Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации9411Conference ProceedingsAssisted reproductive technologiesRudenkoAnastasia Vladimirovna<p>Student&nbsp;</p>anastasiirudenko@gmail.comhttps://orcid.org/0009-0008-0867-7725NoskovaOksana Vladimirovna<p>Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology</p>oksana_noskova_73@mail.ruhttps://orcid.org/0009-0000-4061-032XMaxim Gorky Donetsk State Medical UniversityDonetsk State Medical University1904202413S127311302202410042024Copyright © 2024, Rudenko A.V., Noskova O.V.2024<p><span id="docs-internal-guid-e584b4bf-7fff-9bf3-299b-20b65602b571" style="font-size: 12pt; font-family: 'Times New Roman', serif; background-color: transparent; font-style: italic; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; vertical-align: baseline; white-space-collapse: preserve;">The purpose of the study is to analyze the effectiveness of new assisted reproductive technologies necessary to achieve pregnancy in women facing infertility problems.</span></p> <p><span id="docs-internal-guid-e584b4bf-7fff-9bf3-299b-20b65602b571" style="font-size: 12pt; font-family: 'Times New Roman', serif; background-color: transparent; font-style: italic; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; vertical-align: baseline; white-space-collapse: preserve;">Materials and methods consist of an analysis of the experience of leading domestic and foreign experts in the field of reproductive technologies. The use of the NGS genetic testing method makes it possible to simultaneously determine aneuploidies and unbalanced chromosomal pathologies of the embryo. The use of preimplantation genetic testing of structural rearrangements (PGT-SP) makes it possible to effectively exclude the presence of chromosomal pathology in embryos of patients with karyotype aberrations.</span></p> <p><span style="font-size: 12pt; font-family: 'Times New Roman', serif; background-color: transparent; font-style: italic; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; vertical-align: baseline; white-space-collapse: preserve;"><span id="docs-internal-guid-5ecc7f67-7fff-fcde-ff6e-f69f7a6dabd9" style="font-size: 12pt; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; vertical-align: baseline;">Conclusions. The effectiveness of therapy methods in preparing patients for assisted reproductive technologies depends on the individual characteristics of the patients. </span></span></p>reproductive technologiespregnancypreimplantation genetic testing of structural changesgenetic testing methoduterine microbiomeрепродуктивные технологиибеременностьпреимплантационное генетическое тестирование структурных перестроекметод генетического тестированиямикробиом матки<p>Relevance. The problem of therapeutic methods in preparing patients for assisted reproductive technologies (ART) is a pressing and important problem in the field of reproductive medicine. Assisted reproductive technologies are a set of methods that help couples facing infertility problems achieve the desired result, namely pregnancy. However, despite significant advances in this field, the success rate of assisted reproductive technologies still remains below the desired level. The problem is that not all patients achieve the desired results with assisted reproductive technologies, even with the highest quality medical intervention. Many factors can influence the outcomes of assisted reproductive technologies, and one of them is inadequate or incorrect therapy when preparing patients for the procedure. The purpose of the work is to analyze the effectiveness of new assisted reproductive technologies necessary to achieve pregnancy in women facing infertility problems. Materials and methods of research. The main research methods were the analysis of the experience of leading domestic and foreign specialists in the field of reproductive technologies. Research results. Infertility is a major health problem: Infertility affects a significant proportion of couples worldwide and can have negative psychological, emotional and social consequences. According to the World Health Association dated April 4, 2023, about 17.5% of the adult population suffers from infertility, that is, approximately every sixth person in the world [1]. ART allows many couples to realize their dream of parenthood and overcome infertility. Each patient has individual medical, physiological and psychological characteristics that can affect the results of assisted reproductive technologies. The correct choice of therapy methods and approaches to each patient is critical to achieving the success of assisted reproductive technologies. In general, the issue of therapy methods in preparing patients for assisted reproductive technologies is key to achieving successful results, improving pregnancy outcomes and improving the quality of life of patients. The development of individual approaches to each patient and the optimization of treatment methods are an important area of research in the field of reproductive medicine. Infertility problems and failures of assisted reproductive technologies may be associated with genetic factors. Genomic studies allow for a more in-depth assessment of the individual risk of pathogenic causes that impede the successful use of ART [2]. Thus, two directions in the field of genetic medicine are currently actively developing: next-generation sequencing NGS [3], as well as comparative genomic hybridization - aCGH [4]. The NGS genetic testing method currently allows the determination of aneuploidies and unbalanced chromosomal pathologies of the embryo simultaneously. Preimplantation genetic testing of structural rearrangements (PGT-SP) allows one to effectively analyze the presence of chromosomal pathology in embryos of patients with karyotype aberrations [5]. The NGS method is fundamentally different from other research methods, since it is based on determining the sequence of nucleic acids, which makes it the most accurate. The applicability of this method has been confirmed by successful tests. Thus, in one study, five blastocids of good quality were examined using the NGS method, while only two of them were diagnosed as euploid, one of them was transferred, resulting in successful pregnancy and a favorable birth outcome [6]. In turn, when using the method of comparative genomic hybridization, wide opportunities open up for determining numerical karyotype anomalies, structural rearrangements of chromosomes, as well as microdeletions and microduplications that affect individual segments of chromosomes [7]. The method can be used in the process of artificial insemination to assess the genetic composition embryos before they are transferred to the uterus. This allows a couple or individual to simultaneously learn information about genetic abnormalities in the embryo that may be associated with hereditary or genetic diseases [8]. New developments in the field of genetic medicine, such as whole-genome sequencing and comparative genomics, make it possible to conduct genetic studies and determine the presence of possible genetic variants that may affect reproductive function. These data can help the doctor choose the most appropriate methods of assisted reproductive technologies for each specific case. Immunological disorders can be a reason for the failure of assisted reproductive technologies. However, new methods of immunological preparation are emerging that allow optimizing.Reproductive function by modulating the uterine immune response and increasing embryo survival [11]. Immune events during implantation influence the morphogenesis of the placenta, whether a viable pregnancy will occur, as well as further fetal development and perinatal outcomes. In reproductive disorders, a common finding is Treg cell deficiency or dysfunction, often associated with an increase in Teff cells. Convincing evidence that Treg cell deficiency, dysfunction, or instability is a cause of recurrent pregnancy loss comes from multiple animal models [9, 10]. Given the compelling evidence for the key role of the uterine immune response, there is a need to identify therapeutic interventions , which can effectively influence the immune response to increase endometrial receptivity. What approaches and strategies are being considered to enhance the immunological preparation of the uterus: 1) Immunomodulators: Immunomodulators are substances that alter the function of the immune system, enhancing or suppressing its responses. Potential uses of immunomodulators to prepare the uterus for labor include the use of drugs that can modulate the activity of immune cells and cytokines. There are a number of potent immunomodulators designed to treat specific autoimmune or autoinflammatory diseases. Some of them, for example, intravenous immunoglobulin, TNF inhibitors (artificially synthesized molecules that can inhibit the activity of the pro-inflammatory cytokine TNF) and prednisolone can be used in reproductive medicine. Therapy with such drugs has been carried out in patients with recurrent implantation failure and recurrent miscarriage, but to date clinical data confirming the effectiveness are insufficient. Therefore, further research is needed to determine the safety and effectiveness of such approaches [3]. Implantation failure remains a serious obstacle to in vitro fertilization. Prednisolone as an immunoregulator is widely used to increase the likelihood of implantation and pregnancy. One recent clinical study included 715 women with recurrent implantation failure. Starting from the day they began preparing the endometrium for embryo transfer, half of them took 10 mg of prednisolone, while the rest took a placebo. The study found that the rate of live births among women taking placebo was 38.8%, and among women taking placebo, the rate of live births was 37.8%. 2) Uterine microbiome: The uterine microbiome consists of a variety of microorganisms that inhabit uterine cavity. Research suggests that the balance between beneficial and pathogenic microorganisms influences immunological reactivity and may have an impact on delivery [11]. Research in the field of the uterine microbiome helps to understand its role and the possibility of manipulating it to improve immunological preparation [12]. Microbiome testing in the context of infertility treatment has attracted much attention and is considered promising as a potentially treatable factor in embryo implantation. A small study failed to demonstrate a correlation between the presence of Lactobacillus strains and ongoing pregnancy after analysis of fetal catheter tips. However, a recent meta-analysis of six cohort studies including a total of 1095 women and several other studies found an association between dysbiotic microbiota and impaired reproductive outcomes. Thus, in 2020, the classification of the vaginal microbiome was expanded depending on the number of predominant lactobacilli species [6]. In turn, in 2019, a large-scale study was conducted, the results of which revealed that a decrease in the total number of lactobacilli below 20%, an increase in L. jensenii by more than 30%, the presence of G. vaginalis and Proteobacteria in an amount of more than 28% has a direct relationship with lack of effectiveness of ART. Thus, according to the results of the study, the pregnancy rate is less than 6% [13]. Analyzing the works devoted to research into the influence of the uterine microbiome on ART, it should be noted that at present scientists have not come to a consensus, however, most studies say that the influence The dominance of certain bacteria on the success of ART has not yet been established. However, it has been found that the presence of pathogenic bacteria in the endometrium, such as Atopobium, Bifidobacterium, Chryseobacterium, Gardnerella, Haemophilus, Klebsiella, Neisseria, Staphylococcus and Streptococcus, together with the depletion of Lactobacillus, is associated with impaired reproductive function. These data indicate that the endometrial microbiome should be considered as a possible new cause of implantation failure and/or pregnancy loss [14]. 3) Diet and lifestyle: Healthy lifestyle and proper nutrition may have a positive effect on the immunological preparation of the uterus. Nutrients such as vitamin D, omega-3 fatty acids, and antioxidants may be helpful in maintaining a healthy immune system. Thus, it was found that in women with sufficient levels of vitamin D, pregnancy during ART occurs 1.5 times more often, since it has a beneficial effect on the endometrium. Vitamin D also regulates endometrial expression of the HOXA-10 gene, which is critical during embryo implantation. Typically, the duration of vitamin D intake is up to 3 months, the recommended dosage is: 3060 ng/ml. In addition, it is important to follow recommendations for a healthy lifestyle and nutrition, including moderate physical activity and proper nutrition. Conclusion. It is important to note that the effectiveness of therapy methods in preparing patients for assisted reproductive technologies depends on many factors, including the individual characteristics of the patient, the presence of additional conditions and features of ART. 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