MATERIAL AND METHODS
The study included 128 cases of transfer of a «fresh» embryo to patients of the IVF programm with infertility due to chronic endometritis (ChE). Endometrial washes were taken after a complete clinical and laboratory examination, before entering the programm, on the 19—21 day of the menstrual cycle and the level of some regulatory transport proteins was determined: lactoferrin (LF), alpha2-macroglobulin (α2-MG), albumin and cytokines (TNF-α, IL-6, IL-8). The level of α2-MG in the blood and FJ was determined by rocket immunoelectroforesis using a monospecific antisera; for the study of α2-MG in endometrial washes, the ELISA method and affinity-purified antibodies to this protein were used; cytokines and LF in blood, endometrial flushes and FG were determined by the ELISA method using commercial kits of NPO Vector-Best, Novosibirsk; total protein and albumin in blood and FJ were examined by standard biochemical methods; albumin in flushes — by the method of rocket immunoelectroforesis. The search of predictors of the negative outcome of the IVF procedure was carried out by analyzing of the clinical and immunological data using a penalty-based mathematical logit regression (htnalizedlogysticregression) method.
RESULTS
The method of mathematical logistic regression established prognostic predictors of failure of IVF programms in tube-peritoneal infertility due to chronic endometritis: age of women >30 years; STD; 1 or more loss of pregnancy; re-attempt of IVF (in case of previous failures); in endometrial washes: increased concentration of α2-MG (>4.1 mg/l); in blood serum reduced level of albumin (<42.4 g/l) and increased TNF-α (>3.0 pkg/ml), in FF reduced values of total protein (<59.2g/l) and albumin (<36.0 g/l). The probability of a negative outcome is 80%. The identified clinical and immunological predictors make it possible to improve the prediction of negative outcomes of IVF programms by creating a highly effective calculation scale and algorithm of actions.
CONCLUSION
A prognostic algorithm for negative IVF programm’s outcomes based on clinical-immunological predictors developed with logistic regression will personalize the management of women with tube-peritoneal infertility associated with chronic endometritis. With the sum of points exceeding 20, the probability of a negative outcome of the IVF programm is high, that dictates the need for cryopreservation and delayed embryo transfer.
