Study of athrombogenic and thrombogenic factors of the endothelium in women with an unexpected poor and suboptimal ovarian response during the treatment of infertility by methods of assisted reproductive technology

Backgraund. Today, the problem of infertility is global — according to the World Health Organization, approximately every sixth person in the world suffers from infertility. Assisted reproductive technologies (ART) are actively used for its treatment. The success of ART is determined by the quality and quantity of oocytes obtained. The quality and quantity of oocytes depends on the age of the oocytes and their microenvironment, created by biologically active substances of the vascular endothelium. Objective. To assess the levels of markes of endothelial damage — thrombomodulin and von Willebrand factor — in women with different outcomes of hormonal stimulation of the ovaries during the treatment of infertility using ART methods. Material and methods. Based on voluntary informed consent, a simple open comparative randomized study was conducted with the participation of 53 women in the Volgograd region undergoing infertility treatment using ART methods. Inclusion criteria were age up to 42 years inclusive and anti-Mullerian hormone level more than 1.2 ng/ml. Before ovulation stimulation with gonadotropins, data on ovarian reserve parameters were collected. Based on the results of stimulation, women were divided into 3 groups: 1 — women with high and normal ovarian response — 10 or more oocytes were obtained (comparison group); 2 — women with suboptimal ovarian response — 5-9 oocytes received; 3 — women with a poor response — 4 or fewer oocytes were received. After venipuncture, which was performed in preparation for standard anesthesia, thrombomodulin and von Willebrand factor were quantitatively determined in the blood plasma using an enzyme-linked immunosorbent assay. Results. There were no statistically significant differences between groups when examining thrombomodulin levels. The amount of von Willebrand factor in the plasma of patients with suboptimal and poor response was statistically significantly higher compared to the comparison group. This indicates endothelial damage and a shift in the balance towards thrombus formation in women with low ovarian reserve undergoing infertility treatment using ART methods. Conclusions. Thus, an increase in the level of von Willebrand factor in women with a poor and suboptimal response indicates endothelial damage.