CLINICAL CASE OF SUCCESSFUL IMPLEMENTATION OF REPRODUCTIVE FUNCTION IN A PATIENT WITH GONADAL DYSGENESIS

Abstract

An important problem is the problem of implementing reproductive function in patients with forms of infertility caused by genetic abnormalities. Previously, the prognosis for their reproductive function was considered unfavorable. In modern conditions, by improving IVF techniques using oocyte donation, treatment of infertility in these patients becomes possible. Therefore, studying the features of the tactics of managing such patients at the stage of preconception preparation, the features of IVF protocols, as well as the features of managing pregnancy and labor and delivery is relevant. The purpose of the study is to substantiate the possibility of successful implementation of reproductive function in a patient with gonadal dysgenesis. A clinical case of pregnancy and childbirth in a patient with a typical form of gonadal dysgenesis (karyotype 45 X0) is presented. The diagnosis was made at the age of 15 during a comprehensive examination for primary amenorrhea, and hormone replacement therapy was prescribed. The patient's pregnancy occurred after preparation of the endometrium with estrogens and gestagens as a result of the fourth IVF attempt with the donation of an egg fertilized by her husband's sperm, and was complicated by the threat of termination at 8 and 19 weeks. At 36 weeks, the pregnancy was complicated by severe preeclampsia, which required emergency caesarean section. The course of the postoperative period was uneventful with continuation of therapy for complications of gestation. It is recommended after cessation of lactation - HRT using drugs with an estrogenic component similar in chemical structure to natural ones, gestagenic - metabolically neutral. The study of this clinical case is of undoubted interest, taking into account the peculiarities of management tactics. It is necessary to implement a multidisciplinary approach to the management of such complex patients. Taking into account the peculiarities of the body condition in patients with gonadal dysgenesis and the absence of hormonal ovarian function, it is necessary to ensure optimal preconception preparation, the use of an individual approach to the implementation of the IVF protocol, and the prevention of complications during pregnancy. Fulfillment of these conditions will ensure a positive result of infertility treatment in patients with gonadal dysgenesis who previously did not have the opportunity to realize reproductive function.