Hypoandrogenism and reproductive function — a problem-oriented approach to pregnancy planning. Literature review

Abstract

The author considers pre‑pregnancy care program in women with endocrine imbalances as a complex problem that requires involvement of a multidisciplinary team of doctors in the examination process, including endocrinologists, therapists, gastroenterologists, and if needed, immunologists, nutritionists and hematologists. This approach is stipulated by the frequency of accompanying somatic pathology and the burdened obstetric and gynecological history of such women, in particular, menstrual cycle disorders, infertility, miscarriage, spontaneous abortions, a high percentage of hyperplastic diseases and inflammatory processes of the female genitalia. Disorders of hormonal homeostasis in women with endocrinopathies result in the pro‑inflammatory orientation of their immunity, oxidative stress, which disrupts both the folliculogenesis process and leads to metabolic and morphological changes in the receptor organs of both the female genitalia and other organs of the endocrine system (thyroid gland, adrenal glands), forming a vicious cycle of pathological processes in the endocrine balance of female steroids, which, in turn, is accompanied by disturbances in the homeostasis system of the entire organism. Based on the literature data, the authors made conclusions about the stages of examination of women with hypoandrogenism in the pre‑gravid stage. Speaking about natural pregnancy, the first stage, according to the authors, is to determine the main location of the pathology — the central mechanism (disruption of the hypothalamic‑pituitary‑ovarian‑thyroid‑adrenal chain), genetic enzymatic polymorphisms, deficiency/insufficiency of vitamin D and their elimination. At the second stage, there is a need to determine the state of organs — receptors (endometrium, endocervical glands, vaginal epithelium), the state of detoxification organs and their correction. The third stage is to ensure conditions for full‑fledged ovulation and transport of gametes. The fourth stage is early pregnancy support, prevention, early diagnosis and treatment of vaginal infections. The pregnant woman is monitored together with a specialist in the detected comorbid pathology (geneticist, hematologist, gastroenterologist, therapist, endocrinologist, psychotherapist, etc.). Further research is needed to develop a clear algorithm for pre‑pregnancy care program in women with hypoandrogenism depending on reproductive age, obstetrical and gynecological history, methods of overcoming infertility.