Hormonal function of the corpus luteum, trophoblast and placenta in pregnant twins who were previously treated for infertility
Authors:   SI «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova of National academy of medical sciences of Ukraine», Kyiv, Tumanova L.E. , Kolomiets E.V. ,   SI «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova of National academy of medical sciences of Ukraine», Kyiv
Published: May 2021

Purpose — to study the hormonal function of the corpus luteum, trophoblast. Materials and methods. We have studied hormonal parameters from 7 to 14 weeks of pregnancy in 87 women with twins. The study of hormonal parameters was carried out in three groups (six subgroups): Group I — pregnant women who had a history of endocrine infertility: Ia — 21 patients after IVF, Ib — 10 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF; Group II — pregnant women with a history of infertility of inflammatory genesis: IIa — 35 patients after IVF, IIb — 6 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF; Group III — pregnant women who had a history of combined infertility, inflammatory genesis with endocrine, IIIa — 10 patients after IVF, IIIb — 5 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF. The content of placental hormones in the dynamics of pregnancy at 7–10 and 11–14 weeks was studied: estradiol (E2), progesterone, human chorionic gonadotropin (β-hCG) and pregnancy-associated plasmoprotein (PAPP-A). Determination of E2, progesterone was carried out by enzyme immunoassay using standard kits of the «Delfia» system on an analyzer «1420 Victor 2» from Perken Elmer (USA). β-hCG and PAPP-A were determined by the immunochemiluminescent method using test systems manufactured by Siemens. Results. During dynamic monitoring of hormonal parameters in the blood of women of all three groups during the first trimester, we revealed a progressive increase in the content of estradiol and progesterone. At the same time, the rate of increase in the content of estradiol in the blood in the dynamics of pregnancy was greater than that of progesterone. With twins (after IVF), the increase in progesterone reached more than 50%, and the increase in estradiol up to 30–40%, practically did not depend on the cause of infertility. With multiple independent pregnancies, the increase in progesterone reached ≈40–60% (the lowest increase was with combined infertility), and the increase in estradiol ≈75% and practically did not differ across groups. At 7–10 weeks of gestation, the progesterone concentration was significantly higher in women after IVF compared to those in patients after spontaneous fertilization. In this period, the level of progesterone did not depend on the form of infertility. Similar changes were observed with the level of estradiol in the surveyed women. The progesterone/estradiol ratio was virtually the same across the groups. The level of estradiol in the blood of women (11–14 weeks of pregnancy) also practically did not differ, both depending on the form of infertility and the method of fertilization. At 11–14 weeks, comparing progesterone levels, it is necessary to note reliably high rates in women with multiple pregnancies after IVF, which indicates an intense hormone-producing function due to the placentas of two fetuses. It should be noted that with endocrine and combined infertility in women after IVF with twins, there were significantly higher rates compared to those of women in similar groups after self-fertilization. The content of sex hormones at both 7–10 and 11–14 weeks in all groups during pregnancies after IVF was higher than during pregnancies with natural fertilization. The content of sex hormones at both 7–10 and 11–14 weeks in all groups during pregnancies after IVF was higher than during pregnancies with natural fertilization. The progesterone level in pregnant women at 11–14 weeks with a two-fetal natural pregnancy was 256.45±27.6 nmol/L, while the same indicator in pregnant women with two fetuses after IVF was 337.5±26.7 nmol/L. A longer (up to 13 weeks) decrease in the progesterone/estradiol ratio represents a more pronounced relative progesterone deficiency and hyperestrogenism in women after IVF. High levels of progesterone in the first trimester of pregnancy, especially in women after IVF (Ia, IIa, IIIa groups) were the result of intensive maintenance therapy with progestogens, which is necessary to ensure the gestational process in the I trimester in the IVF program. We also studied the indicators of β-hCG and PAPP-A in pregnant women 11–14 weeks. by groups, as classic markers of screening for congenital malformations of the fetus and the risk of complications of pregnancy. Thus, PAPP-A in pregnancies after IVF did not significantly differ from pregnancies with natural fertilization, but had a tendency to increase in multiple pregnancies. Conclusions. At 7 10 weeks of pregnancy, women with twins after IVF had higher levels of estradiol and progesterone than in women with twins after natural fertilization. At 11 14 weeks of pregnancy in women with twins, estradiol did not differ between groups and did not depend on the method of fertilization, and the level of progesterone was higher in pregnant women after IVF. With twins (after IVF), the growth rate of progesterone is higher than that of estradiol. With self-fertilization, the growth rate of estradiol significantly outpaced the growth of progesterone levels in pregnant women with a history of endocrine and concomitant infertility. The concentration of pregnancy-associated plasmoprotein (PAPP-A) in pregnancies after IVF did not significantly differ from pregnancies with natural fertilization and did not depend on the cause of infertility. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare that they have no conflicts of interest. Key words: estradiol, progesterone, β-hCG, PAPP-A, twin pregnancy after infertility.