**1. Introduction**

76 Enhancing Success of Assisted Reproduction

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> In most developed countries the problem of infertility has acquired not only medical and sociodemographic, but also economic significance. One of the key and vigorously developing trends in modern obstetrics is aimed at overcoming this problem and requires a multidisciplinary approach. The 2010 Nobel Prize was awarded to Robert Edwards, 85-yearold British researcher and recognized the methods of assisted reproductive technologies (ARTs) which introduced a new era in human demography. ARTs are used to solve the problem of infertility; they use all treatment methods and procedures which support in vitro processing of human oocytes, sperm or embryos to become pregnant. These technologies involve in vitro fertilization (IVF) and transcervical embryo transfer, gamete intrafallopian transfer, zygote intrafallopian transfer, embryo intrafallopian transfer, gamete and embryo cryopreservation, oocyte and embryo donation, and surrogacy (Current Practices and Controversies in Assisted Reproduction. Report of.., 2001).

> 25 July 1978 was marked by a significant event in the history of ARTs. On that day, the first "test tube baby" was born in an obstetrics and gynecology clinic located in Oldham, North West England. This was also the birth date of modern assisted reproduction. In Russia, the first baby born by this method was delivered in 1986 in the Research Center for Obstetrics, Gynecology and Perinatology, the division of the Russian Academy of Medical Sciences. Other leading centers in Russia are "Fertimed "Center for Reproduction and Genetics (Moscow), "ART-ECO" Clinic for Reproductive Health (Moscow), "ECO" Center for the

© 2012 Momot et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2012 Momot et al., licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Treatment of Infertility, LLC (Moscow), International Center for Reproductive Medicine (Saint-Petersburg), the Baltic Institute of Human Reproductology (Saint-Petersburg), etc.

The Means of Progress in Improving the Results of *in vitro* Fertilization Based on the Identification and Correction of the Pathology of Hemostasis 79

schemes of ovulation induction. The cases of women under 41 are treated as relatively promising, to reason the use of donated oocytes in older women (Maheshwari et al., 2008). Paternal age also affects the conception rate: it shrinks with men after 35 due to the quality

*Excessive body weight.* Menstrual dysfunction, polycystic ovary syndrome, hyperplastic processes in endometrium, infertility, miscarriage, gestoses, fetal hypotrophies, high rate of operative deliveries make up an incomplete list of reproductive disorders typical of obese women. 40% of women seeking for treatment of infertility in medical centers have excessive body weight; over 15% of such women are obese. The IVF program is preferable to start after the patient's body weight has become normalized; therefore, patients often fail to meet the required standards (Ku et al., 2006; Lintsen et al., 2005; Mc Clamrock, 2008; Megan et al., 2008). Status of the hypothalamus-pituitary-ovary system, suprarenal and thyroid systems. Interaction of the two key pituitary hormones - FSH and luteinizing hormone (LH) - is essential for the adequate growth of follicles, as well as for the formation of viable oocytes. Studies of ovulation induction in hypogonadotropic patients showed that exogenous FSH stimulates the growth of follicles up to the preovulatory stage and its synthesis primarily depends on LH, i.e. adequate maturation of follicles takes place due to this gonadotropin. Insufficient concentration of LH disturbs paracrine mechanisms regulating granulosa cells, as well as endometrial proliferation, and results in inadequate luteal phase (Alviggi et al., 2009; Balasch et al., 1995; Hull et al., 1994). Excessive concentration of LH also negatively affects the growth of follicles to be the result of suppressed aromatase activity, accompanied by fertilization disorders, decreased pregnancy rate decrease and increased miscarriage rate (Hillier, 1994). Thus, the threshold concentration (1-10 IU/l) is optimal for adequate folliculogenesis (Howles et al., 2006). It has been noted that low estradiol level in the blood serum (<200 pmole/l) on the 3rd day of the patient's menstrual cycle is a positive prognostic indicator of successful implantation in the IVF cycle. At the same time, some reports state that basal estradiol level was not a significant indicator of ovarian response to stimulation and did not correlate with the IVF result (Friedler et al., 2005). In recent years, researchers and clinicists have given a lot of consideration to the problem of thyroid gland dysfunction in infertile women (Bellver et al., 2008). Female reproductive system consists of interrelated structural elements: hypothalamus, pituitary gland, ovaries, other endocrine glands and target organs facilitating reproductive function. Thyroid gland is a chief part of the neuroendocrinal system; it significantly affects reproductive function. The hypothalamuspituitary-gonadal and hypothalamus-pituitary-thyroid systems are closely related due to the presence of common central regulating mechanisms. For example, the spread of thyroid gland dysfunction diagnosed at the examination in women, who seek clinical diagnosis and treatment of infertility, ranges from 2.5 to 38.3% (Lazarus & Premawardhana, 2005). In addition to gonadotropic hormones, ovarian function is determined by adrenal hormones produced under impact of ACTH. When a patient has developed any genetic defects in the enzyme systems, cortisol synthesis in adrenal glands decreases with the increase of level of ACTH followed by the increased production of androgens under normal synthesis. This condition may be typical of congenital adrenal hyperplasia. As a result of adrenal

of sperm to have been deteriorated by this age (Saleh et al., 2002).
