Outcomes in poor responders treated with in vitro fertilization/intracytoplasmic sperm injection according to bologna criteria

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:47-50
时间:2019-12
作者:V. N. Lokshin, R. K. Valiev, A. N. Rybina, K. T. Nigmetova, Sh. K. Karibayeva
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Purpose of the study was to evaluate the effectiveness of various approaches of artificial reproductive technologies (ART) in advanced maternal age patients with poor ovarian response (POR). Materials and methods. This is retrospective cohort study of 455 patients with POR who have undergone an IVF and embryo transfer program at from June 2016 to June 2018. Researchers evaluated pregnancy rate (PR) per embryo transferand live birth rate (LBR) per embryo transferas in vitro fertilization (IVF) outcomes. The patients fulfilled Bologna criteria were divided into 5 groups: long protocol, ant-gonadotropin-releasing hormone protocol, freeze embryos transfer without preimplantation genetic diagnostic (PGS), freeze embryos transfer with PGS, natural cycle. Results. There was no statistically significant difference in the age, Anti-Müllerian hormone level and duration of infertility between the groups. Despite different protocols of ovarian stimulation, there was no statistically significant difference in pregnancy rate in fresh cycles. At the same time, cancellation of transfer was significantly higher observed in natural cycles (p <0.001). PR and LBR were statistically significant higher in freeze embryo transfer group 29% and 12.1% vs 13.3% and 5,5% respectively (p<0.001 and p = 0.040). During the transfer of the embryo unexamined by PGS and after PGS the pregnancy rate did not differ (29.4% vs 28.2%, p <0.05), but LBR was statistically significant higher after euploid embryo transfer (8.2% without PGS vs 20.5% after PGS, p = 0.028). Conclusion. The most effective approach in patients with a poor ovarian response was cycle segmentation, cryopreservation of embryos, PGS and transfer of an euploid embryo. This category of patients requires a personalized approach to the treatment of infertility. The choice of protocol in ART program must be carried out with the full voluntary and informed consent of the patient, depending on their desires and capabilities, including financial.

State of the pheto-placenteral complex in pregnant women with obstetric pathology and burdened reproductive history

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:50-53
时间:2019-12
作者:Н. П. Гончарук
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Purpose of the study. To study the fetoplacental system (FPS) status in women with obstetric pathology and a burdened reproductive history. Materials and methods. The study included 500 pregnant women who were divided into four groups: I – 150 women with an uterus scar, II – 150 women after assisted reproductive technologies, III – 150 women with anomalies in labor, 0 – 50 healthy pregnant women without obstetric pathology and without burdened reproductive history. The level of PPS hormones was determined in serum, depending on type of obstetric pathology and characteristics of the reproductive history. The study of hormonal indicators was carried out in the pregnancy dynamics. Fetus state was evaluated with a cardiotocographic study. Results. Increase in placental lactogen level was observed in the pregnancy dynamics in women with obstetric pathology and a burdened reproductive history, but its growth in 21–30 and 31–40 weeks was less than in pregnant women without obstetric pathology and without a burdened reproductive history. Dynamics of the estriol and estradiol levels in the blood in all groups in the gestational age of 21–30 weeks was characterized by approximately the same levels of decrease compared with healthy pregnant women without obstetric complications. Decrease in progesterone secretion was observed in all pregnant women with obstetric pathology and burdened reproductive history. Dynamics of it level in the blood serum during pregnancy up to 20 weeks, 21–30 weeks and 31–40 weeks showed a decrease. This is a reflection of changes in the PPS state in general and leads to fetus deterioration. Conclusions. There is a feto-placental insufficiency in pregnant women with obstetric pathology and with a burdened reproductive history that is manifested by inhibition of the hormonal function of the feto-placental complex and proceeds against the background of fetal heart rate changes. Identified changes require the preventive and therapeutic measures aimed at correcting the fetus impaired condition and changes in FPS

Black cohosh (Cimicifuga racemosa) is a non-estrogenic alternative to hormone replacement therapy

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:72-81
时间:2019-5
作者:В. Вуттке, Д. Зайдлова-Вуттке
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Hormone replacement therapy is still a popular and most effective treatment for vasomotor symptoms and bone loss prevention in the postmenopause but it is not without risks. This has driven many climacteric women to seek for alternatives, chiefly natural products. Phytoestrogens containing soy or red clover preparations, however, when taken at the recommended daily doses, proved to be ineffective to ameliorate climacteric complaints and to prevent osteoporosis. Cimicifuga racemosa (CR) preparations, on the other hand, have been shown to ease climacteric distress. CR extracts are traditionally used to ease climacteric complaints and a number of double-blind placebo-controlled studies have demonstrated this effect. Low or intermediate doses, however, are more effective than high doses. CR extracts do not contain estrogenic compounds: they exert their efficacy through mechanisms linked to the presence of dopaminergic, noradrenergic, serotoninergic and GABA-ergic acting substances, but no estrogenic activity can be expected. There is a widespread, but false, belief that the efficacy of CR preparations is linked to the presence of phytoestrogens in the plant. This review aims at summarizing the available in vitro and in vivo evidence showing that compounds in CR extracts do not bind to oestrogen receptors and thus do not exert any estrogenic effects in the uterus and mammary gland, as shown in vivo in experiments on ovariectomized rats and clinically in postmenopausal women. Studies in ovariectomized rats and in women suffering from climacteric complaints have indicated that substances with neurotransmitter-like activities affect beneficially postmenopausal symptoms such as hot flushes. Some of these compounds, such as triterpenes with GABA-ergic activity and a serotonin analogue, are present and have been identified in the CR extracts. Authors conclude that these activities explain most likely the beneficial effects of CR extracts on climacteric complaints.

Efficiency of the D-chiro-inositol for the polycystic ovary syndrome

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:57-62
时间:2019-4
作者:Т. Л. Архипкина, Л. П. Любимова
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Polycystic ovary syndrome (PCOS) is a common endocrine disorder that develops in 10–15% of reproductive aged women. Over the past two decades, the inositol effectiveness in normalizing the clinical and hormonal disorders associated with PCOS has been actively studied. Inositol and its stereoisomers are classified as insulin sensitizers and act as a second conductor for insulin transmission routes. Myo-inositol and D-chiro-inositol are two of the nine existing stereoisomers the most studied currently, which play an important role in the PCOS physiology and treatment. The aim of the study was to study the Protalis effectiveness in patients with PCOS. 40 women with PCOS (mean age 24.4 ± 0.8 years) who were resistant to previous treatment with clomiphene citrate were examined. Protalis was administered for three months, after the end of the drug intake clomiphene citrate was used according to the standard regimen to restore fertility. The levels of luteinizing hormone, follicle-stimulating hormone, sex hormone binding globulin, total testosterone, antiMullerian hormone, homocysteine, folic acid were determined, and free androgen index was calculated. Fasting insulin was tested in serum and 120 minutes after the glucose load, the HOMA-IR was calculated, and lipid metabolism parameters were studied. Monotherapy with Protalis normalized the menstrual cycle in 52.5%, restore ovulation in 40%, contributed to the pregnancy in 7.5% patients with PCOS, in combination with clomiphene citrate in 27.5% women previously resistant to clomiphene. No changes in body mass index, waist circumference/hip circumference or hirsutism were found. A decrease in hyperandrogenism due to a testosterone decrease and an sex hormone binding globulin increase was found, the carbohydrate, lipid metabolism, and folate status improved. Protalis monotherapy can be recommended for patients with PCOS as a preliminary preparation, potentiating the clomiphene citrate effects, on the background insulin resistance. It is advisable to consider the Protalis use in combination with drugs for standard treatment of PCOS.

Morphofunctional changes of the pelvic organs under conditions of stress urinary incontinence and experimental vaginal prolapse

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:8-13
时间:2019-4
作者:T. F. Tatarchuk, O. О. Yefimenko, V. S. Shkolnikov
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Objective of the study was to analyze the particulars of morphofunctional changes in pelvic organs under conditions of stress urinary incontinence and experimental vaginal prolapse. Materials and methods. The experimental studies were conducted on 50 sexually mature white female rats divided into three groups. The first control group consisted of intact animals; the 2-nd group consisted of animals with replicated stress urinary incontinence model; and the 3-rd group consisted of animals with a combined model, in which, after replication of the stress urinary incontinence model, the vaginal vault fixation to sacro-uterine ligaments was broken, thus causing vaginal prolapse. After withdrawal of animals from the experiment, histological studies of bladder, urethra and vulva were carried out. Study results. After replication of the stress urinary incontinence and vaginal prolapse model, the destructive processes in the mucous membranes of the bladder, urethra, and vulva were developing, the volume of connective tissue in muscle membranes was increasing, the collagen fibers were thickening, and one could observe changes thereof with manifestations of destruction within a 30-day period. A combination of these processes led to an alteration of histoarchitectonics and the muscle ratio and connective tissues in membranes covering the study organs in both groups. Pathological changes accompanied by structural rebuild of bladder, urethra, and vulva tissues were more pronounced in the combined model. Conclusions. Replication of the stress urinary incontinence model in the bladder of female rats caused an overactive state of the above, while the muscle membranes of urethra and vulva became moderately atonic. The combined stress urinary incontinence and vaginal prolapse model used by us was successfully replicated in all animals of the experimental group, which was confirmed by morphofunctional changes in the bladder, urethra and vulva tissues. Functional changes dominated in animals with the stress urinary incontinence model. The animals with a combined stress urinary incontinence and vaginal prolapse model presented with functional changes predominantly observed on day 14, and changes in the histoarchitectonics of the study organs on day 30. Replication of the combined stress urinary incontinence + vaginal prolapse model resulted in swelling of the vulva tissues, accompanied by growth and consolidation of collagen fiber bundles, muscular and mucosal membranes atrophy, and decreased quantity of microcirculatory bed vessels. Pathological changes in structural elements of the vulva after application of the combined model suggested a trophic disturbance, which was confirmed by a decrease in the density of capillaries by 34.24% and fibrosis of arteriolar membranes.

Reproductive health and pregnancy problems of systemic lupus erythematosus

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:56-64
时间:2019-12
作者:И. Ю. Головач, Е. Д. Егудина
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Nowadays, the majority of young women with systemic lupus erythematosus (SLE) can successfully become pregnant, carry pregnancy to term and give birth to a healthy child due to improved therapeutic approaches and consequently reduction in morbidity and mortality. Pregnancy outcomes in these women have also improved significantly over the past decades. Correct timing of conception (taking into account disease activity and target organ damage), careful monitoring of patients for three trimesters and the postpartum period (to timely identify and treat possible obstetric complications or maternal disease flares), as well as the concept of multidisciplinary management, are currently the main points of SLE patients of reproductive age. Growing knowledge about the compatibility of drugs with pregnancy has improved treatment approaches for these patients, which allows controlling maternal disease without harming the fetus. Particular attention and strict monitoring should be dedicated to SLE pregnant women in particular clinical settings: patients with lupus nephritis, patients with a positive titer of antiphospholipid antibodies, antiphospholipid syndrome, and patients with Ro/SSA and/or La/SSB antibodies. Family planning discussions and contraceptive counseling should be part of everyday practice for doctors who observe women with SLE at reproductive age. Another problem is the possible decrease in fertility in these women, which may be due to different reasons. As a result, in recent years, the demand for assisted reproduction methods has increased, so rheumatologists and gynecologists should be ready to advise patients with SLE in this situation. This literature review is based on the evidence-based recommendations on family planning management and women's health issues in SLE and/or antiphospholipid syndrome developed by a multidisciplinary group of experts of the European League Against Rheumatism in 2017.

The state of the fibrinolytic system in HIV-infected pregnant women and parturient women with thrombohemorrhagic risk factors

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:47-50
时间:2020-3
作者:С. Є. Савченко, О. І. Гервазюк, Л. М. Онищик, Ю. С. Мудра, Г. Б. Бойко
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Purpose of the study: to explore the status of the fibrinolytic system in HIV-infected pregnant women and parturient women. Materials and methods. 120 HIV-positive pregnant women with risk factors of thrombohemorrhagic complications were examined. The main group included: IA-O subgroup – 10 patients with HIV-infection stage I who received high-activity antiretroviral therapy before this pregnancy, IB-O subgroup – 20 patients with HIV-infection stage I who started high-activity antiretroviral therapy during this pregnancy, II-O – 21 pregnant women with HIV infection II clinical stage, III-O subgroup – 24 women with HIV-infection III clinical stage. Comparison group consisted of 45 patients with HIV infection without thrombohemorrhagic complications; control group consisted of 40 pregnant women and parturient women without HIV. D-dimer, soluble fibrin-monomer complexes, antithrombin III and XIIa-dependent fibrinolysis time were evaluated. Study results. In II-O and III-O subgroups there were changes of fibrinolytic system state in 18–22 weeks of pregnancy – increased D-dimer and soluble fibrin-monomer complexes, XIIa-dependent fibrinolysis time prolongation and antithrombin III decreased. With pregnancy progression the main group with HIV stage III showed a significant increase of soluble fibrin-monomer complexes and D-dimer with a tendency to XIIa-dependent fibrinolysis time reduction and antithrombin III decreasing. In all women of the main group there were thrombosis signs. In subgroup III-O there were laboratory signs of fibrinolysis activation (shortening the time of XIIa-dependent fibrinolysis) and a tendency to antithrombin III decrease. Parturient women who started taking high-activity antiretroviral therapy during this pregnancy show a slowing of the fibrinolysis processes (shortening of XIIa-dependent fibrinolysis) and a tendency to antithrombin III decrease. In IB-O subgroup there was a further suppression of fibrinolysis (prolonging the time of XIIa-dependent fibrinolysis). Conclusions. Changes in the fibrinolytic system toward suppression of the fibrinolysis process during pregnancy and it activation during labor are significantly present in HIV-infected pregnant women and in women with risk factors for thrombogemorrhagic complications.

Morphological capability of the uterine scar after the previous caesarean section

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:42-46
时间:2020-3
作者:Н. Р. Ковида, Н. П. Гончарук, О. О. Дядик
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Purpose of the study was analysis the particulars of morphological capability of the uterine scar after the previous Caesarean section. Materials and methods. The paper presents the data of morphological study of 100 fragments of uterine scar tissue, which were divided into two groups on clinical grounds. The first group included 50 fragments of the so-called “clinically capable” scars, and the second group included 50 fragments so-called “clinically incapable” scars. Assessment of the uterine scar tissue was performed by immunohistochemical study with monoclonal antibodies, as well as Van Gieson's and Masson's stain. Study results. More pronounced structural changes of the actual muscle fibers and microcirculatory disorders were observed in form of changes in architecture and areas of myometrium tissue homogenization in the group with “clinically incapable” scars using hematoxylin and eosin stain of the uterine scar tissue. In the differentiation of fibrous connective tissue using Van Gieson's stain method in the group of "clinically incapable" scars were manifested as replacement of muscular tissue with connective tissue with the formation of discrete muscular tissue fibers, and expressed perivascular fibrosis. Degenerative-ischemic changes of uterine scar tissue were found in the group of “clinically incapable” scars using immunohistochemical study with monoclonal antibodies to α-SMA. Pathomorphological study of the uterus scar revealed that hypoxic-degenerative changes and irregularity of maturation of collagen tissue, as well as pronounced replacement of muscle tissue with connective tissue with formation of separately immersed fibers of muscle tissue took place in the “clinically incapable” group. Immunohistochemical study with monoclonal antibodies to α-SMA and to CD31 revealed the more pronounced degenerative ischemic changes in the “clinically incapable” group. Conclusions. The revealed changes in the structure of the uterine scar tissue indicate that the state of myometrium, vascular component, regenerative capacity in the “clinically incapable” group on 43.4% worse than in the “clinically capable” group, and may manifest negatively with excessive functional loading of the uterine wall during pregnancy and childbirth.

Place of endocrine-metabolic disorders in the development of endometrium pathology in climacteric women

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:8-11
时间:2019-12
作者:Н. В. Косей, О. В. Занько, С. І. Регеда, О. О. Єфіменко
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] The results of a large number of studies indicate that the incidence of malignant transformation of hyperplasia endometrium increases significantly with age. Important in predicting the likelihood of hyperproliferative endometrial disease in postmenopausal women is a clear understanding of the causative factors that lead to pathological endometrium proliferation in the period of physiological decline of hormonal activity. Purpose of the study. To investigate the frequency and structure of somatic morbidity in women with hyperproliferative endometrial diseases in postmenopause and to determine the place of endocrine and metabolic disorders in the hyperproliferative pathology of endometrium development in this category of women. Materials and methods. Frequency and structure of extragenital morbidity, state of carbohydrate metabolism, lipid metabolism, leptin, estrone, prolactin, sex steroid binding protein, thyroid stimulating hormone and thyroxine levels we analyzed in 98 postmenopausal patients with morphologically confirmed forms of hyperproliferative pathology of endometrium (83 patients with endometrial polyps, 8 women with endometrial hyperplasia without atypia, 7 women with endometrial hypertension with atypia), and in 30 postmenopausal women with no changes in endometrium. Study results. Patients with hyperproliferative diseases had a higher incidence of dyslipidemia (64.28 vs. 20%), obesity (43.87 vs. 6.6%), arterial hypertension (40.81 vs. 26.6%), hypothyroidism (34.69 vs. 10%), and type 2 diabetes mellitus (18.36 vs. 3.3%) than in the control group (р <0,05). Average levels of estrone, leptin, HOMA index were also higher, and sex hormone binding globulin level was lower. Conclusions. Postmenopausal women with hyperproliferative endometrial diseases are characterized by elevated levels of extragenital morbidity and metabolic disturbances that are more common in women with endometrial hyperplasia with/without endometrial atypia than in women with endometrial polyps. Therefore timely diagnosis and treatment of endocrine-metabolic disorders will help to reduce the hyperproliferative pathology of endometrium in postmenopausal women.

The role of vaginal microflora in the genesis of miscarriage

出版物:Reproduktivnaâ Èndokrinologiâ
出版商:Publishing House TRILIST
期数:Volume.0
页码:22-28
时间:2019-4
作者:О. А. Ночвіна
ISSN:2309-4117, 2411-1295
0.1 专否指数
医学
[摘要] Microbiocenosis plays an important role in maintaining homeostasis and is an essential component of the homeostatic system due to its participation in the immunological and endocrine regulation. As an organism’s microflora is a functional complex for supporting homeostasis due to metabolic activity and quantitative relationships, which not only directly affects the immunological status, but also indirectly impacts the reproductive system, the imbalance of the vaginal flora is considered as one of the important causes of a complicated pregnancy. The aim of the study was to evaluate the vaginal microbiocenosis in women with complicated pregnancy and to study the effectiveness of the treatment scheme with using natural micronized progesterone Urozhestan® and the vaginal probiotic Lactoginal®LP for threatened miscarriage against the background of bacterial vaginosis. 67 pregnant women with complicated pregnancy up to 22 weeks of gestation prospectively were examined. Clinical signs of threatening miscarriage were aching pain in the lower abdomen with hemorrhagic secretions from the genital tract and without them, signs of myometrial hypertonus with ultrasound with retrochorial hematoma and without it, shortening of the cervix with the opening of the internal pharynx and cervical canal and without them. The effectiveness of the vaginal microbiocenosis correction was determined by assessing the dynamics of clinical symptoms and the quantitative and qualitative composition of the vaginal biotope. It is proved that in in 70.1% patients with a threatened miscarriage changes in the vaginal biotope in the form of bacterial vaginosis are observed. Analysis of the clinical manifestations of the threatened miscarriage against the prescribed treatment has shown positive dynamics. The presented study results prove the effectiveness of the Lactoginal®LP in combination with natural micronized progesterone Utrogestan® in women with threatened miscarriage against the background of bacterial vaginosis. The frequency of vaginal probiotics use and the possibility of choosing the administration route for progestogen simplifying and individualizing treatment regimens.

1 2 3 4 5 6 7 下一页