Vol 21, No 4 (2019)


The role of the growth hormone in assisted reproductive technologies cycles

Romanov A.Y., Syrkasheva A.G., Dolgushina N.V., Kalinina E.A.


The paper analyzes the literature data on the use of the growth hormone (GH) in ovarian stimulation in assisted reproductive technologies (ART). Routine use of GH in ovarian stimulation in patients with a normal GH level does not increase pregnancy and childbirth rates in ART. Also, no benefits of using GH have been identified for patients with polycystic ovary syndrome, despite the increase in insulin and IGF-1 blood levels. The main research focus is to study the use of GH in patients with poor ovarian response. According to the meta-analysis conducted by X.-L. Li et al. (2017), GH in ovarian stimulation of poor ovarian responders increases the number of received oocytes, mature oocytes number, reduces the embryo transfer cancellation rate and does not affect the fertilization rate. The pregnancy and live birth rates are significantly higher in the group of GH use - by 1.65 (95% CI 1.23-2.22) and 1.73 (95% CI 1.25-2.40) times, respectively. Thus, it is advisable to use GH in ovarian stimulation in poor ovarian responders, since it allows to increases live birth rate in ART. However, further studies should determine the optimal GH dose and assesse it`s safety in ART programs.
Gynecology. 2019;21(4):6-8
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Features of seminal plasma cytokine profile and an occurrence of pregnancy when carrying out a program of assisted reproductive technologies

Dontsova T.V., Babayan A.A., Nikolaeva M.A., Arefieva A.S., Kalinina E.A., Krechetova L.V.


Aim. To asses an effectiveness of assisted reproductive technologies (ART) program given characteristics of the cytokine profile of seminal plasma (SP) entering the female reproductive tract during sexual intercourse. Outcomes and methods. 33 married couples who applied for a treatment of infertility by means of in vitro fertilization /ICSI (Intracytoplasmic Sperm Injection) were included in the prospective study. Patients were recommended to have sexual intercourse with no restrictions during treatment and to have the last sexual intercourse 3 days before an intended transvaginal puncture (ITP). Testing of cytokines (transforming growth factor (TGF)-b1, interferon (IFN)-g, interleukin (IL)-33, IL-6, IL-8, IL-23, IL-10, tumor necrosis factor (TNF)-a, IL-18, IL- 17A, IFN-a, IL-12, monocyte chemotactic protein-1) levels in samples of partners’ SP obtained on the day having ITP were carried out using multiplex analysis with LegendPlex kits (BioLegend, USA). Results. When comparing a cytokine profile of SP in couples who did not become pregnant (n=25) and couples who become pregnant (n=8) increased IL-18 and reduced IL-10 levels (p=0,017 and p=0, 01 respectively) were revealed in the group which got pregnant. To assess a clinical relevance of cytokine content in SP ROC (Receiver Operating Characteristics) curve was used. It was established that determining of IL-18 concentration in SP has the greatest diagnostic significance (the area under a curve was 0.792±0.107, test sensitivity - 62.5%, test specificity - 95.24% at threshold concentration>210.43 pg/ml). Incidence of pregnancy at IL-18 concentration above threshold levels was 83,3% while at lower concentrations of IL-18 pregnancy occurred only in 13.0% of women. Conclusions. Elevated IL-18 levels and decreased IL-10 levels in SP of female patients’ partners who don’t have restriction of sexual life when treating infertility with ART are favorable factors for a pregnancy to occur.
Gynecology. 2019;21(4):9-13
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Differential diagnosis of various forms of functional hypothalamic amenorrhea

Gusev D.V., Kuznetsov S.Y., Ivanets T.Y., Chernukha G.E.


Aim. To investigate the usefulness of differential diagnostic criteria of functional hypothalamic amenorrhea (FHA) related to energy deficiency and stress. Materials and methods. There were provided clinical and laboratory examination of 56 patients with FHA associated with stressful events (group 1) and 64 patients with FHA on the background of eating disorders (group 2), including assessment of adipose tissue, determination of leptin level, adipose tissue index and differential index. Results. Patients of group 2 were distinguished by a more significant deficiency of body mass index, total body fat, and leptin levels in comparison with patients of group 1. The differential index [AUC=0.907 (0.84-0.97)] turned out to be the most informative indicator in the differential diagnosis of various forms of FHA, its threshold value was 21.4, the least informative - body mass index [AUC=0.78 (0.71-0.87)]. Conclusion. The differential index can be considered as an informative differential diagnostic criterion for various forms of FHA.
Gynecology. 2019;21(4):14-18
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Evaluation of the effectiveness of adjuvant anti-progestogen therapy after conservative myomectomy in women of reproductive age

Lebedeva Y.A., Kovalenko I.I., Molchanov O.L., Baibuz D.V., Kulikova N.V.


Relevance. Due to the high prevalence of uterine fibroids in young women and the possible effect on reproductive potential, the development, implementation and application of the most benign treatment methods are a priority. Aim. To evaluate the effectiveness of adjuvant anti-progestogen therapy after conservative myomectomy in women of reproductive age. Materials and methods. A comparative analysis of the results of treatment of patients of reproductive age with uterine myoma has been carried out. Group 1 (n=38) included patients who underwent conservative myomectomy and/or hysteroresectoscopy without subsequent anti-relapse drug therapy. The average age is 31.5 years (4.6). Group 2 (n=43) included patients after conservative myomectomy who received mifepristone as anti-relapse therapy after surgery. The average age is 31.9 years (4.5). Results. Mifepristone therapy, as an adjuvant treatment after conservative myomectomy, can significantly reduce the risk of recurrence, stabilize the size of the uterus, reduce the severity of clinical manifestations in the form of pain syndrome and heavy menstruation associated with relapse, thereby improving the reproductive health of women. Conclusions. The use of adjuvant anti-progestogen therapy after conservative myomectomy in women of reproductive age is a very effective method for treating uterine fibroids and can be considered as a therapy of choice in such patients.
Gynecology. 2019;21(4):19-23
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Experience of conservative treatment of genital prolapse with urogynecological pessaries

Yarin G.Y., Vilgelmi I.A., Liuft E.V.


Background. Pelvic organ prolapse is one of the most common women's diseases worldwide. Genital prolapse incidence among women over 50 is on average 41%. There are variety methods for genital prolapse treatment; they are divided into surgical and non-surgical ones. One of the conservative treatment methods is a use of pessaries. According to different studies an efficacy of pessary therapy is approximately 60%. Aim to estimate a safety and efficacy of genital prolapse conservative treatment with a cube pessary on the basis on standardized questionnaires. Outcomes and methods. In ANO “NRITO Clinic” Urology and Gynecology Center 26 women with various degree genital prolapse were treated with pessary within the period from August 2015 to March 2016. Efficacy of pessaries use, patient satisfaction with this treatment method and complications rate were estimated. Results. Urogynecological cube pessary use in a treatment of various types of genital prolapse is quite an effective method (p<0.05). Conclusions. Further studies are required to determine a safety and efficacy of long-term pessary therapy.
Gynecology. 2019;21(4):24-26
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Late reproductive age and modern technology

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Gynecology. 2019;21(4):27-32
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Workplace factors and reproductive health: causation and occupational risks assessment

Babanov S.A., Strizhakov L.A., Agarkova I.A., Tezikov Y.V., Lipatov I.S.


Background. Exposure to physical and chemical work-related hazards can lead to an impairment of reproductive function, gynecological diseases and a pregnancy course worsening. Aim to determine methods of prevention and treatment of occupational disorders of the reproductive system in women and men who deals with harmful labour conditions. Outcomes and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-15 years was conducted. The review includes articles from peer-reviewed literature. Results. Evaluation of a relationship and its degree between a reproductive system diseases and workplace conditions showed that women working in harmful conditions (class 3.1-3.3) had complications of pregnancy and childbirth disorders which were to a high or medium degree related to their labour conditions. Newborns’ health disorders were assessed as a category of very high degree relationships with the mother’s work. Thus the fact that maternal occupational risks induce a child’s health disorders can be considered as fundamentally proven. This study data showed that occupations of high risk of a reproductive health disorders include female workers who work in conditions of class 3 of the 2nd degree of harm. Conclusions. Obstetrician-gynecologists, occupational physicians who work as part of medical commissions for preliminary and periodic medical examinations as well as obstetrician-gynecologists who deals with women of reproductive age in women’s consultation clinic and reproductive health centers (including those planning childbearing) need to make decisions strictly according to legal and regulatory acts on health protection of employees who work under arduous and harmful labour conditions, and above all to consider on maintenance of their reproductive function.
Gynecology. 2019;21(4):33-43
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Vitamin-mineral complexes as a protector of obstetric and perinatal complications (review of literature)

Pestrikova T.Y., Yurasova E.A.


Relevance. Despite the achievements of modern medicine, the problem of reducing complications of the gestational period and perinatal outcomes still does not lose its relevance. Lack of security and/or unbalanced consumption of vital micronutrients are factors of constant negative impact on health, growth, development and formation of organs and systemogenesis in all age periods. Unbalanced nutrition, in particular vitamin deficiency conditions, is considered by the World Health Organization as a problem of starvation, which has a direct impact on the incidence and mortality of the population. Aim. Analysis of literary sources to identify the effect of vitamin-mineral complexes on pregnancy and perinatal outcomes. Materials and methods. To write this review, we searched for domestic and foreign publications in Russian and international search engines (PubMed, eLibrary, etc.) over the past 30 years. The review included articles from peer-reviewed literature. Results. The review addresses balanced nutrition for pregnant women who receive close attention throughout the world. The optimal provision of vitamins and minerals for women during the gestational period, when the need for essential micronutrients is significantly increased, is a prerequisite for the physiological course of pregnancy and the full development of the fetus. This is especially important in the conditions of the northern and equivalent territories. The need for vitamins in women during pregnancy and lactation increases by 1.5 times, due to the intensive work of the endocrine system of women, the transfer of some nutrients to the fetus. Deficiency of certain vitamins is a risk factor for the development of birth defects, premature birth, and the birth of children with low body weight. Conclusions. The domestic combined vitamin-mineral preparation with micro and macro elements was created specifically taking into account the changing needs of the woman’s body for vitamins and minerals at different stages of pregnancy. Compatibility of components in 1 tablet is provided by special production technology.
Gynecology. 2019;21(4):44-50
pages 44-50 views

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