The aim: This review was aimed to understand the role of different types of autoantibodies like antiphospholipid, antithyroid, antisperm, antinuclear, anti-ovarian autoantibodies and heat shock protein HSP 60 in the process of implantation in the normal way of conceiving and IVF and also to estimate that how the presence of these autoantibodies affect the normal pregnancy outcome. Materials and methods: This review process performed in the obstetrics and gynaecology postgraduate department, Bogomolets national medical university, Kyiv, Ukraine. It was a review of already published papers not to need the ethical board committee's approval. By following the literature review guidelines, this paper was written and searched for relevant studies regarding autoantibodies and implantation, published in medical literature till 2020 were included in this review process. The search is done for studies published till 2020 in the English language from the Medline database, including Google Scholar, PubMed, Web of Science and Cochrane library database. Conclusions: Our recent work found that the involvement of APA, ANA and/or ATA in recipients of oocyte donations did not affect their pregnancy outcomes. Some researchers did not give any clear conclusion about these risks, and some stated that the use of some immunodepressant agents could be useful to reduce the harmful effects of these autoantibodies associated with implantation failure. Each autoantibody has a different mechanism of action to create the pathological state, some have direct effect, and some indirectly impact implantation. In future, further high-quality studies need to be performed for better understanding.
A search of peer-reviewed articles regarding heat shock proteins (HSP’s) especially HSP 60 and 70 was conducted in this review to understand its role in the development of various complications like miscarriage, preterm birth, tubal infertility and spontaneous abortion associated with chlamydial HSP 60 in IVF, male infertility, preeclampsia, cancer, immune system activation, autoimmune diseases, coronary heart disease, dysregulation of steroidal hormone from the endometrium and its up-regulation in stress response. ELISA, western blotting, immunofluorescence, and affinity chromatography were the most common methods researchers used to determine and separate HSP 60 and antibodies related to it. Heat shock proteins are responsible for normal folding of other proteins and prevent its abnormal folding and cause degradation of abnormally folded proteins, mitochondrial protein transport, DNA metabolism, regulation of apoptosis are their significant functions. HSP 60 is a homologue of bacterial HSP 60 (GroEL) and needs co-chaperonin HSP 10 for its proper functioning. Gynaecological and obstetrical complications were more prevalent in most studies. Pregnant women were mostly affected subjects. Abnormal HSP 60 leads to a high level of unfolded or misfolded proteins, which in turn activate other body systems to produce the clinical outcome. Some researchers stated that there is no association between preterm birth and HSP 60 & 70, chlamydial HSP 60 antibodies trigger tubal infertility, preeclamptic pregnancies has detectable HSP60 as compared to control, GroEL leads to tubal infertility and IVF failure, chlamydial (CHSP 60) activates autoimmunity. HSP60 seropositivity reduces the opportunities of ectopic pregnancy, levels of HSP 60 does not stay constant throughout the menstrual cycle in reference to control, while other opposed these conclusions in their research works. According to some researchers, HSP 60 is a risk factor for pregnancy-related pathologies development, and some other opposed this theory and considered HSP 60 as a safety factor for normal pregnancy outcome, according to this review harmful effect of HSP 60 dominate, in future further high-quality studies need to be done for better understanding.
Infertility is a unique pathology because it concerns a couple, not one person, and is the cause of a whole range of medical, social, demographic and economic problems. With the active development of assisted reproductive technologies, the demand for solving the problem of infertility has grown significantly. However, the prevalence of infertility remains stable, indicating many «white» spots in the diagnosis and treatment of this pathology and determining the search for new risk factors, diagnostic criteria, and treatment algorithms. Purpose — to analyze the factors that may affect implantation, namely the presence of lupus anticoagulant and antiphospholipid antibodies in women with infertility who have undergone in vitro fertilization. Materials and methods. A survey of 106 women diagnosed with infertility underwent treatment with assisted reproductive technologies in September 2019 — February 2021. The control (1) group consisted of women who received infertility treatment according to the standard scheme: controlled ovarian stimulation, gamete collection, intracytoplasmic sperm injection and embryo transfer. The main (2) group included patients who received aspirin, anticoagulants, and intravenous IgG immunoglobulins in addition to the standard treatment regimen. In the present study, levels of lupus anticoagulant and antiphospholipid antibodies were determined in both groups. Results. The study found no differences between groups of patients in levels of antibodies (AB) to phospholipids (IgG), beta-2-glycoprotein (IgG, IgM) and lupus anticoagulant (screening, confirmation) in the two groups of patients (p>0.05). Difference in two groups were in levels of AB to beta-2-glycoprotein IgM in controls, on average, 9.42 units/ml (5.86 units/ml — 12.35 units/ml), and in patients of main group — 7.23 units/ml (3.14 units/ml — 10.58 units/ml), p=0.015. One-factor logistic regression models were used to clinically understand the influence of factors associated with the risk of implantation failure. The analysis did not reveal a connection between risk of implantation failure and levels of autoantibodies (aAB) to phospholipids (IgG, IgM), beta-2-glycoprotein (IgG, IgM) and lupus anticoagulant (screening, confirmation) in two groups of patients (p>0.05 in all cases). Conclusions. The presence of aAB and/or antiphospholipid syndrome during the establishment of infertility factors is an essential component of the algorithm for diagnostic search for the cause of infertility and miscarriage. However, based on the obtained data, the presence of aAB in the study does not affect the implantation process nor affects the treatment 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 the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: infertility, implantation failure, antiphospholipid syndrome, assisted reproductive technologies.
Relevance. Infertility is one of the most significant medical problems with significant demographic, economic and social consequences that affects millions of people of reproductive age. An estimated 48 to 186 million couples worldwide suffer from infertility. Most causes of infertility such as male factor, endocrine pathology and tubal factor can be diagnosed. However, there are reasons that do not lend themselves to primary identification. One of these reasons is infertility due to implantation failure. Objective: to determine the influence of anatomical, morphological and infectious factors on implantation failure during in vitro fertilization. Materials and methods. A prospective, open, controlled study of 106 infertile patients who underwent examination and treatment using assisted reproductive technologies was conducted in the period «September 2019 – February 2021». All patients were divided into 2 groups. Control group 54 entered patients. The main group included 52 patients who additionally underwent complex therapy with aspirin, heparin and intravenous immunoglobulins. One-factor and six-factor models of logistic regression of the risk of implantation failure have been analyzed. Results. The analysis revealed an increased risk of implantation failure in the presence of previous ureaplasma infection (p = 0.029), OR = 3.68 (95% CI 1.14-11.9). The risk also increases (p = 0.012), OR = 4.36 (95% CI 1.38-13.8) in the presence of an anomaly of the uterine cavity and after laparoscopic surgery (p = 0.015), OR = 3.53 (95% CI 1.28-9.78). Conclusions. Based on obtained data, presence of pathology of the pelvic organs and/or previous infections do not have an isolated effect on implantation failure. The risk of implantation failure should be assessed with other factors that affect the implantation process.
Infertility is a significant demographic and socio-economic problem, which is solved with assisted reproductive technologies. Relevance of the infertility problem continues to grow, which leads to the search for new methods to improve the success of assisted reproductive technologies. Purpose — to analyze the effect of anthropometric factors, obstetrical and gynaecological history on the risk of implantation failure in women with infertility who have fertilization in vitro. Materials and methods. An analysis of 106 infertile women who were treated with assisted reproductive technologies in September 2019 — February 2021. The control group consisted of women who received infertility treatment according to the standard treatment regimens: controlled ovarian stimulation, gamete sampling, intracytoplasmic sperm injection and embryo transfer. The study group included patients who received antiplatelet agents, anticoagulants and intravenous immunoglobulins G in addition to the standard therapy. Results. In this study, no differences were found in the two study groups regarding age, height, weight, body mass index, menarche, menstrual duration, coitus (p>0.05). During the analysis, it was found that with increasing age of a woman, the risk of unsuccessful implantation increases, OR=1.11 (95% CI 1.01–1.21) for each year, with increasing patient height, the risk decreases (p=0.006), OR=0.85 (95% CI 0.76–0.96) for each centimetre, with an increase in the number of sexual intercourses per week (p=0.012), OR=1.71 (95% CI 1.12–2.60) the risk increases by each unit. Implantation success with using modified treatment regimens with additional aspirin, low molecular weight heparins, intravenous immunoglobulins G, was higher (p=0.049), OR=0.37 (95% CI 0.14–0.99) compared to the standard infertility treatment scheme. Conclusions. This study found unfavourable effects of age, woman's height, and sexual intercourses on embryo implantation. Additional use of aspirin, low molecular weight heparin, intravenous immunoglobulin G as a supplemental therapy to standard treatment regimens of infertility with IVF had a successful impact on the effectiveness of embryo implantation. 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 the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: implantation failure, infertility, assisted reproductive technologies, in vitro fertilization (IVF).
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