REPRODUCTIVE OUTCOMES IN COUPLES WHO LOST THEIR CHILD DURING THE WAR: EVALUATING THE EFFECTIVENESS OF A STATE ASSISTANCE PROGRAM FOR POST-WAR FAMILIES APPLYING FOR ASSISTED REPRODUCTIVE TECHNOLOGIES

Problem Statement: The reproductive potential and outcomes in families that have endured the tragedy of military losses remain understudied, despite the escalating frequency of wars over the past decades. Treating couples in such situations, who experience severe psychological trauma, are of very advanced age, and face natural declines in fertility, poses a challenge for fertility specialists. In Armenia, the government has implemented an extensive program to assist such families, encompassing full funding for IVF programs, including gamete donation and surrogacy.

The purpose of our study was to ascertain the reproductive potential and outcomes among families of fallen soldiers, as well as to evaluate the results and merits of state assistance programs for these families.

Methods: In this prospective controlled study, we investigated 80 women aged 39-53 years who had lost their sons in the Artsakh war (group A), and 78 women (group B, Control) of the same age who had never had children. IVF procedures were conducted for all of them between 2021 and 2023. Both groups were divided into two subgroups based on age (advanced – 39-44; very advanced – 45-53) and the type of oocyte used (autologous or heterologous). X2 (Chi-square) and Mann-Whitney non-parametric statistical tests were employed to assess differences between the two groups.

Results: There was no statistically significant difference in the cumulative pregnancy rate between the two groups (27.9% vs. 25%, p>0.05). In subgroups utilizing donor oocytes, pregnancy rates were significantly higher in women of advanced age compared to those of very advanced age (48% vs. 37%, p<0.05). The average time to pregnancy (13.5 vs. 8.57 months) and miscarriage rate (30% vs. 21%) were significantly higher in the group of women who lost their child during the war.

Conclusion: Families who lost their sons during the war even with very advanced age can achieve a good success rate through ART. Further studies are required to better understand the impact of post-war trauma on the reproductive characteristics of these families. Governmental financial assistance presents an unprecedented opportunity for these couples to overcome their tragedy and establish a new foundation for their families.