Cervical immune changes in women with infertility and post-traumatic stress disorder in the dynamics of treatment
DOI:
https://doi.org/10.15574/HW.2024.5(174).49Keywords:
infertility, posttraumatic stress disorder syndrome, interleukin-6, interleukin-8, lactoferrin, secretory leukocyte proteinase inhibitor, trauma-oriented psychotherapyAbstract
More than 48 million couples in the world suffer from infertility, which, in addition to numerous social consequences, also has a psychological impact.
Aim - to study the peculiarities of the cervical local immune status in patients with PTSD and infertility in order to improve the treatment of fertility disorders.
Materials and methods. Cervical concentrations of IL-6, IL-8, lactoferrin and secretory leukocyte proteinase inhibitor were studied, as well as their dynamics during treatment in 112 women with infertility, divided into 3 groups. The Group I - 36 women who had the criteria of post-traumatic stress disorder syndrome, which developed after the diagnosis of infertility, the Group II - 31 women with infertility that arose against the background of post-traumatic stress disorder, Group III - 45 patients with infertility without criteria for post-traumatic stress disorder. For control, 50 healthy women were examined. Groups of infertility were divided into 2 subgroups each. 18 women of subgroup IA and 15 of IIA were treated for infertility according to its cause, 18 women of subgroup IV and 16 of IIV additionally received trauma-based psychotherapy sessions.
Results. All patients with infertility showed an increased content of all studied pro-inflammatory cytokines. After 3 months, patients of subgroups IA and IIA retained an increased content of pro-inflammatory cytokines. The content of IL-8 and lactoferrin after 3 months reached normal values in subgroups IV and IIV, and SILP - only in patients of subgroup IIV.
Conclusions. In patients of all examined groups, the level of IL-6 and IL-8, SILP and lactoferrin in cervical mucus was significantly increased compared to similar values in the control group, which indicates the activation of the anti-inflammatory link of the immunoinflammatory reaction. The highest value of IL-6 and SILP is characteristic of women of group I, lactoferrin - of women of group II. The use of trauma-oriented psychotherapy in the complex treatment of patients with infertility on the background of PTSD allows achieving a more pronounced decrease in IL-8 levels in women of subgroup IA. A decrease in cervical IL-6 and SILP concentrations on the background of psychotherapy was obtained only in women of subgroup IIV, which has a beneficial effect on the implementation of reproductive function.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the participating institution. Informed consent of the patients was obtained for the study.
The authors declare the absence of a conflict of interest.
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