АМБУЛАТОРНОЕ ВЕДЕНИЕ БЕРЕМЕННОСТИ У ЖЕНЩИН ПОСЛЕ ПРИМЕНЕНИЯ СОВРЕМЕННЫХ ТЕХНОЛОГИЙ ЛЕЧЕНИЯ БЕСПЛОДИЯ: ОБЗОР ЛИТЕРАТУРЫ
Ключевые слова:
Вспомогательные репродуктивные технологии, беременность, амбулаторное ведение беременности, бесплодиеАннотация
В статье представлены результаты анализа имеющихся отечественных и зарубежных публикаций, посвященных амбулаторному ведению беременности у женщин после применения современных технологий лечения бесплодия. Показано, что в современной медицинской практике отсутствуют чётко дифференцированные критерии ведения беременности у женщин после естественного зачатия и после ЭКО. С одной стороны, это обусловлено различной динамикой акушерских и перинатальных осложнений у этих категорий пациенток, а с другой — различными методологическими подходами систем здравоохранения разных стран.
Библиографические ссылки
Ranjbar F, Warmelink JC, Gharacheh M. Prenatal attachment in pregnancy following assisted reproductive technology: a literature review. Journal of Reproductive and Infant Psychology. 2020;38(1):86–108. doi: 10.1080/02646838.2019.1705261.
Solmonovich R, Kouba I, Jackson FI, Alvarez A, Goldman RH, San Roman G, Blitz MJ. Association of in vitro fertilization with severe maternal morbidity in low-risk patients without comorbidities. Fertility and Sterility. 2025;Feb;123(2):262-269. doi: 10.1016/j.fertnstert.2024.09.015.
Wang C, Johansson ALV, Nyberg C, Pareek A, Almqvist C, Hernandez-Diaz S, Oberg AS. Prediction of pregnancy-related complications in women undergoing assisted reproduction, using machine learning methods. Fertility and Sterility. 2024 Jul;122(1):95-105. doi: 10.1016/j.fertnstert.2024.02.024.
Urata Y, Harada M, Komiya S, Akiyama I, Tuchida C, Nakaoka Y et al. Lifestyle and fertility-specific quality of life affect reproductive outcomes in couples undergoing in vitro fertilization. Frontiers in endocrinology (Lausanne). 2024;Mar 20:15:1346084. doi: 10.3389/fendo.2024.1346084.
Kellow NJ, Le CJ, Fabrizzio H, Dordevic AL, Bennett CJ. The effect of dietary patterns on clinical pregnancy and live birth outcomes in men and women receiving assisted reproductive technologies: a systematic review and meta-analysis. Advances in nutrition. 2022;Jun 1;13(3):857-874. doi: 10.1093/advances/nmac023.
Sharma A, Mahajan C, Saraswathy K, Puri M, Babu N. Struggling with primary infertility: psychological well-being and associated factors in north Indian women. Journal of the anthropological survey of India. 2022;71(1):68–83. doi: 10.1177/2277436X211073849.
Minas A, Fernandes ACC, Junior VLM, Adami L, Intasqui P, Bertolla RP. Influence of physical activity on male fertility. Andrologia. 2022;54(7):e14433. doi: 10.1111/and.14433.
Kim EJ, Nho JH. Lifestyle Interventions for Adults with Infertility. Journal of lifestyle medicine. 2022;12(2):69. doi: 10.15280/jlm.2022.12.2.69.
Walker C, Mills H, Gilchrist A. Experiences of physical activity during pregnancy resulting from in vitro fertilisation: an interpretative phenomenological analysis. Journal of reproductive and infant psychology. 2017;35(4):365-379. doi:10.1080/02646838.2017.1313968.
Kakargia E, Mamalakis E, Frountzas M, Anagnostou E, Siristatidis C. The role of maternal physical activity on in vitro fertilization outcomes: a systematic review and meta-analysis. Archives of gynecology and obstetrics. 2023;07(6):1667-1676. doi: 10.1007/s00404-022-06606-0.
Charkamyani F, HosseinkhaniA, Samani L N, Khedmat L. Reducing the adverse maternal and fetal outcomes in IVF women by exercise interventions during pregnancy. Research quarterly for exercise and sport. 2019 Dec;90(4):589-599. doi: 10.1080/02701367.2019.1639601.
Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet. 1986; 1(8489): 1077-1081. doi: 10.1016/s0140-6736(86)91340-1.
Hales CN, Barker DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia. 1992; 35(7): 595-601. doi: 10.1007/BF00400248.
Trop-Steinberg S, Gal M, Azar Y, Kilav-Levin R, Heifetz EM. Effect of omega-3 supplements or diets on fertility in women: a meta-analysis. Heliyon. 2024 Apr 6;10(8):e29324. doi: 10.1016/j.heliyon.2024.e29324.
Demir K, Caliskan ST, Celik S, Akdeniz M, Goc RY. The effect of folic acid, B12, D, and E vitamins and melatonin levels in the follicular fluid taken by the intracytoplasmic sperm injection method on pregnancy. Pakistan Journal of Medical Sciences. 2024 Jan-Feb;40(3Part-II):433-437. doi: 10.12669/pjms.40.3.7929.
Chen Y, Yang J, Zhang L. The impact of follicular fluid oxidative stress levels on the outcomes of assisted reproductive therapy. Antioxidants (Basel). 2023 Dec 14;12(12):2117. doi: 10.3390/antiox12122117.
Ogawa S, Ota K, Takahashi T, Yoshida H. Impact of homocysteine as a preconceptional screening factor for in vitro fertilization and prevention of miscarriage with folic acid supplementation following frozen-thawed embryo transfer: a hospital-based retrospective cohort study. Nutrients. 2023 25;15(17):3730. doi:10.3390/nu15173730.
Tian M, Zeng S, Cai S, Reichetzeder C, Zhang X, Yin C. et al. 25(OH)VitD and human endocrine and functional fertility parameters in women undergoing IVF/ICSI. Frontiers in Endocrinology (Lausanne). 2022 29;13:986848. doi: 10.3389/fendo.2022.986848.
Chiu Y-H, Karmon AE, Gaskins AJ, Arvizu M, Williams PL, Souter I et al. Serum omega-3 fatty acids and treatment outcomes among women undergoing assisted reproduction. Human Reproduction. 2018 1;33(1):156-165. doi: 10.1093/humrep/dex335.
Winter HG, Rolnik DL, Mol BWJ, Torkel S, Alesi S, Mousa A et al. Can dietary patterns impact fertility outcomes? A Systematic Review and Meta-Analysis. Nutrients. 2023 May 31;15(11):2589. doi: 10.3390/nu15112589.
Gaskins AJ, FL Nassan, Yu-Han Chiu, Mariel Arvizu, Paige L Williams, Myra G Keller et al. Dietary patterns and outcomes of assisted reproduction. American Journal of Obstetrics and Gynecology. 2019; Jun;220(6):567.e1-567.e18. doi: 10.1016/j.ajog.2019.02.004.
Sanderman E A, Willis SK, Wise LA. Female dietary patterns and outcomes of in vitro fertilization (IVF): a systematic literature review. Nutrition Journal. 2022 Jan 18;21:5. doi: 10.1186/s12937-021-00757-7.
Chai Y, Li Q, Wang Y, Niu B, Chen H, Fan T et al. Cortisol dysregulation in anxiety infertile women and the influence on IVF treatment outcome. Frontiers in Endocrinology (Lausanne). 2023 Jun 13:14:1107765. doi: 10.3389/fendo.2023.1107765.
Fallahzadeh H, Zareei MAH, Momayyezi M, Malaki MH, Keyghobadi N. The comparison of depression and anxiety between fertile and infertile couples: a meta-analysis study. International Journal of Reproductive BioMedicine. (2019) 17(3):153–62. doi: 10.18502/ijrm.v17i3.4514.
Kiani Z, Simbar M, Hajian S, Zayeri F, Shahidi M, Saei Ghare Naz M, et al. The prevalence of anxiety symptoms in infertile women: a systematic review and meta-analysis. Fertility Research and Practice. 2020 6:7. doi: 10.1186/s40738-020-00076-1.
Huang MZ, Kao CH, Lin KC, Hwang JL, Puthussery S, Gau ML. Psychological health of women who have conceived using assisted reproductive technology in Taiwan: findings from a longitudinal study. BMC Womens Health. 2019 Jul 12;19(1):97. doi: 10.1186/s12905-019-0801-7.
René C, Landry I, de Montigny F. Couples’ experiences of pregnancy resulting from assisted reproductive technologies: A qualitative meta-synthesis. International Journal of Nursing Studies Advances. 2022 Dec; 4: 100059. doi: 10.1016/j.ijnsa.2021.100059.
Pellerone M, Martinez-Torvisco J, Giuseppa Razza S, Commodari E, Miccichè S. Precursors of Prenatal Attachment and Anxiety during Pregnancy in Women Who Procreate Naturally and Pregnant Women following Assisted Reproduction Technology. International Journal of Environmental Research and Public Health. 2023 Oct 19;20(20):6945. doi: 10.3390/ijerph20206945.
Mahmoud MY, Labib K, Sileem SA, Mustafa FA, Hamed WM, Elhamid AA et al. The impact of music therapy on anxiety and pregnancy rate among infertile women undergoing assisted reproductive technologies: a systematic review and meta-analysis. Journal of Psychosomatic Obstetrics & Gynecology. 2022 Jun;43(2):205-213. doi: 10.1080/0167482X.2021.1977277.
Li YQ, Shi Y, Xu C, Zhou H. Cognitive behavioural therapy improves pregnancy outcomes of in vitro fertilization-embryo transfer treatment: a systematic review and meta-analysis. Journal of International Medical Research. 2021 Nov;49(11):3000605211050798. doi: 10.1177/03000605211050798.
Bello FA, Adeolu JO, Abdulmalik JO, Abdus-Salam RA, Egbokhare OA, Otekunrin OA et al. Reducing anxiety and depression in infertility among Nigerian women: an exploratory psycho-educational intervention trial (RADIANT) study protocol. Pan African Medical Journal. 2021;18:39-43. doi: 10.11604/pamj.2021.39.43.23703.
Zhang H-R, Zhang C, Ma P-H et al. Pregnancy Benefit of Acupuncture on in vitro Fertilization: A Systematic Review and Meta-Analysis. Chinese Journal of Integrative Medicine. 2023;29(11):1021-1032. doi: 10.1007/s11655-023-3748-3.
Lin G, Li X, Jin Yie SL, Xu L. Clinical evidence of coenzyme Q10 pretreatment for women with diminished ovarian reserve undergoing IVF/ICSI: a systematic review and meta-analysis. Annals of Medicine. 2024 Dec;56(1):2389469. doi: 10.1080/07853890.2024.2389469.
Ma J, Wang M, Zuo Q, Ma H, Wu S. Analysis of use of different rFSHs during IVF/ICSI-assisted conception in elderly population and effect of double trigger on clinical outcomes. The Journal of Maternal-Fetal & Neonatal Medicine. 2024 Dec;37(1):2352790. doi: 10.1080/14767058.2024.2352790.
Basar M. Enhancing outcomes in IVF laboratories: navigating the human element through leadership and emotional intelligence. The Journal of Assisted Reproduction and Genetics. 2024 Sep 3. doi: 10.1007/s10815-024-03239-x.
Кузнецов СИ, Опатовская ЯВ, Аскерова МГ, Аскеров РА. Гистероскопия с вакуум-аспирацией эндометрия при повторных неудачах имплантации: диагностическая значимость и влияние на успех ЭКО. Уральский медицинский журнал. 2024;23(2):17-24. (In Russ.). doi: 10.52420/umj.23.2.17.
Zhang JT, Lee R, Sauer MV, Ananth CV. Risks of Placental Abruption and Preterm Delivery in Patients Undergoing Assisted Reproduction. JAMA Network Open's Journal. 2024 Jul 1;7(7):e2420970. doi: 10.1001/jamanetworkopen.2024.20970.
Поддержка лютеиновой фазы в циклах вспомогательных репродуктивных технологий / Н. И. Тапильская, А. М. Гзгзян, С. В. Объедкова, С. А. Дьяконов // StatusPraesens. Гинекология, акушерство, бесплодный брак. – 2021. – № 1(75). – С. 25-33. (In Russ.). doi: https://doi: org/
Клинические рекомендации ESHRE: овариальная стимуляция в программах ЭКО и ИКСИ (перевод на русский под ред. проф. Корсака В.С.) // Акушерство и гинекология: новости, мнения, обучение. 2021. Т. 9, № 2. С. 34-47. (In Russ.). doi:10.33029/2303-9698-2021-9-2-34-51.
Маясина Е.Н., Буев Ю.Е., Аскеров Р.А., Ямалыева Н.Ш., Кичигина Е.А., Корнилова А.С., Салимов Д.Ф. Сравнительный анализ эффективности вагинальных форм прогестерона в программах экстракорпорального оплодотворения. Проблемы репродукции. 2023;29(5):54‑59. (In Russ.). doi: 10.18565/aig.2024.38.
Сыркашева А.Г., Петросян Я.А., Долгушина Н.В. Гестагены в программах вспомогательных репродуктивных технологий // Гинекология. 2019;21(2):76-79. (In Russ.). doi: 10.26442/20795696.2019.2.190238
Пестова Т.И., Колода Ю.А., Смирнова А.А., Львова А.Г., Боярский К.Ю., Денисова Ю.В. Нормативное регулирование применения гестагенов в России в эру индивидуализированного подхода к поддержке лютеиновой фазы в программах вспомогательных репродуктивных технологий. Проблемы репродукции. 2024;30(4):59‑70. (In Russ.). DOI: https://doi: org/
Garg A, Zielinska AP, Yeung AC et al. Luteal phase support in assisted reproductive technology. Nature Reviews Endocrinology. 2024 Mar;20(3):149-167. doi: 10.1038/s41574-023-00921-5.
Nagy B, Szekeres-Barthó J, Kovács GL et al. Key to Life: Physiological Role and Clinical Implications of Progesterone. International Journal of Molecular Sciences. 2021; Oct 13;22(20):11039. doi: 10.3390/ijms222011039.
Беременность после экстракорпорального оплодотворения: акушерские и перинатальные риски / М. Б. Игитова, А. Б. Казанина, Т. М. Черкасова [и др.] // Акушерство и гинекология. 2024;7:58-64. (In Russ.). doi: 10.18565/aig.2024.94.
Bosdou JK, Anagnostis P, Goulis DG et al. Risk of gestational diabetes mellitus in women achieving singleton pregnancy spontaneously or after ART: a systematic review and meta-analysis. Hum Reprod Update. 2020 May 22;26(4):514–544. doi: 10.1093/humupd/dmaa011.
Wicklow B, Retnakaran R. Gestational Diabetes Mellitus and Its Implications across the Life Span. Diabetes Metab J. 2023 May;47(3):333-344. doi: 10.4093/dmj.2022.0348.
Клинические рекомендации Министерства здравоохранения Российской Федерации «Гестационный сахарный диабет». – 2024. – Текст : электронный // Рубрикатор клинических рекомендаций : сайт. – URL: https://roag-portal.ru/recommendations_obstetrics (дата обращения: 10.07.2025).
Яковлева О.В., Глухова Т.Н., Рогожина И.Е. Основные принципы ведения беременности после вспомогательных репродуктивных технологий // Медицинский вестник Северного Кавказа. 2020;15(1):140-145. (In Russ.). doi: 10.14300/mmnc.2020.15035.
Johnson KM, Hacker MR, Thornton K, Young BC, Modest AM. Association between in vitro fertilization and ischemic placental disease by gestational age. Fertility and Sterility. 2020;114(3):579-586. doi: 10.1016/j.fertnstert.2020.04.029.
Resta S, Scandella G, Mappa I et al. Placental Volume and Uterine Artery Doppler in Pregnancy Following In Vitro Fertilization: A Comprehensive Literature Review J Clin Med. 2022 Sep 29;11(19):5793. doi: 10.3390/jcm11195793.
Wang Y, Chen Q, Wang Y. Effects of Different Endometrial Preparation Regimens during IVF on Incidence of Ischemic Placental Disease for FET Cycles. J Clin Med. 2022 Nov 2;11(21):6506. doi: 10.3390/jcm11216506.
Zhang JT, Lee R, Sauer MV et al.Risks of Placental Abruption and Preterm Delivery in Patients Undergoing Assisted Reproduction. JAMA Netw Open. 2024 Jul 1;7(7):e2420970. doi: 10.1001/jamanetworkopen.2024.20970.
Sacha CR, Harris AL, James K et al. Placental pathology in live births conceived with in vitro fertilization after fresh and frozen embryo transfer. Am J Obstet Gynecol. 2020 Apr;222(4):360.e1-360.e16. doi: 10.1016/j.ajog.2019.09.047.
Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol. 2022 Feb;226(2S):S1108-S1119. doi: 10.1016/j.ajog.2020.08.045.
Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. International Journal of Gynecology & Obstetrics. 2019;145(Suppl 1):1-33. doi: 10.1002/ijgo.12802.
Tocariu R, Stan D, Mitroi RF, Căldăraru DE, Dinulescu A, Dobre CE, Brătilă E. Incidence of complications among in vitro fertilization pregnancies. Journal of Medicine and Life. 2023; Mar;16(3):399-405. doi: 10.25122/jml-2023-0048.
Kawai T, Jwa SC, Ogawa K et al Maternal Vitamin D Deficiency Is a Risk Factor for Infants' Epigenetic Gestational Age Acceleration at Birth in Japan: A Cohort Study. Nutrients. 2025 Jan 20;17(2):368. doi: 10.3390/nu17020368.
Subramanian A, Carr CM, Papp E et al.Effect of vitamin D3 supplementation starting mid-pregnancy on placental angiogenic factors and terminal villi: a secondary analysis of a randomized controlled trial in Bangladesh. BMC Pregnancy Childbirth. 2025 Jul 11;25(1):752. doi: 10.1186/s12884-025-07566-4.
Hasan HA, Barber TM, Cheaib S, Coussa A. Preconception Vitamin D Level and In Vitro Fertilization: Pregnancy Outcome. Endocr Pract. 2023 Apr;29(4):235-239. doi: 10.1016/j.eprac.2023.01.005.
Клинические рекомендации Министерства здравоохранения Российской Федерации «Нормальная беременность». – 2024. – Текст : электронный // Рубрикатор клинических рекомендаций : сайт. – URL: https://roag-portal.ru/recommendations_obstetrics (дата обращения: 10.07.2025).
Mirnamniha M., Faroughi F., Tahmasbpour E., Ebrahimi P., Beigi Harchegani A. An overview on role of some trace elements in human reproductive health, sperm function and fertilization process. Rev. Environ. Health. 2019;34:339–348. doi: 10.1515/reveh-2019-0008.
Martinez-Morata I., Sobel M., Tellez-Plaza M., Navas-Acien A., Howe C.G., Sanchez T.R. A state-of-the-science review on metal biomarkers. Curr Environ Health Rep. 20 июня 2023 г.;10(3):215–249. doi: 10.1007/s40572-023-00402-x.
Erdoğan K, Sanlier NT, Sanlier N. Are epigenetic mechanisms and nutrition effective in male and female infertility? Journal of Nutritional Science. 2023; Sep 26:12:e103. doi: 10.1017/jns.2023.62.
Gonzalez-Martin R, Palomar A, Perez-Deben S et al. Higher concentrations of essential trace elements in women undergoing IVF may be associated with poor reproductive outcomes following single euploid embryo transfer. Cells. 2024 May 15;13(10):839. doi: 10.3390/cells13100839.
Zhou L., Liang K., Li M., Rong C., Zheng J., Li J. Metal Elements Associate with in Vitro Fertilization (IVF) Outcomes in 195 Couples. J. Trace Elem. Med. Biol. 2021;68:126810. doi: 10.1016/j.jtemb.2021.126810.
Сведения об авторах
О.В. Прохорова - кандидат медицинских наук, доцент кафедры акушерства и гинекологии с курсом медицинской генетики, prokhorova-ov@yandex.ru, https://orcid.org/0000-0002-9051-4528
Е.А. Росюк – кандидат медицинских наук, доцент кафедры акушерства и гинекологии с курсом медицинской генетики, elenakdc@yandex.ru, https://orcid.org/0000-0003-1303-3955
А.Р. Тен - кандидат медицинских наук, доцент кафедры акушерства и гинекологии с курсом медицинской генетики, tenar79@mail.ru, https://orcid.org/0000-0002-6349-9756
О.Р. Мусина – старший преподаватель кафедры иностранных языков и межкультурной коммуникации
О.А. Якубова – доктор медицинских наук, доцент кафедры акушерства и гинекологии, онкологии, пластической хирургии и медицинской косметологии, https://orcid.org/0000-0003-1316-1359
Information about the author
O.V. Prokhorova – Ph.D. in medicine, Associate Professor in the Department of Obstetrics and Gynaecology with a Medical Genetics course, prokhorova-ov@yandex.ru, https://orcid.org/0000-0002-9051-4528
E.A. Rosyuk – Ph.D. in medicine, Associate Professor in the Department of Obstetrics and Gynaecology with a Medical Genetics course, elenakdc@yandex.ru, https://orcid.org/0000-0003-1303-3955
А.R. Ten - Ph.D. in medicine, Associate Professor in the Department of Obstetrics and Gynaecology with a Medical Genetics course, tenar79@mail.ru, https://orcid.org/0000-0002-6349-9756
O.R. Musina is a senior lecturer at the Department of Foreign Languages and Intercultural Communication
Oltinoy A. Yakubova – Professor of the Department, Doctor of Medical Sciences, https://orcid.org/0000-0003-1316-1359
