Clinical effectiveness of preconception training in women with sexually transmitted infections after an IVF program

Abstract

The objective: to prove the clinical effectiveness of preconception preparation of the women with a history of sexually transmitted infections (STIs) after pre-gravid training before assisted reproductive technology (ART) cycles.Materials and methods. 115 women received the suggested pre-gravid training, of which 56 women became pregnant after ART programme and were included in the 1st group and received medical and preventive measures offered by us; 132 women after standard pre-gravid training, of which 55 women became pregnant after ART program and were included in the II group and received generally accepted medical and preventive measures. A clinical analysis of the pregnancy course, childbirth and the condition of newborn children was conducted in 111 women (I and II groups). All patients in the I and II groups had STIs in medical history. Statistical processing of research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 8.0”. Results. The rate of threat of pregnancy interruption was significantly lower in the I group – 6 (10.7 %) patients than in the II group – 19 (34.5 %; p<0.001); missed abortion was determined in 3 (5.3 %) cases in the I group versus 6 (10.9%) cases in the II group; spontaneous pregnancy interruption in the I trimester was in 2 (7.1 %) patients in the I group versus 4 (7.3%) women in the II group. Pregnancy was terminated in 5 (8.9 %) pregnant women in the I group and 10 (18.2 %) – in the II group (p<0.05). The threat of late abortion in women in the I group was found significantly less than in patients in the II group – 4 (7.8 %) versus 12 (26. 7%) persons, respectively (p<0.05). Fetal growth retardation (FGR) was diagnosed significantly less in the pregnant women of the I group than in pregnant women of the II group, – 11 (21.6 %) versus 17 (37.8 %) individuals, respectively (p<0.05). The results of cardiotocography (CTG) demonstrated that the satisfactory fetal state was determined in 40 (78.4 %) pregnant women in the I group, which is statistically significantly more than in the II group – 23 (51.1 %; p<0.05) cases.Doubtful non-stress test data were found in the I group more less – 10 (19.6 %) patients versus 15 (33.3 %) cases the II group (p<0.05). Pathological data of CTG were registered in 1 (2.0 %) pregnant women in the I group versus 7 (15.6%) cases in the II group (p<0.05). The risk of fetal distress in the pregnant women in the I group was 13.9 % (95 % CI 7.8-20.0), RR=0.5 (95% CI 0.16-0.66; p=0.002), which confirms the effect of the pre-gravid complex of medical and preventive measures on the fetal distress reducing in the pregnant women of the I group.Premature births were observed significantly less in patients in the I group, than in the II group, which amounted to 6 (11.7 %) versus 12 (26. 7 %) persons (p<0.05). The condition of newborns in the I group was satisfactory in 49 (85.9 %) cases, and the total level of children born with asphyxia in the I group decreased by 2.5 times (p<0.05).Conclusions. Pathogenetically based pre-gravid preparation and therapy proved to be effective for the onset of pregnancy after ART method and positive pregnancy outcomes in 48.6 % of the women; it reduced the reproductive losses by 2 times, the threat of abortion by 3.2 times, the threat of premature birth by 1.6 times, preeclampsia and fetal growth retardation by 1.5 times, and fetal distress during delivery by 2.2 times.