RETROSPECTIVE ANALYSIS OF THE CLINICAL PICTURE OF PATIENTS WITH REDUCED OVARIAN RESERVE DURING LONG AND SHORT PROTOCOLS OF OVULATION STIMULATION IN THE PROGRAMS OF ASSISTED REPRODUCTIVE TECHNOLOGIES
Authors: Khmil S.V. , Terletska N.Yu. 
Published: October 2023

Abstract. The purpose of the study is to analyze the clinical and anamnestic picture medical cards of patients with reduced ovarian reserve to compare the effectiveness of ovulation stimulation protocols (short and long).

Materials and methods. In accordance with the aim of our study, the general clinical data of of one hundred and thirty-seven women with infertility against the background of reduced ovarian reserve with long and short ovulation stimulation protocols and the control group in the programs of assisted reproductive technologies were retrospectively analyzed. The medical records of the patients were divided into three separate groups. The first group consisted of fifty-five women with reduced ovarian reserve, who underwent controlled ovarian stimulation according to a short protocol with gonadotropin-releasing hormone antagonists (anti-GnRH). The second group consisted of fifty-two patients with reduced ovarian reserve who underwent controlled ovarian stimulation according to a long protocol with gonadotropin-releasing hormone agonist (a-GnRH). The third comparison group (control) consisted of of thirty women with tubal factor infertility.

Research results and their discussion. A retrospective analysis of medical records, anamnestic data, and general clinical indicators of women with reduced ovarian reserve who underwent ovulation stimulation using short and long protocols and control patients with tubal factor infertility was performed. The clinical and anamnestic picture of women with a reduced ovarian reserve showed a predominance of primary infertility, both in all parts of the study and in groups of women with a reduced ovarian reserve. The average age of women included in the retrospective medical analysis varied from thirty to forty-two years. These research groups (first and second) are characterized by an older reproductive age. During the analysis of the hormonal profile of the patients of the studied groups, features characteristic of women with a reduced ovarian reserve were also revealed. When analyzing the level of antimüllerian hormone, it was found that level of anti-Müllerian hormone  was significantly reduced while level of follicle-stimulating hormone was correspondingly increased. These both features are primarily the basic reasons for the decrease in the ovarian reserve. It was analyzed that there was no significant difference in menstrual function between the women of the experimental group and the women of the control group (by the tubal factor of infertility). The body mass index (BMI) in the three groups when compared did not have a pronounced statistical difference, and fluctuated within the normal range in the experimental groups and ranged from eighteen integers and five tenths to to twenty-four integers and nine tenths kg/m2. When analyzing the frequency of surgical interventions in women of reproductive age with a reduced ovarian reserve, it was found that surgical interventions on the organs of the small pelvis also affect a woman's ovarian reserve.

Conclusions. The results of of our research indicate characteristic clinical and anamnestic differences in patients with reduced ovarian reserve compared to patients with infertility which is caused by tubal factor. Risk factors for the occurrence of infertility against the background of a reduced ovarian reserve include a history of surgical interventions, older reproductive age, several unsuccessful attempts at assisted reproductive technologies, bad habits, hereditary factors, etc.