Лечение бесплодия у пациентки с повторными неудачами имплантации

Авторы:

Е. В. Ожогина,

Е. В. Федорова,

Е. В. Минашкина,

Акиньшина С.В.

Журнал: Проблемы репродукции. 2026;32(1):64-68.

DOI: 10.17116/repro20263201164

Прочитано: 1080 раз

Резюме

Представлено клиническое наблюдение пациентки с повторными неудачами имплантации (ПНИ) эмбрионов при использовании вспомогательных репродуктивных технологий (ВРТ). Актуальность проблемы обусловлена тем, что ПНИ встречаются у 10% пар, проходящих лечение бесплодия с помощью ВРТ. В клиническом случае проведено тестирование эмбрионов на анеуплоидии и выполнена коррекция патологии матки и эндометрия. Выявлена изолированная циркуляция антител к бета-2-гликопротеину 1 в низких титрах, не соответствующая международным критериям антифосфолипидного синдрома (АФС). Однако после консультации с врачом-гематологом и врачом-ревматологом решено провести профилактическую терапию с использованием низких доз ацетилсалициловой кислоты и низкомолекулярных гепаринов, что является признанной первой линией лечения при акушерском АФС и позволяет добиться живорождения у 80—85% пациентов. Этот случай демонстрирует важность многофакторного подхода к диагностике и лечению ПНИ с учетом как хромосомных, так и иммунологических факторов. Опыт показывает, что индивидуализированный подход к лечению повышает шансы на успешную беременность у пациенток с ПНИ.

Ключевые слова

клинический случай
вспомогательные репродуктивные технологии
имплантация
антифосфолипидный синдром
иммунология
анеуплоидия
эндометрит

Дата поступления: 30.07.2024

Дата принятия в печать: 06.11.2024

Дата публикации: 01.03.2026

Литература / References

Luo X, He Z, Ma R, Lin N, Li L, Li Y, Ke Y, Meng X, Wu Z. Narrative Review of Multifaceted Approaches to Managing Recurrent Implantation Failure: Insights and Innovations. Clinical and Experimental Obstetrics and Gynecology (CEOG). 2024;51(4):87. https://doi.org/10.31083/j.ceog5104087
Boniface C, Esfandiari N. Immunology Updates in Recurrent Implantation Failure in In Vitro Fertilization. Current Obstetrics and Gynecology Reports. 2024;13:16-23. https://doi.org/10.1007/s13669-024-00375-0
Papadimitriou E, Boutzios G, Mathioudakis AG, Vlahos NF, Vlachoyiannopoulos P, Mastorakos G. Presence of antiphospholipid antibodies is associated with increased implantation failure following in vitro fertilization technique and embryo transfer: A systematic review and meta-analysis. PLoS One. 2022;17(7):e0260759. https://doi.org/10.1371/journal.pone.0260759
ESHRE Working Group on Recurrent Implantation Failure; Cimadomo D, de Los Santos MJ, Griesinger G, Lainas G, Le Clef N, McLernon DJ, Montjean D, Toth B, Vermeulen N, Macklon N. ESHRE good practice recommendations on recurrent implantation failure. Human Reproduction Open. 2023(3):2023, hoad023. https://doi.org/10.1093/hropen/hoad023
Zeng M, Wen P, Duan J. Association of antinuclear antibody with clinical outcome of patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment: A meta-analysis. Journal of Reproductive Immunology. 2019;82(3):e13158. https://doi.org/10.1111/aji.13158
ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, Middeldorp S, Mcheik S, Peramo B, Quenby S, Nielsen HS, van der Hoorn ML, Vermeulen N, Goddijn M. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Human Reproduction Open. 2023(1):2023,hoad002. https://doi.org/10.1093/hropen/hoad002
Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesus G, Delluc A, Desai S, De Sancho M, Devreese KM, Diz-Kucukkaya R, Duarte-Garcia A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. The 2023 ACR/ EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis & Rheumatology Journal. 2023;75(10):1687-1702. https://doi.org/10.1002/art.42624
Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, Cuadrado MJ, Dörner T, Ferrer-Oliveras R, Hambly K, Khamashta MA, King J, Marchiori F, Meroni PL, Mosca M, Pengo V, Raio L, Ruiz-Irastorza G, Shoenfeld Y, Stojanovich L, Svenungsson E, Wahl D, Tincani A, Ward MM. EULAR recommendations for the management of antiphospholipid syndrome in adults. Annals of the Rheumatic Diseases (ARD). 2019; 78(10):1296-1304. https://doi.org/10.1136/annrheumdis-2019-215213
Kuschel B, Schäfer-Graf UM, Schmidt M, Kühnert M, Hagenbeck C, Thürmel K. Management of Rheumatic Diseases During Pregnancy and Breastfeeding: Position Paper of the Working Group for Obstetrics and Prenatal Medicine in the German Society for Gynecology and Obstetrics e. V. (AGG — Section Maternal Diseases in Pregnancy). Geburtshilfe und Frauenheilkunde. 24;84(2):130-143. https://doi.org/10.1055/a-2201-2680
Mirzaei M, Amirajam S, Moghimi ES, Behzadi S, Rohani A, Zerangian N, Samani NK, Soudagar S, Ghazanfarpour M. The effects of hydroxychloroquine on pregnancy outcomes in infertile women: a systematic review and meta-analysis. Journal of Medicine and Life. 2023;16(2):189-194. https://doi.org/10.25122/jml-2022-0095
Guo Y, Su Y, Zhang M, Ji H, Zhao C, Ling X, Shen R. Hydroxychloroquine improves pregnancy outcomes in patients undergoing frozen embryo transfer with positive serum autoantibodies. American Journal of Reproductive Immunology. 2023;90(1):e13732. https://doi.org/10.1111/aji.13732
Gao R, Deng W, Meng C, Cheng K, Zeng X, Qin L. Combined treatment of prednisone and hydroxychloroquine may improve outcomes of frozen embryo transfer in antinuclear antibody-positive patients undergoing IVF/ICSI treatment. Lupus. 2021;30(14):2213-2220. https://doi.org/10.1177/09612033211055816
Ye S, Liu Y, Zhao X, Ma Y, Wang Y. Hydroxychloroquine improves pregnancy outcomes of women with positive antinuclear antibody spectrum test results. Frontiers in Medicine. 2023;10:1113127. https://doi.org/10.3389/fmed.2023.1113127
Bérard A, Sheehy O, Zhao JP, Vinet E, Quach C, Bernatsky S. Chloroquine and Hydroxychloroquine Use During Pregnancy and the Risk of Adverse Pregnancy Outcomes Using Real-World Evidence. Frontiers in Pharmacology. 2021;12:722511. https://doi.org/10.3389/fphar.2021.722511
Chambers CD, Johnson DL, Xu R, Luo Y, Felix R, Fine M, Lessard C, Adam MP, Braddock SR, Robinson LK, Burke L, Jones KL; OTIS Collaborative Research Group. Birth Outcomes in Women Who Have Taken Hydroxycholoroquine During Pregnancy: A Prospective Cohort Study. Arthritis and Rheumatology Journal. 2022; 74(4):711-724. https://doi.org/10.1002/art.42015
Huybrechts KF, Bateman BT, Zhu Y, Straub L, Mogun H, Kim SC, Desai RJ, Hernandez-Diaz S. Hydroxychloroquine early in pregnancy and risk of birth defects. American Journal of Obstetrics and Gynecology. 2021;224(3):290.e1-290.e22. https://doi.org/10.1016/j.ajog.2020.09.007

Лечение бесплодия у пациентки с повторными неудачами имплантации

Авторы:

Е. В. Ожогина,

Е. В. Федорова,

Е. В. Минашкина,

Акиньшина С.В.

Журнал: Проблемы репродукции. 2026;32(1):64-68.

DOI: 10.17116/repro20263201164

Прочитано: 1080 раз

Резюме

Ключевые слова

клинический случай
вспомогательные репродуктивные технологии
имплантация
антифосфолипидный синдром
иммунология
анеуплоидия
эндометрит

Дата поступления: 30.07.2024

Дата принятия в печать: 06.11.2024

Дата публикации: 01.03.2026

Литература / References

Luo X, He Z, Ma R, Lin N, Li L, Li Y, Ke Y, Meng X, Wu Z. Narrative Review of Multifaceted Approaches to Managing Recurrent Implantation Failure: Insights and Innovations. Clinical and Experimental Obstetrics and Gynecology (CEOG). 2024;51(4):87. https://doi.org/10.31083/j.ceog5104087
Boniface C, Esfandiari N. Immunology Updates in Recurrent Implantation Failure in In Vitro Fertilization. Current Obstetrics and Gynecology Reports. 2024;13:16-23. https://doi.org/10.1007/s13669-024-00375-0
Papadimitriou E, Boutzios G, Mathioudakis AG, Vlahos NF, Vlachoyiannopoulos P, Mastorakos G. Presence of antiphospholipid antibodies is associated with increased implantation failure following in vitro fertilization technique and embryo transfer: A systematic review and meta-analysis. PLoS One. 2022;17(7):e0260759. https://doi.org/10.1371/journal.pone.0260759
ESHRE Working Group on Recurrent Implantation Failure; Cimadomo D, de Los Santos MJ, Griesinger G, Lainas G, Le Clef N, McLernon DJ, Montjean D, Toth B, Vermeulen N, Macklon N. ESHRE good practice recommendations on recurrent implantation failure. Human Reproduction Open. 2023(3):2023, hoad023. https://doi.org/10.1093/hropen/hoad023
Zeng M, Wen P, Duan J. Association of antinuclear antibody with clinical outcome of patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment: A meta-analysis. Journal of Reproductive Immunology. 2019;82(3):e13158. https://doi.org/10.1111/aji.13158
ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, Middeldorp S, Mcheik S, Peramo B, Quenby S, Nielsen HS, van der Hoorn ML, Vermeulen N, Goddijn M. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Human Reproduction Open. 2023(1):2023,hoad002. https://doi.org/10.1093/hropen/hoad002
Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesus G, Delluc A, Desai S, De Sancho M, Devreese KM, Diz-Kucukkaya R, Duarte-Garcia A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. The 2023 ACR/ EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis & Rheumatology Journal. 2023;75(10):1687-1702. https://doi.org/10.1002/art.42624
Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, Cuadrado MJ, Dörner T, Ferrer-Oliveras R, Hambly K, Khamashta MA, King J, Marchiori F, Meroni PL, Mosca M, Pengo V, Raio L, Ruiz-Irastorza G, Shoenfeld Y, Stojanovich L, Svenungsson E, Wahl D, Tincani A, Ward MM. EULAR recommendations for the management of antiphospholipid syndrome in adults. Annals of the Rheumatic Diseases (ARD). 2019; 78(10):1296-1304. https://doi.org/10.1136/annrheumdis-2019-215213
Kuschel B, Schäfer-Graf UM, Schmidt M, Kühnert M, Hagenbeck C, Thürmel K. Management of Rheumatic Diseases During Pregnancy and Breastfeeding: Position Paper of the Working Group for Obstetrics and Prenatal Medicine in the German Society for Gynecology and Obstetrics e. V. (AGG — Section Maternal Diseases in Pregnancy). Geburtshilfe und Frauenheilkunde. 24;84(2):130-143. https://doi.org/10.1055/a-2201-2680
Mirzaei M, Amirajam S, Moghimi ES, Behzadi S, Rohani A, Zerangian N, Samani NK, Soudagar S, Ghazanfarpour M. The effects of hydroxychloroquine on pregnancy outcomes in infertile women: a systematic review and meta-analysis. Journal of Medicine and Life. 2023;16(2):189-194. https://doi.org/10.25122/jml-2022-0095
Guo Y, Su Y, Zhang M, Ji H, Zhao C, Ling X, Shen R. Hydroxychloroquine improves pregnancy outcomes in patients undergoing frozen embryo transfer with positive serum autoantibodies. American Journal of Reproductive Immunology. 2023;90(1):e13732. https://doi.org/10.1111/aji.13732
Gao R, Deng W, Meng C, Cheng K, Zeng X, Qin L. Combined treatment of prednisone and hydroxychloroquine may improve outcomes of frozen embryo transfer in antinuclear antibody-positive patients undergoing IVF/ICSI treatment. Lupus. 2021;30(14):2213-2220. https://doi.org/10.1177/09612033211055816
Ye S, Liu Y, Zhao X, Ma Y, Wang Y. Hydroxychloroquine improves pregnancy outcomes of women with positive antinuclear antibody spectrum test results. Frontiers in Medicine. 2023;10:1113127. https://doi.org/10.3389/fmed.2023.1113127
Bérard A, Sheehy O, Zhao JP, Vinet E, Quach C, Bernatsky S. Chloroquine and Hydroxychloroquine Use During Pregnancy and the Risk of Adverse Pregnancy Outcomes Using Real-World Evidence. Frontiers in Pharmacology. 2021;12:722511. https://doi.org/10.3389/fphar.2021.722511
Chambers CD, Johnson DL, Xu R, Luo Y, Felix R, Fine M, Lessard C, Adam MP, Braddock SR, Robinson LK, Burke L, Jones KL; OTIS Collaborative Research Group. Birth Outcomes in Women Who Have Taken Hydroxycholoroquine During Pregnancy: A Prospective Cohort Study. Arthritis and Rheumatology Journal. 2022; 74(4):711-724. https://doi.org/10.1002/art.42015
Huybrechts KF, Bateman BT, Zhu Y, Straub L, Mogun H, Kim SC, Desai RJ, Hernandez-Diaz S. Hydroxychloroquine early in pregnancy and risk of birth defects. American Journal of Obstetrics and Gynecology. 2021;224(3):290.e1-290.e22. https://doi.org/10.1016/j.ajog.2020.09.007

Лечение бесплодия у пациентки с повторными неудачами имплантации

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Лечение бесплодия у пациентки с повторными неудачами имплантации

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