The role of the indices of the haemostatic system and angiogenic factors in prognosis of pregnancy complications after in vitro fertilization
The objective. To find interrelations between impaired heamostasis values, angiogenic growth factors and pregnancy complications after in vitro fertilization. Patients and methods. The examination included 83 female patients, who took part in the assisted reproductive technology (ART) programmes. All patients were divided into 3 groups depending on the revealed disorders of the haemostatic system (presence of genetic thrombophilia, genetically undetermined hypercoagulation, and without disorders of the haemostatic system). The levels of antiogenic growth factors (levels of soluble vascular-endothelial growth factor receptor 1 (sVEGFR1) and placental growth factor (PlGF)) were examined in the first trimester of gestation, and also dynamic follow-up of the subsequent course of pregnancy and childbirth was performed. Results. As has been found, in the presence of genetic thrombophilia the levels of sVEGFR1 are by 1.3 times higher as compared with pregnant women without disorders of the haemostatic system, and PlGF values are by 1.3 times lower than in patients with physiological pregnancy. In 30% of patients with thrombophilia and a complicated course of the 1st trimester of gestation after IVF (threatened miscarriage, chorion detachment and retrochorionic haematoma) sVEGFR1 values are significantly lower than in patients with a chronic form of DIC syndrome and not having impaired heamostatis. A dynamic observation of the course of pregnancy has shown that changes of the values of the angiogenic growth factors in blood plasma, namely, increased sVEGFR1 levels and decreased PlGF in the 1st trimester resulted in development of gestosis and PI: in pregnant women with thrombophilia in 41.7 and 66.7%, in patients with chronic DIC syndrome - in 40 and 46.7%, and in women without impaired haemostatic systems - in 25 and 33.3%, respectively. Conclusion. Early detection of disorders in the haemostatic system such as genetic thrombophilia and genetically undetermined hypercoagulation, and also early diagnosis of changes of the levels of angiogenic growth factors in the first trimester of gestation permit to detect risk factors for development of threatened miscarriage, FPI and gestosis in pregnant women after IVF.