- The condition of hormonal homeostasis in the first trimester of pregnancy after the application of assisted reproductive technologies
The condition of hormonal homeostasis in the first trimester of pregnancy after the application of assisted reproductive technologies
HEALTH OF WOMAN. 2019.9(145): 26–31; doi 10.15574/HW.2019.145.26
V.O. Benyuk, L.M. Vygivska, I.V. Maidannyk, V.F. Oleshko N.V. Kulagina
Bogomolets National Medical University, Kiev
The article represents results of a prospective examination of pregnant women whose anamnesis was complicated by infertility and were treated by the means of assistant reproductive technologies application.
The objective: to study features of hormonal homeostasis in pregnant women after ART application in the dynamics of I trimester of pregnancy in order to improve the tactics of antenatal surveillance and prevention of obstetric and perinatal complications.
Materials and methods. To achieve this aim in the dynamics of prospective study, 299 pregnant women were comprehensively examined, were divided into two groups. The main group included 249 women whose pregnancy occurred as a result of ART application. The control group consisted of 50 pregnant women with spontaneous onset of pregnancy and its physiological course, which became registered at the antenatal clinic in 6-8 weeks of pregnancy.
Basic clinical and laboratory studies, which included a general analysis of blood and urine were conducted to all pregnant women of the examined groups. The concentration of β-HG, placental hormones (progesterone and estradiol), pituitary gland (prolactin) and adrenal glands (cortisol (K)), which more reflect the dynamic development of pregnancy and affect its course and intrauterine fetal condition were determined in blood plasma of women after treated infertility.
Results. The determination of the main hormones that provide implantation and further progression of pregnancy in women of the main group after the use of therapeutic cycles of ART indicates the need for their dynamic monitoring during the first trimester of pregnancy. Detecting an insufficient levels of sex hormones during the initial examination, we considered it appropriate to refer the pregnant woman to the risk group for the development of pregnancy complications with hormonal parameters, and assessed their insufficiency as a risk factor for the threat of miscarriage, which from our point of view requires a complex correction to prevent clinical manifestations of the threatening abortion. One of the main factors of possible adverse course of pregnancy after art is insufficient level of β-HG at the stage of establishing the fact of pregnancy and during the first trimester. Our research found that in significant majority of cases, pregnancy after ART application over tubal-peritoneal, and endocrine types of infertility takes place in progesterone failure that causes the occurrence of violations of the processes of implantation and development of the ovum and clinically evident miscarriage since I trimeter pregnancy.
Conclusions. The revealed deviations in the concentration of stress-associated hormones cortisol and prolactin with a high probability may indicate an increased stress load, which in pregnant women after the application of ART therapeutic cycles manifests already from the beginning of pregnancy.
We consider it appropriate to continue the dynamic examination of these indicators during pregnancy and to continue further in-depth examination of pregnant women after the ART application.
Key words: pregnancy, infertility, assisted reproductive technologies, cortisol, prolactin.
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