Poor ovarian response in assisted reproductive technology programs: An association with autoimmune ovarian lesion


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Abstract

No adequate response to standard superovulation protocols in the assisted reproductive technology (ART) programs is called «poor ovarian response» (POR). Patients with the latter have few mature oocytes, which decreases the chances of conception and the efficiency of ART programs. Autoimmune ovarian tissue lesion may be a presumed pathogenetic factor for the development of POR. Objective. To study an association between the detection of different types of autoantibodies, including antiovarian tissue antibodies, and the reduction of an ovarian response in the ART programs. Subject and methods. A prospective cohort study included 150 patients treatedfor infertility by in vitro fertilization (IVF). According to the 2011 ESHRE criteria, the patients were divided into a group of patients with POR (n = 65) and a group of those with a normal ovarian response (n = 85). Enzyme immunoassay (EIA) was used to determine different types of serum autoantibodies in all the patients. IgM and IgG antibodies to the zona pellucida (anti-ZP), follicle-stimulating hormone (anti-FSH), gonadotropin-releasing hormone (anti-GnRH), total antiovarian (total AOA), anti-chorionic gonadotropin (anti- CG), anticardiolipin (anti- CL), and anti-fi 2-glycoprotein-1 (anti-P 2- GP) antibodies were identified. Follicular fluid IgA and IgG autoantibodies were also determined by EIA. Results. Statistically significant higher levels of IgM total AOA, IgM and IgG anti-ZP, IgG anti-GnRH, and IgG anti-fi 2- GP were found in the women with POR than in those without POR (p < 0.05). At the same time, there was a statistically significant negation correlation between the level of IgM anti-ZP and the number of obtained embryos (r = -0.16; p = 0.047). ROC curve regression analysis revealed the threshold anti-ZP level in relation to the presence of POR, which accounted for 0.140 units for IgM and 0.152 units for IgG. Conclusion. The antibodies damaging ovarian tissues may play a role in the development of premature ovarian failure, one of whose clinical manifestations is the ovarian POR to ovulation stimulation in the ART programs.

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About the authors

Roza Eduardovna Vanyan

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: r_vanyan@oparina4.ru
Postgraduate of the Department of Assistive Reproductive Technology in the Treatment of Infertility

Irina Vladimirovna Menzhinskaya

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: i_menzhinskaya@oparina4.ru
MD, PhD, Senior Researcher, Laboratory of Clinical Immunology

Nataliya Vitalievna Dolgushina

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: n_dolgushina@oparina4.ru
M.D., Ph.D., M.P.H., Head of R&D Department

Elena Anatolievna Kalinina

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: e_kalinina@oparina4.ru
PhD, MD, Head of the IVF department

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