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Tubal infertility: clinical-immunological particularities and treatment by means of assisted reproduction


Author: Hotineanu Alina
Degree:doctor of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Year:2009
Scientific adviser: Veaceslav Moşin
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 9 December, 2008
Approved by NCAA on the 26 February, 2009

Abstract

Adobe PDF document0.40 Mb / in romanian

Thesis

CZU 618.177-089.888.11+618.12-089.87

Adobe PDF document 0.93 Mb / in romanian
127 pages


Keywords

reproductive function, urogenital infections, female tubal infertility, hydrosalpinx, laparoscopy, assisted reproduction, seminal material, cytokines, autoantibodies, biochemistry

Summary

In the work there are presented the aspects of pathogenesis, diagnosis and treatment of tubal infertility by assisted reproductive technologies (ART) methods. The study was carried out in the National Centre for Reproductive Health and Medical Genetics on 286 patients with tubal infertility.

As a result of performed diagnosis there was detected the increased incidence of ureaplasma, mycoplasma and chlamydia infections among the women with tubal infertility, especially with formation of hydrosalpinx.

It was determined that the patients with hydrosalpinx run the growing risk for development of reproductive autoimmunity with frequent detection of anticardiolipin antibodies and antibodies to heat shock protein (anti-cHSP60).

The studies carried out have shown the considerable change of biochemical composition of tubal secretion in case of hydrosalpinx: increase of pH and bicarbonates level, decrease of osmolarity, concentration of calcium, glucose and lactate. The results we have obtained allow characterizing the secretion of hydrosalpinx as a biochemically changed, hyperalkaline, hypo-osmolar medium with the low content of microelements and nutrients.

The estimation of the concentration of cytokines in the hydrosalpinx fluid has shown the extremely high secretion of proinflammatory cytokines (IL1β, IL6, THF-α), cytokines TH1 (IFNγ, IL-2), and antibodies to cHSP60 in the tubal secretion. At the same time, the component TH2 of the immune system T-helper (IL4) was not activated. Immunological and biochemical imbalance of the tubal secretion has determined the sharp spermatotoxic effect on the migration of spermatozoa in the biological cultures.

The clinical results of the application of assisted reproduction to the patients with tubal infertility have shown the considerably lower level of implantation and pregnancy rate and higher level of the preclinical pregnancy loss by the patients with hydrosalpinx and ampullary tubal obstruction, compared to the group of patients with isthmic tubal obstruction. Proximal tubal clamping before the IVF procedure by the patients with ampullary obstruction and especially with formation of hydrosalpinx improves the prognosis for obtaining and successful development of pregnancy.

As a result of the study that has been carried out there were elaborated algorithms of optimization of diagnosis and management of patients with tubal infertility, included in the program of assisted reproduction.