Перспективні методи лікування передчасної недостатності яєчників

Abstract

Premature ovarian failure (PОF) in women under 40 is a medical condition in which ovarian follicles are exhausted and cease to function normally as both reproductive and endocrine organs. This condition often leads to infertility because it is associated with hypoestrogenia, which causes menstrual irregularities and pregnancy failure. Decreased estrogen secretion also causes many menopausal symptoms, such as hot flashes, night sweats, and insomnia. In addition, the longterm consequences of POF increase the risk of lifelong skeletal vulnerability and cardiovascular as well as neurocognitive disorders. The purpose of the work is to collect, analyze and summarize data from recent years about promising methods of treatment of premature ovarian failure, namely about autologous ovarian tissue transplantation, creation of artificial ovaries and oocytes, treatment with iron nanoparticles, intraovarian injections of autolytic platelet-rich plasma. It should be noted that premature ovarian failure (POF) differs from menopause in that ovarian failure may not be permanent; in such patients with POF, pregnancy is spontaneous and occurs infrequently. Our analysis and summarization of data from recent years suggests that 1) because autologous ovarian tissue transplantation requires tissue collection, this method is generally applicable to a specific patient group, women who are expected to have ovarian failure after cancer therapy, and a group of patients who experience gamete depletion as a result of a prognosis or even a diagnosis of POF. Ovarian tissue transplantation, which has been known for two decades, still has significant risks and technical limitations and is not recognized as a reliable method in clinical practice. 2) the concept of "artificial ovary" remains at the stage of experimental development of cellular systems in animals. Whereas, by creating artificial oocytes from several different sources (cell types), live birth has already been achieved in animals. And expectations are aimed at a steady progression to their clinical use in humans. 3) the use of zero-valent iron nanoparticles under the conditions of experimental immune complex failure has a certain corrective effect on the disorder of ovarian function. There is reason to believe that the effect of the treatment with zero-valent iron nanoparticles is fundamentally different from the macroscopic one in the effects on cells and, apparently, in the mechanisms of action - which requires further study. 4) treatment with platelet-rich plasma (PRP) remains an invasive ultrasound-guided procedure with risks that are not yet fully understood. At this point, PRP should still be considered an experimental procedure for patients with POF (premature ovarian failure). It is relevant to continue research on the influence of PRP components on the ovary, to evaluate the effect of the PRP concentration, which could play a key role in the proliferation and differentiation of mesenchymal cells; and to establish the optimal time intervals between PRP procedures, the volume treatment, and the maximum and minimum number of such procedures. In general, the proposed promising methods (autologous ovarian tissue transplantation, creation of artificial ovaries and oocytes, use of nanomaterials (iron nanoparticles), intraovarian injections of autolytic platelet-rich plasma) are achievements in biomedical engineering aimed at overcoming infertility, associated with premature ovarian failure.