OBJECTIVE

Comparative analysis of oocyte quality in patients with tubal-peritoneal genesis of in-fertility with or without tubectomy in anamnesis in assisted reproductive technology (ART) pro-grams.

MATERIAL AND METHODS

The article presents the results of determining matrix metalloproteinases in follicular fluid and its morphology in patients with tubal-peritoneal genesis of infertility in ART programs. A total of 94 patients were examined. For comparative analysis, two groups were formed: Group 1 (control) — 20 patients without a history of tubectomy, Group 2 (main) — 74 patients with a tubectomy for hydrosalpinx, ectopic pregnancy in anamnesis. Intragroup analysis was performed based on the effectiveness of ART programs in each group: Group 1: successful ART outcome — n=14, unsuccessful ART outcome — n=6; Group 2: successful ART outcome — n=24, unsuccessful ART outcome (main) — n=50. A protocol with gonadotropin-releasing hormone agonists (a-GnRH) was used in 43 patients, and with gonadotropin-releasing hormone antagonists (ant-GnRH) in 51 patients. The IVF/ICSI (in vitro fertilization/introcytoplasmic sperm injection) fertilization type was used in 21 (22.3%) patients. Excellent and good quality embryos (A, AB) were used for transfer. As a result of the ART programs, the pregnancy rate was 40.4%, the birth rate was 40.4% (38 newborns). Clinical, anamnestic, instrumental, and laborato-ry research methods were used for the analysis. The content of matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) was determined by quanti-tative solid-phase enzyme-linked immunosorbent assay of the �sandwich� type using a test sys-tem. Enzyme-linked immunosorbent assay was performed on an automatic plate photometer. The morphology of follicular fluid was studied by the wedge dehydration method. The facies ob-tained by wedge dehydration were studied using a stereomicroscope equipped with a Pixera vid-eo camera, using the Morphotest program. Photos were obtained at different magnifications — ×80, ×400.

RESULTS

In patients with tubal genesis of infertility, with successful outcomes of ART programs, the MMP-1 level was 1.4±0.3 ng/ml, with unsuccessful ones — 6.1±6.9 ng/ml, reaching 7.9±7.4 ng/ml and higher. With increasing age, its level decreased (r= –0.3; p<0.05), amounting to 2.5±3.6 ng/ml in women over 30 years old (t=2.1; p<0.01), but increased with increasing duration of in-fertility (r=0.3; p<0.05). With infertility duration of less than 4 years, the MMP-1 level was equal to 2.8±3.9 ng/ml, with duration of more than 4 years — 6.9±7.2 ng/ml (t=2.3; p<0.05). The TIMP-1 level in successful outcomes of ART programs was 2450.0±404.9 ng/ml, in unsuccessful ones — 2312.0±409.0 ng/ml, in tubal infertility — 2365.8±413.6 ng/ml. The TIMP-1 level within 1500—2350 ng/ml is not able to neutralize the effects of MMP-1. In patients without tubectomy, type 1 facies (normal) with preserved structural formation was revealed. In patients with tubectomy, type 2 facies (ordered) and pathological markers indicating residual inflammatory processes, microcirculation disorders were revealed, and in patients with unsuccessful outcomes — a more pronounced degree of ischemic-hypoxic state, stasis phenomena and the presence of markers of endothelial dysfunction (r=0.8).

CONCLUSION

In patients with tubal genesis of infertility, duration of infertility more than 4 years, MMP-1 level of 6.9±7.2 ng/ml, with tubectomy for hydrosalpinx (odds ratio — OR 26.4; 95% confidence interval — CI 3.5—207.4) and ectopic pregnancies (OR 34.7; 95% CI 4.1—294.5) per-formed more than 2 years ago (p<0.05), with gynecological (chronic endometritis (OR 8.5; 95% CI 1.8—39.4), ovarian cysts (OR 8.5; 95% CI 1.9—39.4) and somatic (frequent colds (OR 3.3; 95% CI 1.2—8.9), cardiovascular diseases (OR 8.0; 95% CI 0.9—65.8) diseases, underweight (OR 4.4; 95% CI 0.5—37.2) residual signs of inflammatory processes are detected in the follicular fluid (MMP-1 level 7.9±7.4 ng/ml and markers are determined (r=0.8) indicating impaired blood sup-ply, ischemic-hypoxic damage and endothelial dysfunction, which reduces the qualitative and quantitative indicators of oocytes, thereby leading to a sharp decrease in fertility in ART pro-grams.