Personalized Strategies for Fertility Preservation in Women with Chronic Urogenital Infections: From Immunomodulation to Assisted Reproductive Technologies

Abstract

DOI: 10.52705/2788-6190-2025-3-14
УДК 618.177-022.7-092:612.017:577.27:615.832.9-085:616-08-039.71

Abstract Background. Infectious infertility is one of the leading challenges in modern reproductive medicine, characterized by a high rate of implantation failures and recurrent inflammatory processes. Chronic urogenital infections affect not only the local microbiome but also immune and molecular pathways, leading to cytokine imbalance, reduced endometrial receptivity, and the development of oxidative stress. This highlights the need for new personalized treatment strategies aimed not only at eliminating the pathogen but also at restoring immune homeostasis and endometrial functionality.
Objective. To evaluate the effectiveness of personalized fertility-preservation strategies in women with chronic vulvovaginal and cervical infections, taking into account the immunological profile, microbiome status, oxidative stress levels, and markers of endometrial receptivity, as well as to determine the role of ozone therapy and antioxidant support as adjuvant methods in preparation for assisted reproductive technology (ART) programs.
Materials and methods. A total of 150 women of reproductive age with infertility of infectious origin were examined. All patients underwent comprehensive assessment, including microbiological testing (Lactobacillus spp., Gardnerella vaginalis, Candida spp.), immunological evaluation (IL-6, IL-8, TNF-α, CD8⁺), hormonal testing (AMH), assessment of cervical mucus quality (Insler score), and endometrial biopsy with determination of HOXA10 and LIF expression. Patients were stratified by type of infection and treatment protocol: standard therapy; standard therapy plus ozone therapy; standard therapy plus ozone therapy combined with antioxidants.
Results. The addition of ozone therapy resulted in a significant decrease in proinflammatory cytokines (IL-6 by 44%, IL-8 by 39%, TNF-α by 41%), increased cytotoxic activity of CD8⁺ lymphocytes, and normalization of the microbiome (increase in Lactobacillus spp., decrease in Gardnerella vaginalis). The inclusion of antioxidant support provided an additional reduction in malondialdehyde (MDA) levels and an increase in superoxide dismutase (SOD) activity, which was associated with restoration of HOXA10 and LIF expression in the endometrium. The clinical pregnancy rate within 6 months after treatment was highest in the combined therapy group (73% vs. 45% in the control group, p < 0.01).
Conclusions. Chronic urogenital infections lead to profound immunological, microbiological, and molecular disturbances that impair women’s reproductive potential. A personalized approach that considers cytokine profile, oxidative stress, and endometrial receptivity markers makes it possible to optimize treatment, improve ART outcomes, and reduce the recurrence of infections. Ozone therapy in combination with antioxidants represents a promising pathogenetically justified component of comprehensive therapy for infertility of infectious origin.