tubal pregnancy.
Key words: auxiliary reproductive techniques, tubal pregnancy, cryoextracts of placenta.