The role of the morphofunctional state of endometrium in the realization of reproductive function in in vitro fertilization complicated by ovarian hyperstimulation syndrome

Abstract

Ovarian hyperstimulation syndrome (OHSS) remains the most important, potentially lifethreatening iatrogenic complication of controlled ovarian stimulation (COS). COS alters the expression profiles of more than 150 genes in the endometrium in both animals and humans. The morphological and functional state of the endometrium in women with OHSS is poorly understood. There is limited and controversial information about pregnancy outcomes in patients with OHSS. The purpose of the study was to improve reproductive results in women with infertility during in vitro fertilization complicated by OHSS, based on the development of a methodology for preparing patients for the transfer of vitrified / warmed embryos and minimally invasive assessment of endometrial receptivity before embryo transfer. Material and methods. In the course of experimental modelling of OHSS, the morphofunctional state of the endometrium, myometrium and ovaries was studied in 110 female hybrid mice. Based on the data obtained, a minimally invasive technique for assessing the receptivity of the endometrium before embryo transfer was proposed and a pathogenetic substantiation of the feasibility of individualized preparation of women for the transfer of vitrified / warmed embryos was carried out, an appropriate technique was developed, and its effectiveness was assessed. Results. Negative changes in the morphofunctional state of the endometrium of mice and women in the presence of OHSS have been proven. In women, changes in the expression of implantation molecules (HOXA-10, VEGF, LIF, IL-6, IL-6R, LIFR, gp130), a decrease in inducible NO-synthase activity, impaired endometrial immune reactivity (expression of lymphocyte subpopulations CD45, CD56, CD138) were revealed. The use of individualized preparation of the endometrium for the transfer of vitrified / warmed embryos, which included drugs that restore the state of the ovarian-endometrial system (anti-inflammatory, decongestants, improve microcirculation, normalize endometrial function, endometrial molecular profile and endometrial immunoreactivity) before embryo transfer increased the number of live births in women with transferred OHSS 2.11 times (OR 3.17±0.50; 95% CI 1.20-8.39; p<0.02). Conclusions. It is advisable to transfer embryos during in vitro fertilization in case of OHSS no earlier than four months after vitrification, after preliminary treatment aimed at improving the morphofunctional state of the ovaries and endometrium, using a minimally invasive technique for assessing endometrial receptivity. All human studies were conducted in compliance with the rules of the Helsinki Declaration of the World Medical Association "Ethical principles of medical research with human participation as an object of study". Informed consent was obtained from all participants.