External Genital Endometriosis Research Articles

Changes in the level of anti-inflammatory and pro-inflammatory cytokines in patients with external genital endometriosis (literature review)

Changes in the level of anti-inflammatory and pro-inflammatory cytokines in patients with external genital endometriosis (literature review)

Correlation between MR semiotics and intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment

Objective. To identify the correlation between magnetic resonance (MR) semiotics and the intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment. Material and methods. We performed a retro- and prospective analysis of MR studies of pelvic organs in 77 female patients with pelvic pain syndrome, aged from 24 to 39 years. We assessed the intensity of the pain syndrome using a visual analog scale (VAS). The patients were divided into 2 groups: 1st-patients with external genital endometriosis (EGE) without involving the posterior pelvic compartment, 2nd-patients with EGE of the posterior pelvic compartment. The patients of the second group were divided into subgroups: 1 – endometriosis of the posterior pelvic compartment without MR signs of intestinal wall invasion, 2 – posterior compartment endometriosis with MR signs of intestinal wall invasion. The study was conducted on a GE Signa 1.5 Tesla MRI scanner. Results. In the second group of patients with endometriosis of the posterior pelvic compartment, the pain syndrome (8.00 (7.00–9.00) was more intense than in the first group of patients without endometriosis of the posterior pelvic compartment 7.00 (5.00–7.00), p<0.001 and we evaluated a retrovaginal, retrocervical and posterior uterine localization. In the second subgroup of patients with signs of the intestinal wall invasion, the pelvic pain syndrome on the VAS was statistically significantly more intense 8.00 (8.00-10.00) than in the first subgroup of patients without signs of the intestinal wall invasion 7.00 (6.00–7.00) (P<0.001). Conclusion. Patients with identified deep infiltrating endometriosis of the posterior pelvic compartment have more pronounced manifestations of the pelvic pain syndrome then patients with endometriosis of other localizations.

Assessment of the rehabilitation programs effectiveness in patients with painful external genital endometriosis

In patients with a painful form of external genital endometriosis (EGE), the prevailing symptom is chronic pelvic pain, which significantly reduces the quality of life (QoL). It causes disorders of the physical, psycho-emotional and sexual health of women of reproductive age, leading to distress, maladaptation, anxiety-depressive disorders, disruption of social functioning and family relationships. Objective. To evaluate the effectiveness of the rehabilitation program for women with a painful form of EGE after radical treatment in the rehabilitation period. Materials and methods. In the examined cohort were included a total of 104 patients of reproductive age 42.4±3.7 years with a painful form of EGE after radical treatment: Group 1 – 49 women with "active" rehabilitation; Group 2 – 55 patients with "passive" rehabilitation tactics in accordance with standards and National Clinical Guidelines. Integral assessment of QoL (objective) was performed using clinical, laboratory (cancer antigen-125 (CA-125), cancer antigen-19.9 (CA-19.9), interleukin-6 (IL-6), tumor necrosis factor (TNF), femoflor – 16, pH-metric titration), and instrumental studies (ultrasound, magnetic resonance imaging (MRI)). At the control points: before, in 5–9 days, 1,3,6 and 12 months after surgical treatment. Results. Patients with "active" rehabilitation tactics (Group 1) had a significantly more pronounced decrease in the levels of the assessed biomarkers in blood serum, normalization of the urogenital tract microbiocenosis and restoration of pelvic organs and structures, unlike patients in the comparison group. Conclusion. The use of comprehensive personalized rehabilitation in patients with painful form of EGE after radical treatment has demonstrated its effectiveness. Widespread introduction of rehabilitation programs into routine clinical practice is necessary.

DETERMINATION OF IL-1β mRNA GENE EXPRESSION AND HMGB-1 mRNA GENE EXPRESSION IN WOMEN WITH GENITAL ENDOMETRIOSIS ASSOCIATED WITH INFERTILITY AT THE STAGE OF PREPARATION FOR ASSISTED REPRODUCTIVE TECHNOLOGIES

Despite the large number of studies on the identification and search for noninvasive early diagnostic markers of genital endometriosis, this problem remains relevant today. It is important to introduce early diagnosis of genital endometriosis for the purpose of timely prevention and treatment.Objective: to study the expression levels of IL-1β and HMGB-1 mRNA genes in women with genital endometriosis associated with infertility, and to evaluate the effect of our proposed preparation for assisted reproductive technologies on the level of IL-1β and HMGB-1 mRNA gene expression.Material and methods. To analyze gene expression IL-1β and HMGB-1 and determine relative normalized mRNA expression IL-1β and HMGB-1, the polymerase chain reaction method was used with real-time reverse transcription(RT-PCR. The object of molecular genetic studies using the RT-PCR method was the fraction of mononuclear cells isolated from the whole blood of patients with endometriosis. In this study, we performed a retrospective analysis of the medical records of 30 women with infertility undergoing an assisted reproductive technology program. The main group consisted of 20 women diagnosed with external genital endometriosis who underwent assisted reproductive technologies. Women in the main group, in addition to standard training for assisted reproductive technologies, received a probiotic containing Lactobacilli 1010 manufactured by Unic Biotech Ltd, India. They took one pill twice a day for one month as part of a general treatment before undergoing assisted reproductive technologies. We determined the expression level of IL-1β and HMGB-1 before and after this preparation stage. The control group consisted of 10 women who had tubal infertility due to a previous inflammatory disease, but according to the results of a comprehensive clinical and laboratory examination, they were compared to healthy women. These women, aged 21 to 42 years, with a mean age of 29,75 years, did not receive our proposed preparation with the inclusion of a probiotic. This study was conducted at the Bukovyna State Medical University and the clinic "Yuzko medical center".Results. In the main group, the IL-1β mRNA gene expression level before training was (26,7877±0,01), which was significantly higher than the level after training (0,1610±0,01*). Consequently, the use of the probiotic led to a dramatic reduction in elevated mesothelin levels, underscoring its efficacy and potential application in assisted reproductive technology training programs. Also, a high level of expression of mRNA genes can be noted HMGB-1in whole blood of women of the main group before preparation for assisted reproductive technologies (table 2). Expression level of mRNA genes HMGB-1in whole blood of women of the main group before preparation for assisted reproductive technologies was (11,9198±0,01). After our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic, the mRNA gene expression level HMGB-1in the whole blood of women of the main group was (0,2821±0,01*). Therefore, our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic is quite effective, since the expression levels of IL-1β mRNA genes and HMGB-1sharply decreased.Conclusions. Extremely high expression of mRNA genes IL-1β and HMGB-1 indicates a close connection between the pathogenesis of endometriosis and inflammation. The inclusion of probiotics in the complex scheme of preparation for assisted reproductive technologies leads to a noticeable improvement in the well-being of the patient and a significant decrease in the expression of IL-1β and HMGB-1 mRNA genes. Therefore, we recommend our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic.

Клінічна характеристика жінок із жіночою сексуальною дисфункцією та ендометріозом

Endometriosis is a disease characterized by the presence of endometrial tissue outside the uterine cavity. Endometriosis refers to estrogen-dependent diseases, clinically manifested by dysmenorrhea, dyspareunia, dyschezia. Decreased fertility in women with endometriosis is associated with the presence of chronic inflammation that leads to pelvic pain and infertility. It is believed that endometriosis is associated with mood disorders such as anxiety or depression, which can create a pathological background for sexual dysfunction. Purpose - to establish the relationship between female sexual dysfunction (FSD) and external genital endometriosis in order to optimize women's pregravid preparation. Materials and methods. 100 women of reproductive age were examined. The main group (the Group I) consisted of 70 women who had external genital endometriosis (diagnosed by ultrasound examination of the pelvic organs, ovarian endometrioma size up to 5 cm). The main group was divided into 2 subgroups: IA - 40 women with FSD and endometriosis; IB - 30 women with FSD without endometriosis. The control group (the Group II) included 30 healthy reproductively active women in the pre-gravid stage. In the course of the study, the nosological unit approved by the World Health Organization (1999) was taken into account and taken as a basis - FSD, which include disorders of desire, arousal and reaching orgasm, dyspareunia and vaginismus. The results of clinical and biochemical studies were processed using a specialized package of statistical programs Statistica 8.0 (StatSoft Inc., USA). The following criteria were used for statistical processing of the obtained data: Kruskal-Wallis test, Mann-Whitney U test, Pearson chi-squared (χ2) test, Wilcoxon test. Results. The analysis of the definition of FSD in women with endometriosis clearly indicates the presence of signs of FSD in all areas and is statistically significantly different from the indicator of healthy women. Conclusions. There is a relationship between endometriosis and FSD that can be determined using the FSFI Questionnaire Calculator. Since FSD and endometriosis have a polymorbid background, treatment should be carried out by a multidisciplinary team of doctors and be personalized. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

International Endometrial Tumor Analysis (IETA) descriptors in the diagnosis of chronic endometritis

Objective: to compare the terms, definitions and measurement methods developed by the IETA group with the ultrasound criteria of chronic endometritis (CE) used in Russia.Material and methods. A retrospective cohort study of 158 reproductive age women with clinical and laboratory diagnosis of CE was carried out. Sonographic examination was performed in the early or middle proliferative phase (cycle day 4–10 days) with the use of Affiniti70 ultrasound system (Philips, the Netherlands) with a multifrequency 3D endocavitary probe. Uterine corpus volume, endometrial thickness and volume were measured, followed by percentage endometrial/uterine volume ratio calculation, the so-called adjusted endometrial volume. Qualitative analysis of grayscale imaging included assessment of endometrial structure and echogenicity; closure or separation of the endometrial layers; contour of endometrial midline; the presence of acoustic artifacts, such as reverberation in the presence of gas or liquid in the uterine cavity, described by a number of authors. Relevant IETA descriptions were searched when assessing all qualitative CE features. In parallel, a qualitative score analysis proposed by the IETA group was carried out.Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.Results. The comparative analysis of endometrium description in CE indicates a similar measurement technique for endometrial and intrauterine lesions thickness, both proposed by the IETA group and used in our country. Most of the IETA descriptors for qualitative ultrasound findings may be used in CE diagnosis. However, there are no some significant ultrasound features for identifying the inflammation, such as marked and partially or completely thickened midline, as well as gas focuses within the endometrium or in the uterine cavity, in IETA description.Conclusion. Terminology standardization allows compare the results and perform multicenter studies followed by meta-analysis for the diagnosis of chronic endometritis, if researchers use the similar descriptors.

Ultrasound image of ovarian endometrioma as an indicator of external genital endometriosis

Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.

Non-invasive diagnostics of endometriosis based on plasma miRNA expression

Aim. To develop a method for noninvasive diagnosis of external genital endometriosis based on plasma microRNA concentrations.Materials and Methods. 80 women of reproductive age who were admitted to the gynecological department for routine laparoscopy were retrospectively examined, according to the results of which and histological examination, the patients were divided into 2 groups: the main group — 54 patients with laparoscopically and histologically confirmed external genital endometriosis (EGE); the control group — 26 patients without EGE. Before laparoscopy, a blood sample was taken from all patients for a molecular-biological study of the expression of 10 microRNAs: miR-183, miR-125b, miR-126, miR-16, miR-15a, miR-200a, miR-20a, miR-21, miR-222 and miR-29b. Identification of the studied and normalizing RNAs (U6 RNA and 103a microRNA) was performed according to the method of Chen et al. The presented values of the expression of the studied microRNAs are given in the form of 2-ΔCt. The expression ratio is given in the form of 2-ΔCt (main)/2-ΔCt (control), if the expression in the group of patients with endometriosis exceeded that in the control group, and in the form of 2-ΔCt (control)/2-ΔCt (main), if vice versa.Results. Comparison of the expression of 10 mi-croRNAs between the two groups revealed statistically significant differences only in miR-183: its expression in patients with EGE was statistically 1.5 times higher than that in women of the control group (p=0.017).We have not detected a difference in the expression of mir-200a, while according to other researchers, representatives of the mir-200 family are among the most frequent whose expression changes with endometriosis. MIR-16 expression also did not differ statistically among the patients we examined, whereas a group of American colleagues revealed its increase in patients with endometriosis and with endometriosis-associated ovarian tumors. We found no difference in mir-21 expression. The results of other researchers are contradictory: some found its increase in endometrioid cysts compared with eutopic endometrium, an increase in the epithelium of the fallopian tubes with their endometriosis compared with unaffected; others did not reveal a difference between the eutopic endometrium of endometriosis patients and healthy women, but showed a decrease in expression in peritoneal foci and foci of deep infiltrative endometriosis compared with eutopic endometrium.The expression of mir-222 was reduced in the patients we examined with endometriosis, which goes against the existing ideas about the pro-oncogenic role of this microRNA. An increase in its expression in cancer of the stomach, bladder, liver, lungs, breast, endometrium, ovaries is described. At the same time, the oncosuppressive effect of mir-222 is also known in prostate cancer, squamous cell carcinoma of the oral cavity.Conclusion. Taking into account the revealed statistically significant difference in microRNA expression by ROC analysis, we determined their effectiveness and specificity in the diagnosis of EGE. Of course, further studies with a large contingent of patients are needed to confirm the diagnostic value of these biomarkers. In addition, our study did not allow us to establish a statistical difference in microRNA expression in patients with impaired fertility. But it is the test that makes it possible to differentiate female infertility — associated with endometriosis and without it, as a rule, tubal-peritoneal genesis — that will become a key tool in the personalized management of patients with infertility.In our work, the distribution of patients by stages of EGE turned out to be uneven (there were no women with stage I at all) and it was not possible to establish a statistical difference in microRNA expression depending on the "length of service" of the disease.

Comorbid pathology of the mammary glands and endometriosis: risk factors and prognosis

Aim: based on a retrospective analysis, the relationship between external genital endometriosis and comorbid breast pathology was established and risk factors were identified, their comparison and the formation of a prognostic risk criterion were determined. Materials and Methods: to address the objectives of the study, a retrospective analysis of 470 cases of patients treated for external genital endometriosis after surgical treatment and comorbid breast pathology was conducted. The control group included 30 healthy non-pregnant women. Statistical processing was performed on a personal computer using the statistical software package Statistica 10. Results: As a result of the analysis, the age of the patients ranged from 23 to 40 years. The average age of patients in the study group was (32.2}1.18) years, and in the control group (31.1}1.35) (p>0.05). The groups were homogeneous in terms of age (p>0.05), marital status (p>0.05) and level of education (p>0.05). Close relatives in 208 (44.25}2.18) % (OR=8.86; 95 % CI: (0.68-10.53); p<0.002) cases suffered from benign (hormone-dependent) tumours and tumour-like diseases of the uterus and appendages in isolation or in various combinations (fibroids, adenomyosis, endometrial hyperplasia). It was also found that 102 (21.70}1.67) % of patients had endometriosis, which may indicate a genetic predisposition to this disease. In the closest relatives of EM patients: in 118 (25.10}2.01) % of the examined parents, breast problems were noted, in 66 (14.04}1.12) % – diabetes mellitus, and in 98 (20.85}1.22) % thyroid diseases were detected, which in total amounted to (60.00}2.23) % (OR=9.12; 95 % CI: (0.58-11.54); p<0.002). Early menarche almost tripled the risk of EM (OR=2.72; 95% CI: (1.02-5.11); p<0.002), and menstrual irregularities doubled it (OR=2.04; 95% CI: (1.09-3.14); p<0.05), higher education, urban residents – 2.2 times higher (OR= 2.27; 95 % CI: (1.11-3.63); p<0.05), diseases of the gastrointestinal tract and hepatobiliary complex – 5.2 times higher (OR=5.27; 95 % CI: (1.89-12.03); p<0.05), frequently recurrent inflammatory diseases of the appendages – 3 times higher (OR=3.14; 95 % CI: (0.91-5.14); p<0.05), dysmetabolic manifestations (thyroid dysfunction) – 5 times higher (OR=5.11; 95 % CI: (1.61-9.503); p<0.002). Conclusions: Thus, in endometriosis and dyshormonal diseases of the mammary glands, menstrual and generative function disorders, along with clinical symptoms of pelvic pain, dysmenorrhoea, autonomic nervous system disorders and sexual dysfunction, are significant components of this problem, initiating comorbidity processes in target organs in the setting of hormonal maladaptation. Therefore, these comorbidities become a trigger for the activation of systemic hormonal imbalance and become an urgent interdisciplinary problem that requires further study.

Evaluation of aromatase expression in endometrioid heterotopias and endometria in patients with external genital endometriosis

Evaluation of aromatase expression in endometrioid heterotopias and endometria in patients with external genital endometriosis

Features of cytokine production at the systemic and local level in patients of reproductive age with external genital endometriosis

Objective: to establish the features of cytokine production in patients of reproductive age with external genital endometriosis at various stages of the disease.Materials and methods: the study included 52 patients with external genital endometriosis (EGE). Group I consisted of 31 patients with stages I–II of EGE, group II — 21 patients with stages III–IV of the disease, control group — 20 women without endometriosis. Serum samples were obtained before anesthesia, and peritoneal fluid (PF) samples were obtained during endoscopic examination of patients. Determination of the content of cytokines in blood serum and peritoneal fluid was carried out by enzyme immunoassay using a multifunctional counter for enzyme immunoassays with Victor software (Finland). TNF-α, IL-10 — using reagents from BenderMed Systems (Austria). IL-13, IL-18 using reagents from Cloud-CloneCorp (USA) according to the manufacturer’s recommendations. Application software packages (Megastat and Statistica 10.0) were used to create a database and conduct statistical research. To determine statistical differences between groups, the Mann-Whitney test was used for independent groups and the Wilcoxon test for dependent groups. P values less than 0.05 were considered statistically significant. Data are presented as median and quartiles.Results: at stages I–II of EGE, an increase in the level of TNF-α, IL-18 was detected in the blood serum and peritoneal fluid, which can stimulate proliferation, invasion of endometrial cells and neovascularization; stage III–IV of the disease was characterized by an increase in the level of TNF-α, IL-10, IL-13 in the peritoneal fluid, which promotes disease progression by evading ectopic endometrial cells from immune control.Conclusion: the identified features of the production of pro- and anti-inflammatory cytokines at the systemic and local level at various stages of EGE confirm their importance in the development of the disease. Further research is needed to understand the mechanisms underlying the progression of NGE and to develop methods for early diagnosis.

Dienogest therapy: a window of opportunity for endometriosis

Endometriosis is a disease characterized by a benign growth of tissue identical to the endometrium outside the uterine cavity with an accompanying inflammatory process. The exact prevalence of external genital endometriosis (EGE) is unknown. According to some data, the prevalence varies from 2% to 10% among the general female population and up to 50% among women with established infertility. Currently, there is no single theory that could fully explain the causes and mechanisms of the development of the disease. The etiopathogenesis of endometriosis is widely discussed and remains uncertain. The main clinical markers of the disease are chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. The progressive and recurrent course of EGE with a significant deterioration in the quality of life of women is the main motivation for the scientific community in the search for radical therapeutic methods. The main goal of therapy is to reduce pain, correct reproductive dysfunction, prevent / slow down the occurrence of such long-term consequences associated with endometriosis, such as fibrosis, adhesions and malignant transformation. Available advanced technologies aimed at establishing and studying the pathophysiology of endometriosis have made it possible to optimize therapeutic strategies. However, many controversial issues still arise in routine clinical practice. This article will provide an overview of the general basic concept of disease pathogenesis and highlight the role of hormonal treatment (dienogest) in women with endometriosis.

Prevention of endometriosis recurrence after surgical treatment

Introduction. The relevance of studying the mechanisms underlying the development of adenomyosis is determined not only by its high prevalence reaching 40% among reproductive aged women, but also by its association with unexplained infertility (60%), as well as woman’s quality of life impairment.Aim. To enhance efficiency of therapy after surgical treatment of endometriosis and minimize the risk of disease recurrence.Materials and methods. In a cohort prospective comparative study conducted on the basis of the gynecological department of the Inozemtsev City Clinical Hospital, 80 patients of reproductive age who underwent organ-preserving treatment for external genital endometriosis and nodular adenomyosis were included. Dienogest (Zafrilla) was prescribed to 65 patients at a dose of 2 mg/day (1 tablet) from day 2 after surgical treatment continuously for 6 months, taking into account contraindications to its use, 15 patients refused to take the drug in the postoperative period, and made up the control group.Results. The results of the study showed that after surgical treatment of external genital endometriosis and the nodular form of adenomyosis and the appointment of suppressive therapy with Zafrilla, after 3 months, the intensity of the pain syndrome was transformed according to the VAS, NRS, B&B scales by one step, and after 6 months it decreased to a slight (p < 0.05), which contributed to the improvement of the quality of life of patients based on the EHP-30 questionnaire. The long-term results of the study allow us to recommend the drug Zafrilla, with high compliance, good tolerance, a favorable safety profile, in order to reduce pain, the intensity of menstrual flow, and prevent recurrence of the disease based on 24 months of observation.Conclusion. An integrated approach to the treatment of external genital endometriosis and nodular adenomyosis, including surgical treatment and suppressive therapy with Zafrilla, made it possible to realize reproductive function in 48% of patients. Taking dienogest for 24 weeks provided effective relief of pain, alleviated the symptoms of the disease, as well as improved the quality of life and realized reproductive plans.

Probiotics and NLRP3 mRNA inflammasome levels in women with endometriosis-related infertility undergoing assisted reproductive technologies.

This research was conducted at Bukovinian State Medical University and the Centre of Reproductive Medicine and included a total of 30 infertile women. The control group consisted of 10 women with tubal infertility resulting from a prior history of inflammation, who, following a comprehensive clinical and laboratory assessment, exhibited no other underlying health conditions and could be regarded as essentially healthy individuals. Participants in the control group ranged from 21 to 42 years, with an average age of 29.75 years. The control group did not receive the probiotic Femina Probiz. The main group, on the other hand, included 20 women diagnosed with external genital endometriosis who were undergoing assisted reproductive technologies. These patients were administered the probiotic Femina Probiz manufactured by Unic Biotech Ltd in India. They were instructed to take one tablet containing 10×10^9 Lactobacillus organisms twice daily for one month as part of their preparatory treatment before proceeding with assisted reproductive technologies. The levels of NLRP3 inflammasome were measured before and after this preparatory phase. The incidence of primary infertility was significantly higher in patients belonging to the main group.

ENDOMETRIOSIS ASSOCIATED INFERTILITY: VERSIONS AND COUNTERVERSIONS

Reproductive disorders rank as rather challenging problems in modern gynecology. At present, there is no unequivocal opinion and unified approaches to endometrial receptivity. The change in this complex process causes implantation disorders. The article provides up-to-date information on the molecular and genetic characteristics of the endometrium and on endometrium receptivity models. It also touches upon the pathogenesis of female infertility, associated with external genital endometriosis (EGE).
 Numerous foreign and domestic articles consider gene expression in endometriosis. According to the published data, the number of differentially expressed genes in endometriosis varies significantly. It has been proven that if mutations occur in a single gene, its function can still be performed due to compensatory mechanisms. Such compensation is provided by the work of signaling pathways – cascades of protein-protein interactions that transmit signals inside the cell. It is known that the degree of activation of intracellular signaling pathways is a better marker of a pathological process than gene expression.
 Comparison of eutopic and ectopic endometrium is one of the promising lines of endometriosis research. It is revealed that the abovementioned endometrial samples are similar in morphological characteristics, but this fact has not led to the creation of a single diagnostic test. Thus, it is relevant to search for new statistically valid criteria for early diagnosis of endometriosis using minimally invasive or non-invasive research methods that would also allow predicting the disease recurrence and improve the quality of predicting endometriosis associated infertility.

Frequency and structure of thyroid disfunction is at gynaecological diseases

The objective. Women have a study of frequency and structure of thyroid violations with gynaecological diseases. Materials and methods. The screening estimation of pathology of thyroid is conducted was mine-out in 298 women with infertility (basic group) and in 50 fertility of women which appealed to the clinic for the selection of method of contraception (control group). The selection of patients was carried out by the opened cohort method as far as handling of patients infertility in the separation of maintainance and proceeding in a reproductive function. A questionnaire is conducted in 205 women with infertility. The inspection of patients with infertility was conducted in accordance with the generally accepted diagnostic algorithm, including endoscopic methods, and treatment – depending on found out reasons of infertility. Results. Prevalence of thyroid pathology women with infertility had at 3,8 time higher as compared to fertility women (48,0% and 12,5% respectively, p<0,05). In the structure of thyroid pathology at infertility prevailed the transmitter of antibodies to thyroperoxidase in combination with the signs of echo of autoimmune thyroiditis (24,0%); hypothyroidism as a result of autoimmune thyroiditis (9,4%), including manifest (0,8%) and subclinical (8,6%) women and euthyroid goitre (7,8%), while part of patients with infertility and thyrotoxicosis was low (0,6%). The estimation of the state of the reproductive system for women with infertility depending on found out pathology of thyroid rotined that a leading place in the structure of reasons of infertility for women external genital endometriosis occupied with autoimmuny thyroiditis - 34,4%, for women with found out a hypothyroidism is an endocrine factor of infertility (polycystic ovary syndrome) – 29,8%, for patients with the compensated hypothyroidism is external genital endometriosis (26,6%), for women with a euthyroid goitre and for patients without pathology of thyroid - pipe peritoneal factor (33,3% and 39,8%, respectively). Conclusion. The results of questionnaire, conducted for women with infertility, showed the low diagnostic value of clinical symptoms of hypothyroidism as compared to laboratory diagnostics in verification of this diagnosis. A sensitiveness of symptoms was low and hesitated from 16,1% to 27,8%, while specificity of symptoms was considerable and varied from 85,1% to 94,5%. A leading place in the structure of reasons of infertility for women with autoimmuny thyroiditis occupies external genital endometriosis (34,4%); for patients with a hypothyroidism is endocrine infertility (29,8%), for women with a euthyroid goitre and without pathology of thyroid - pipe peritoneal factor of infertility (33,3% and 39,8%). The got results must be taken into account at development of algorithm of diagnostic and treatment-and-prophylactic measures.

Evaluation of survivin expression in the endometrium and endometriotic lesions in patients with genital endometriosis, type 1 diabetes mellitus and their comorbidity

BACKGROUND: The prevalence of external genital endometriosis is high, yet there is insufficient understanding of its etiology and pathogenesis. This coupled with the challenges posed by its diagnosis and treatment, and its co-occurrence with type 1 diabetes mellitus, underscores the significance of this issue.
 AIM: The aim of this study was to evaluate the expression of survivin in the eutopic endometrium, endometriotic lesions, and their concomitant conditions in patients with external genital endometriosis and type 1 diabetes mellitus.
 MATERIALS AND METHODS: This study enrolled 43 female patients of reproductive age who were divided into four groups. The main group (n = 17) included women with surgically and histologically confirmed external genital endometriosis combined with type 1 diabetes mellitus. The external genital endometriosis group (n = 9) comprised women with isolated external genital endometriosis, while the type 1 diabetes mellitus group (n = 6) included patients with type 1 diabetes mellitus only. Finally, the control group (n = 6) consisted of women without any gynecological pathology. Biological specimens were collected during the follicular phase of the menstrual cycle, and morphological examination was carried out through histological and immunohistochemical evaluation of the endometrium and endometrioid heterotopias. Statistical analysis of the data was performed using the Jamovi software program, with statistical significance defined as p 0.05.
 RESULTS: Our findings indicate that patients with external genital endometriosis and comorbid type 1 diabetes mellitus exhibit a statistically significant increase in survivin expression in the endometrium compared to the control group or patients with type 1 diabetes mellitus only. However, no significant difference was observed in survivin expression in endometriotiс lesions between patients with external genital endometriosis and those with external genital endometriosis combined with type 1 diabetes mellitus.
 CONCLUSIONS: The data obtained suggest the role of survivin in the pathogenesis of external genital endometriosis, regardless of the presence of type 1 diabetes mellitus.

Psycho-emotional status in patients with endometriosis-associated pain syndrome in various disease phenotypes

BACKGROUND: Patients with endometriosis-associated pain syndrome in combination with anxiety or depression have lower treatment effectiveness and satisfaction with both the disease itself and the pain syndrome compared to patients with pain syndrome but without depression or anxiety.
 AIM: The aim of the study is to assess the relationship between psychosocial status and endometriosis-associated pain syndrome in patients with different phenotypes of endometriosis using pain assessment scales, psychosocial state assessment scales, and quality of life assessment scales.
 MATERIALS AND METHODS: We examined 81 patients using a number of questionnaires: Visual Analogue Scale, Numeric Rating Scale, Hospital Anxiety and Depression Scale, Beck Depression Scale, Spielberger State-Trait Anxiety Inventory, and Short Form-36 quality of life assessment. The patients were divided into three groups: isolated adenomyosis (n = 39), adenomyosis combined with external genital endometriosis (n = 21), and the control group (n = 21).
 RESULTS: Our study has shown that patients with adenomyosis combined with external genital endometriosis had the highest scores on all questionnaires for assessing anxiety and depression, as well as a low quality of life in general, which significantly differed from those in the control group (p 0.05). The results in the group of women with isolated adenomyosis are not so unambiguous and, overall, somewhat better than in the group of patients with adenomyosis combined with external genital endometriosis, but significantly worse compared to the control group. When assessing the severity of dysmenorrhea, higher scores were also found in the group of women with adenomyosis combined with external genital endometriosis: 6.64 2.11 cm (Visual Analogue Scale) and 6.9 2.05 cm (Numeric Rating Scale), while in the group of women with isolated adenomyosis, the scores were 5.29 1.9 cm and 5.83 1.72 cm, respectively (p = 0.028). Women in the control group had no pain syndrome.
 CONCLUSIONS: Poor mental and physical health scores obtained in this study in women with external genital endometriosis dictate the need for an objective and multicomponent assessment of the psycho-emotional status in patients, followed by complex treatment and team management with related specialists.

Expression of NF-κB, Bcl-2 and Caspase-8 apoptosis markers in endometrium in external genital endometriosis and chronic endometritis: A retrospective study

Aim. To study the regulation of apoptosis in the endometrium of women with chronic endometritis (CE) and external genital endometriosis (EGE) based on the study of the expression of its regulators such as transcription factor (NF-), Bcl-2 and Caspase-8.
 Materials and methods. The study evaluated the expression of apoptosis factors such as Caspase-8, NF-B transcription factor, and Bcl-2, in patients with chronic endometritis (CE, n=23), external genital endometriosis (EGE, n=20), and intact endometrium (control group; n=7). Statistically significant differences were found for all test markers (p0.05).
 Results. The increased expression of apoptosis factors is probably related to high endometrial pro-inflammatory activity in both CE and EGE. For EGE, this effect is more pronounced at the transcription level in the form of an increase in the expression of the transcription factor NF-B in both glandular and stromal endometrial cells. It is probably due to the systemic nature of the chronic inflammatory process. For CE, despite the antiapoptotic activity of Bcl-2, an increase in Caspase-8 expression in the endometrium may also indicate a predominance of innate immunity activation.
 Conclusion. The imbalance of pro- and antiapoptotic factors can be an inducer of both cytotoxic and cytoprotective mechanisms of EGE and CE. However, it requires further research.

Magnetic resonance imaging for non-invasive diagnosis of various forms of endometriosis in women with infertility

BACKGROUND: Endometriosis is one of the most common causes of infertility, affecting approximately 6%10% of women of reproductive age. For many decades, laparoscopic surgery has been considered the gold standard for diagnosing various forms of endometriosis. However, diagnostic laparoscopy, despite its widespread use, is an invasive and expensive procedure with certain risks. Current scientific literature increasingly shows that the methods of radiological diagnosis (ultrasound and magnetic resonance imaging [MRI]) are the main and most promising for verification of endometriosis. The advantages of MRI over ultrasound are multiplanar images, high tissue contrast, and smaller size of detectable heterotopias.
 AIM: To assessing the sensitivity and specificity of MRI for diagnosing different forms of endometriosis.
 METHODS: A retrospective analysis of the medical histories and instrumental studies of 129 women of reproductive age (mean age of the participants was 30.54.6 years) with a clinical diagnosis of infertility and suspected genital endometriosis was conducted. At the first stage of the study, the patients underwent a comprehensive MRI with one-stage magnetic resonance hysterosalpingography to assess the pelvis and tubal patency. Further, laparoscopic surgery (LS) was performed to confirm/refute the diagnosis of genital endometriosis, provide surgical treatment, or further search for possible causes of infertility. The results obtained with MRI and LS were compared, and the sensitivity and specificity of MRI for diagnosing external and internal genital endometriosis were assessed.
 RESULTS: According to the data obtained, the specificity of MRI for diagnosing peritoneal endometriosis was 74% (95% confidence interval [CI], 57%85%), and the sensitivity was 94% (95% CI, 87%99%). Diagnostic accuracy of the technique was 86% (95% CI, 79%91%). The most frequent localization of endometrioid heterotopias was retrocervical (41%). The specificity of this technique for diagnosing endometrioid ovarian cysts was 92% (95% CI, 82%97%), and the sensitivity amounted for 98% (95% CI, 90%100%). Diagnostic accuracy of the technique was 94% (95% CI, 88%96%). The specificity and sensitivity of MRI for the diagnosis of adenomyosis were 96% (95% CI, 92%99%) and 99% (95% CI, 87%100%), respectively. Diagnostic accuracy of the technique was 97% (95% CI, 93%99%). Our results were consistent with the literature data on the accuracy of MRI for diagnosing endometriosis.
 CONCLUSIONS: Based on the results, MRI is a promising non-invasive method for diagnosing various forms of endometriosis. The performance of a comprehensive MRI allows obtaining sufficiently accurate information about the condition of the pelvic organs, detecting the manifestations of genital endometriosis, and reducing the time for examining women with infertility.