Immunological interaction of organisms of the women with infertility included in the IVF program
Authors:   Ivano-Frankivsk National Medical University, Ukraine, Lytvyn N.V. 
Published: March 2021

It is known from scientific research that immune effector mechanisms that are under the regulatory influence of the pituitary gonadotropins and sex hormones at the local level become critical for successful implantation. In such patients, at the pre-conceptual stage and at the stage of the program of fertilization of «in vitro fertilization» (IVF), pathological mechanisms of violation of trophoblast invasion are triggered, in which activated in the early stages of pregnancy development, the immune-pathological process leads to the implementation of the mechanism of miscarriage. Since all the processes of immunological recognition, protection or detachment in married couples with unsuccessful implantation attempts within the IVF program in early pregnancy, undergo directly at the conception cycle, immunotherapy should be started immediately before pregnancy, which creates preconditions for the formation of complete trophoblast invasion. The objective: to evaluate some of the indicators of the cytokine profile in women with infertility and clinical manifestations of subchorionic hematoma in the first trimester of pregnancy. Patients and methods. We have performed a clinical and laboratory-instrumental examination of 80 women with infertility, treated under the conditions of IVF program, with manifestations of subchorionic hematoma. The control group included 20 patients with no reproductive function impairment. In parallel, studies and analysis of the peculiarities of vascular endothelial function and cytokine profile were performed using immunoassay. Results. At the pre-conceptional stage against the background of accustomed miscarriage in anamnesis, an increase in 3.2 times of IL-1b concentration in the peripheral blood of the studied groups of women (p<0.05), TNF-a – in 7.3 times and a decrease in 2.6 times of the content of IL-4 against the data of the control group (p<0.01) were observed. Estimation of the cytokine status in this category of patients during the nidation stage and the development of the fetal egg allowed to mark a progressive increase in 3.6 times of the IL-1b level, as well as a significantly higher was percentage of TNF-a level in 4 times as compared to the control (p<0.05), while IL-4 level remained lower in 3.0 times as for the control indeces (p<0.05). Conclusions. The performed studies of the immune system in pregnant women with treated infertility showed moderate inhibition and an imbalance of immunological parameters characteristic for pregnancy with the presence of maternal suppression. The analysis of the obtained results testifies to the necessity of general immune-correction and prophylactic treatment in this category of patients. Thus, it is evident that the inadequate activation of the local protective factors of the immune system plays a major role in the pathogenetic mechanisms of miscarriage initiating, which requires the expansion of the boundaries of scientific research and is a promising direction for further research. Key words: infertility, miscarriage, subchorionic hematoma, auxiliary reproductive technologies, cytokines.