Healthy Women Of Reproductive Age Research Articles

Seroepidemiological study of Epstein-Barr virus infection in reproductive age women in Bulgaria

Abstract Background At the present stage, studies on the involvement of Epstein-Barr virus (EBV) in neonatal pathology are rare. Establishing seroprevalence among women of reproductive age has important epidemiological significance in order to determine the risk of infection during pregnancy and intrauterine infection of the fetus. The aim of the study is to determine the seroepidemiological status of EBV in reproductive age women. Methods We conducted a prospective seroepidemiological study in which 96 healthy women of reproductive age (18 to 49 years) were tested during the period December 2023 - January 2024 in Medical Center “Clinical Institute for Reproductive Medicine”- Pleven, Bulgaria. Participants were surveyed on a voluntary basis. The exclusion criteria were: presence of autoimmune disorder, immunosuppressive states, malignancy and populations at risk such as persons under 18 years of age and pregnant women. The presence of specific antibodies were detected using a standardized Anti-EBV VCA IgM, Anti-EBV VCA IgG and Anti-EBV EBNA-1 IgG ELISA kits. The demographic and anamnestic data were collected for each participant in Case Report Form. Results The average age of the women was 34.41±5.44 years. Dominating were women with higher education (76.04%) living in urban areas (91.67%). The results of the seroepidemiological study of markers for EBV show that 98.96% of women of reproductive age are seropositive. There was no significant correlation between the presence of antibodies and socio-demographic indicators (living area, education and number of family members). Conclusions The results of this study imply that only 1.04% of the reproductive age women in Pleven region are susceptible to infection with EBV. Although interpretation of the serological status indicates a low risk of primary infection, active monitoring of high-risk groups pregnant women is necessary because of the possibility of EBV reactivation. Key messages • On-going monitoring of the seroepidemiological EBV status in reproductive age women is necessary to determining the possibility of EBV reactivation and to reduce the teratogenic risk of the infection. • Seroepidemiological surveillance of markers for EBV infection in reproductive age women is part of effective preventive measures at the public health level.

Criteria for identifying a risk group for iron deficiency anemia from among healthy women of reproductive age

The article presents the results of a survey of healthy women of reproductive age with the definition of criteria for identifying a risk group for anemia from among them. The criteria were the indicators of peripheral blood: a decrease in the concentration of Hb (below 120.0 g/l) of blood and hematocrit, an expansion of RDW, a decrease in the volume of red blood cells (MCV), as well as a decrease in the amount of serum iron, ferritin, total protein that do not reach the lower limit of normal and the presence of a history of diagnosis of somatoform dysfunction of the autonomic nervous system. The application of the identified criteria for the early diagnosis of iron deficiency will allow effective timely preventive measures to prevent the development of iron deficiency anemia in women of reproductive age.

Some parameters of the immune system in women with hyperandrogenism

The article is dedicated to studying certain parameters of the immune system, which holds great significance in obstetrics and gynecology. Examining immune system parameters allows for identifying disruptions in reproductive-aged women with hyperandrogenism, which holds crucial practical implications. The authors conducted an immunological study of women with hyperandrogenism and women without this pathology. The aim of the study was to investigate the immune system status in women suffering from hyperandrogenism. Materials and methods of the study: 58 reproductive-aged women diagnosed with hyperandrogenism, under observation at the Women’s Health Center “AyolCare” in Tashkent, were examined. Comprehensive clinical and laboratory examinations were conducted for all women. The control group comprised 35 practically healthy reproductive-aged women. The obtained results indicate that women with altered hormonal balance, including those with hyperandrogenism, experience specific changes in the immune system. The conducted research revealed that the levels of T lymphocytes and T helper/inducer cells decrease, while the number of T killer cells, CD25+ cells (carrying IL-2 receptor), and CD95+ cells (carrying apoptosis signaling receptor) increases. The elevated levels of CD95+ cells indicate increased activation of apoptosis processes, which serve as a protective function of T killer cells. This increase in lymphocyte activation is likely associated with elevated levels of mature activated macrophages and a range of cytokines they produce, which directly stimulate lymphocytes. The detected imbalance in immunological parameters likely indicates that in hyperandrogenism, either the elimination of activated clones of T helper cells is absent or disrupted, which usually leads to the formation of immune response suppression. The increase in the number of activated clones of T lymphocytes is observed in the decreased process of their apoptosis, which is likely intensified by the influence of androgens.

Type 1 diabetes mellitus; ovarian reserve; anti-Müllerian hormone; ovarian function

BACKGROUND: Prolonged course of diabetes mellitus often leads to the development of vascular complications, insufficiency of ovarian function. The occurrence of diabetes mellitus in women before pregnancy (pregestational diabetes mellitus) it can have various adverse consequences for the mother, fetus, child and the course of pregnancy. Pregnancy planning in women with pregestational diabetes significantly improves the outcomes of pregnancy and childbirth. AIM: The aim of this study was to analyze gonadotropic and ovarian function parameters in patients with type 1 diabetes mellitus depending on the age of onset, duration and compensation level of the disease. MATERIALS AND METHODS: The patients included into this clinical prospective study were divided into two groups. The main group consisted of 216 patients with type 1 diabetes mellitus aged 18 to 39 years (mean age: 27.1 ± 3.1 years). The control group consisted of 30 healthy women of reproductive age. Chemiluminescent immunoassay was used to determine blood serum levels of anti-Müllerian hormone, follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, testosterone, free testosterone, and sex hormone-binding globulin from day 2 to day 5 of the menstrual cycle. Serum progesterone levels were measured on days 20–23 of the menstrual cycle for three consecutive cycles. Glycated hemoglobin levels were also studied in the blood serum of patients with type 1 diabetes mellitus. All the patients underwent pelvic ultrasound examination to assess the cohort of antral follicles and ovarian volume. RESULTS: The average age of menarche in patients with type 1 diabetes mellitus who developed the disease at the age of under 10 years was 14.2 ± 1.2 years. This was higher than in the group of girls with the onset of the disease over the age of 10 years (13.5 ± 1.2 years) and in women of the control group (11.9 ± 1.1 years). When assessing the ovarian reserve in patients with type 1 diabetes mellitus, we found a decrease in anti-Müllerian hormone level and antral follicle count in the group of women with disease onset at the age of under 10 years. We did not find differences in the ovarian reserve parameters in patients depending on disease duration. Normogonadotropic normoprolactinemic ovarian insufficiency was detected in 154 (71.3%) of 216 patients, while the rest 62 (28.7%) women had an ovulatory menstrual cycle. In patients with anovulation, luteal phase deficiency and ovulatory menstrual cycle, we found no differences between the age of development of type 1 diabetes mellitus, its duration, glycated hemoglobin levels, total daily insulin dose and insulin dose per kilogram of body mass. In patients receiving intensive insulin therapy with continuous subcutaneous insulin infusion, glycated hemoglobin level was lower than in those receiving multiple dose insulin injection therapy. CONCLUSIONS: The average age of menarche in patients with type 1 diabetes mellitus is higher than in healthy women. The ovarian reserve parameters in patients with early onset of the disease, before 10 years of age, are lower than in patients who developed type 1 diabetes mellitus after 10 years of age. Duration of pregnancy planning period depends on compensation level of the disease and lasts from six to 12 months. This requires the doctor and patient to prepare for the implementation of reproductive tasks as early as possible, especially in patients whose disease onset occurred in pre-pubertal period.

Co-infection of human papillomavirus and herpes simplex virus-2 with cervical dysplasia among women in Kaduna State, Nigeria

Background: The epidemiology of human papillomavirus (HPV) and co-infections with herpes simplex virus type 2 (HSV-2) remains poorly characterized in Africa. High risk HPV (hrHPV) infection is the primary cause of 99.7% all cervical cancer especially in the presence of genital ulcer disease (GUD) which is usually caused by HSV-2. Herpes simplex virus-2 might interact directly with hrHPV to increase the risk of cervical cancer. Co-infection of HPV and HSV-2 in asymptomatic women could provide a clue to early diagnosis of cervical cancer and this could aid in the development of new strategies for effective management and improvement of the quality of life of women who are infected. If the synergy between HPV and HSV-2 can be prevented, there may be significant reduction of the incidence of cervical cancer. Methodology: This was a descriptive cross-sectional study of 515 randomly selected apparently healthy women of reproductive age whose cervical samples were screened for HPV and HSV-2 in Kaduna State, Nigeria. The cervical samples were collected by liquid-based cytology (LBC) for detection of cervical epithelial cell abnormalities (CEA) and molecular detection of HPV and HSV-2 using conventional polymerase chain reaction (PCR) assay. Extracted viral DNAs from the samples were amplified by convectional PCR using specific hrHPV (HPV 16,18, 31 and 45) primer sets and a broad spectrum MY09/11 and GP5+/6+ primers for a wider range of HPV genotypes while HSV-2 DNA was detected by florescence-based PCR assay with HSV-2 gG primers and probes. Results: PCR assay revealed that 14.7% (n=76) of the 515 selected women harbored HPV, HSV-2 or both. The prevalence of HPV, hrHPV, HSV-2 and HPV/HSV-2 co-infection among in the study participants are 11.8% (n=61), 9.3% (n=48), 5.6% 4% (n=29) and 2.3% (n=12) respectively. The frequency of HPV detection in HSV-2 infected participants (41.4%, 12/29) was significantly higher (OR=6.295, p<0.0001) than in HSV-2 negative participants (10.1%, 49/437), but only co-infections of HPV-31 (p=0.004) and HPV-18 (p=0.040) with HSV-2 were significantly associated. Cervical cytology reports on the smears revealed prevalence of cervical epithelial abnormalities (CEA) of 16.7% (n=86), with cervical dysplasia prevalence of 6.4% (n=33), consisting of high grade squamous intraepithelial lesion (HGSIL) of 1.6% (n=8), low grade squamous intraepithelial lesion (LGSIL) of 4.1% (n=21) and atypical squamous cells of uncertain significance (ASCUS) of 0.8% (n=4). The frequency of HPV detection in women with cervical dysplasia (93.9%, 31/33) was significantly higher (OR=14.22, p<0.0001) than in women without cervical dysplasia (6.2%, 30/482), and all HPV genotypes were significantly associated (p<0.05) with cervical dysplasia except HPV 16 (p=0.051). Also, the frequency of HPV/HSV-2 co-infection among women with cervical dysplasia (15.2%, 5/33) was significantly higher than among women without cervical dysplasia (1.5%, 7/482) (OR=12.12, p<0.0001). Comparing women with cervical inflammatory and atrophic changes (n=53), women with cervical dysplasia (HGSIL, LGSIL and ASC-US) had significantly higher frequency of HPV infection (χ2=42.829, p=0.000), HSV-2 infection (χ2=25.140, p=0.001) and HPV/HSV-2 co-infections (χ2=66.602, p=0.000). Conclusion: Co-infection rate of hrHPV and HSV-2 among women in Kaduna State is 2.3%. Demographic factors significantly influencing the rate of co-infections included age and marital status. In spite of the screening method using the traditional Pap smear, GUD and cervical cancer continues to be a major public health problem, thus more sensitive and specific methods such as liquid based cytology technique and polymerase chain reaction for early detection of cervical dysplasia and hrHPV or HSV-2 in asymptomatic women should be adopted for routine use

Establishment of cutoff values for anti-β2 glycoprotein I antibodies in women of reproductive age in Southwest China

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis and obstetric morbidity, with accurate laboratory examination of antiphospholipid antibodies (aPLs) being crucial for diagnosis. This study focused on anti-β2 glycoprotein I (aβ2GPI) antibodies and aimed to establish the first population-based cutoff values for aβ2GPI IgA/IgM/IgG antibodies in non-pregnant women of reproductive age in Southwest China. The study cohort comprised 181 healthy women of reproductive age for study. Blood samples were collected on an early morning fast. Anti-β2GPI antibodies including IgA, IgM and IgG were measured in serum using the HOB® BioCLIA kit. According to the Clinical and Laboratory Standards Institute (CLSI) guidelines, the study used non-parametric percentile methods to calculate the 95th, 97.5th, and 99th percentiles cutoff values for aβ2GPI IgA/IgM/IgG antibodies, along with corresponding 90% confidence intervals (CI), while excluding outliers. A total of 168 independent samples were collected for verification, including 85 samples from healthy subjects and 83 samples from APS patients, in order to evaluate the analytical performance of the obtained cutoff values. The 99th percentile cutoff values were 3.36 RU/mL for aβ2GPI IgA, 27.54 RU/mL for aβ2GPI IgM and 1.81 RU/mL for aβ2GPI IgG, which indicated that the levels of aβ2GPI IgM antibodies were generally higher compared to those of IgA and IgG antibodies. Our established reference range was confirmed to be successful in validating the detected values of aβ2GPI antibodies in all healthy controls. With the 99th percentile cutoff value, the sensitivity was 14.46% for aβ2GPI IgA, 22.89% for aβ2GPI IgG, and 9.64% for aβ2GPI IgM in APS patients. This study established population-based cutoff values that are applicable to the local population for the accurate laboratory examination of aβ2GPI antibodies in non-pregnant women of reproductive age. The study also recommends paying more attention to IgM positivity in women of reproductive age.

Plasma volume is associated with micronutrient mass but not concentration in healthy US women of reproductive age

BackgroundPlasma transports nutrients and composes more than half of the volume of blood. A few prior studies suggest that plasma volume fluctuations may impact certain micronutrient concentrations. We hypothesized a slight negative correlation between plasma volume and micronutrient biomarkers throughout the menstrual cycle in healthy women of reproductive age (n = 45). MethodsThe study involved three visits during one menstrual cycle where fasting blood samples were taken to measure biomarker concentrations for zinc, copper, magnesium, manganese, iron, ferritin, retinol, and hemoglobin. A bolus dose of indocyanine green (ICG; equivalent to 0.25 mg.kg-1 of body weight) was injected to measure plasma volume. The total circulating micronutrient biomarker mass was calculated using the plasma volume and biomarker concentration. We used Spearman's correlation and fractional polynomial regression techniques to assess the relationship between plasma volume and biomarker concentration and mass. ResultsPlasma volume ranged from 1210 to 3520 mL. During all three visits, the correlation between micronutrient biomarker concentrations and plasma volume ranged from -0.05 to 0.10 (all P > 0.05); However, there was a strong positive correlation between biomarker mass and plasma volume, ranging from 0.26 to 0.95 (all P < 0.05). Five of the eight biomarkers examined (zinc, copper, magnesium, retinol, and hemoglobin) showed a correlation coefficient > 0.70 (P < 0.001) between mass and plasma volume. ConclusionOur findings indicate that biomarker concentrations are maintained across a range of plasma volume, suggesting that plasma volume may not be necessary to interpret micronutrient status in healthy non-pregnant women of reproductive age.

State of the vaginal biocenosis depending on the species diversity of lactobacilli

Bacterial vaginosis is one of the most common reproductive health problems in women. Lactobacillus spp. play a leading role in the vaginal biocenosis and provide local antimicrobial defense, but not all species are equally capable of protecting the vaginal ecosystem from pathogens. Diagnostic methods in practical healthcare do not allow identification of Lactobacillus spp. species, which limits the ability to comprehensively assess the status of the vaginal biocenosis. We conducted a study in which we compared microscopy data of the examined smear with the detection of Lactobacillus spp. and other microorganisms. The aim of the study was to evaluate the species composition of Lactobacillus spp. from the vagina depending on morphologic characteristics and composition of associated flora. The study included 64 conditionally healthy women of reproductive age from 18 to 35 years old. The study of species composition of the vaginal biocenosis and typing of lactobacilli was carried out by real-time PCR methods. The obtained results were processed using generally accepted methods of descriptive and ordinal statistics. During the study, it was found that the vaginal biocenosis was dominated by species of Lactobacillus spp. L. crispatus, L. vaginalis, L. iners and L. jensenii. L. johnsonii was rarely found, and L. acidophilus was not detected. Typing results showed that the vagina was more frequently colonized by more than one species of Lactobacillus spp. while a single species of Lactobacillus spp. was detected less frequently. A correlation was found between Lactobacillus spp. species and bacilli thickness. If thick bacilli are detected in gynecological smear microscopy, they belong to the species L. crispatus, which has high colonization resistance and is a factor in the stability of the vaginal biocenosis. If smear microscopy reveals thin bacilli, then these are species of L. iners and L. jensenii. These representatives of Lactobacillus spp. are not directly related to the dysbiotic state of the vagina, but may indicate the possible development of dysbiosis in the future.

P-241 The in vivo human uterine pH and uterine fluid composition differs from pH and composition of clinically used in vitro preimplantation embryo culture media

Abstract Study question To study the pH and uterine fluid composition in the human uterus three days after a positive LH test or ovum pick-up. Summary answer The uterine pH three days after a positive LH test or ovum pick-up was 6.8. Concentrations of 37 components were determined in uterine fluid. What is known already In assisted reproductive technologies (ART), the in vitro culture of human preimplantation embryos is known to play a crucial role in the success of In Vitro Fertilization (IVF) treatments. It affects live birth rates and child outcomes such as birth weight. Numerous commercial embryo culture media are routinely used in clinical practice worldwide, but their composition is primarily based on laboratory-based clinical insights and experimental studies with animal models. Studies on the natural human preimplantation embryo environment during the physiologically relevant time of the menstrual cycle are limited. Study design, size, duration A cross sectional clinical study was conducted to study the uterine pH and the composition of human uterine fluid. The uterine pH was measured in 53 women on the third day after LH surge (N = 46) or ovum pickup (N = 7), as that time in the menstrual cycle is associated with endometrial receptivity for embryo implantation. Twenty-two samples of aspirated uterine fluid, that were collected at the same time, were analyzed for the concentrations of thirty-seven components. Participants/materials, setting, methods Healthy women of reproductive age with normal functional uterine anatomy were included. Uterine pH was determined using pH probe inserted through outer sheath of an Embryo Transfer (ET) catheter at the lithotomy position. Uterine fluid was then aspirated using a syringe connected to outer sheath of this ET catheter. Collected samples were analyzed using a Cobas 8000 chemistry analyser and ultra-performance liquid chromatography-tandem mass spectrometry. Main results and the role of chance The mean pH in the uterine cavity on the third day after a positive LH test (6.75 ± 0.22) or ovum pick-up (6.82 ± 0.18) was clearly lower than the pH used in routine clinical practice for preimplantation embryo culture (pH 7.3 ± 0.1). Calcium, phosphate, lactate(L), pyruvate, albumin and 21 amino acids were present at different concentrations in human uterine fluid compared to most commonly used preimplantation embryo culture media. Immunoglobulins, citrulline, ornithine and uric acid were present in uterine fluid, but not in clinically used culture media. Limitations, reasons for caution As the uterine cavity is only one part of the reproductive tract, our measurements do not fully represent the complete in vivo environment of preimplantation embryo development. We only studied 37 components, recognizing that uterine fluid likely contains additional components. Wider implications of the findings The observed differences between the uterine pH and the composition of uterine fluid and the pH and composition of preimplantation embryo culture media used in routine clinical practice could be a starting point to further optimize in vitro embryo culture in ART treatments. Trial registration number Not applicable

P-652 Chronic kidney disease and female reproductive hormonal profile: A multi-centre cohort study

Abstract Study question Does Chronic Kidney Disease (CKD) impact female reproductive hormone profiles? Summary answer Women with CKD had significantly lower AMH and testosterone, and significantly higher LH levels. There were no differences in FSH, oestradiol, prolactin and progesterone. What is known already Chronic diseases, such as CKD, is rising in women of reproductive age. It is expected that the prevalence of CKD in adults will increase to 16.7% in 2030.Coupled with improvements in obstetric care and advancement in assisted reproductive technology, more women with CKD are seeking to conceive with ART. It is known that CKD reduces fertility, but underlying mechanisms are not fully understood. It is proposed that CKD leads to dysregulation of the hypothalamus-pituitary-ovarian (HPO) axis, but studies are small, use outdated assays, are done at different times in the menstrual cycle and do not compare with healthy controls. Study design, size, duration Observational cohort study involving women with CKD and healthy women of reproductive age without underlying medical conditions was conducted between August 2021-September 2022.Women with CKD were identified from four units to attend a study visit at a tertiary fertility unit.Healthy controls were recruited via word of mouth and from couples within the unit undergoing treatment for male factor infertility.For the study to be powered 100 women with CKD and 50 healthy controls were recruited. Participants/materials, setting, methods Ethical approval was provided by the Health Research Authority (IRAS 285546) and written informed consent was obtained from participants.Serum Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), prolactin, testosterone, oestradiol, progesterone, Anti Mullerian Hormone (AMH) and b-HCG were taken between the first and fifth day of menstrual cycle. If there was amennorhoea, bloods were taken on a day suiting them. Comparisons between controls and CKD Stage utilised t-test and Mann Whitney U tests according to data-distribution. Main results and the role of chance 101 women with CKD and 63 healthy women were recruited. The mean age of women in the CKD group was 35.1± 6.7 years and of controls was 33.44 ±4.8 years, median BMI for CKD women was 25.45 kg/m2 (IQR 22.7,29.4) and controls was 24.5 kg/m2 (IQR 22,26.7).The renal cohort had similar numbers in each of the four CKD stages. 20.8% women had renal transplants.The two cohorts were matched for age and BMI. Median AMH (13.6(IQR 3,4,28.7) vs 18.4 (IQR 11.2,33.6) pmol/L;p=0.03) was significantly lower in the renal group than controls. Median testosterone concentrations (0.6 (IQR 0.5,0.9) vs 0.5 (IQR 0.4,0.7)nmol/L; p = 0.01) were significantly lower in women with CKD even from stage 1 CKD. LH (4.4 (IQR 3.2,5.5) vs 5.9 (IQR 3.8,9.4) IU/L;p=0.001) concentrations were significantly higher in women with CKD compared to controls but there were no differences in FSH, oestradiol, prolactin and progesterone. LH increased and testosterone and AMH concentrations fell with CKD severity. Interestingly, b-HCG was &amp;gt;6 IU/L in 3.0% (3/101) patients with CKD. When stratified by CKD stage; CKD stage 2 and onwards had significantly higher LH concentrations (p = 0.03).CKD stage 3 and above participants had significant lower AMH concentrations (p = 0.002).This is at a later stage of CKD than previously published. Limitations, reasons for caution Although this is the largest study of its kind known to explore female hormonal profiles in women with CKD, the numbers are still limited. In addition, our population had a mixed ethnic background but due to the small numbers we were unable to analyse the results per ethnic category. Wider implications of the findings This is the largest prospective study comparing fertility hormonal profiles in women with CKD and healthy controls. Unfortunately, there remains a paucity of evidence on the effects of CKD on female fertility. Future work includes exploring longitudinal changes which will better facilitate patients to make informed and timely fertility-related decisions. Trial registration number 285546

Psychosomatic status of women of reproductive age with adenomyosis

The objective: to study the impact of adenomyosis on the psychosomatic status of women of reproductive age.Materials and methods. A complex clinical-laboratory and instrumental prospective examination for women with adenomyosis was conducted in 224 patients aged 30 to 50 years (average age – 42.0±1.8 years). These patients were included in the main group of the study. The patients of the main group were divided into two subgroups depending on the form of adenomyosis: Group I – diffuse form – 106 women, Group II – nodular form – 118 women.The control group included 84 healthy women of reproductive age with a regular ovulatory menstrual cycle and no history of gynecological diseases.To assess the psychosomatic status of patients with adenomyosis we used the Aleksandrowicz method: a questionnaire of neurotic disorders – symptomatic (QND- S).Results. The conducted studies established that the largest number of patients were 36–40 years old – 92 (41.1±3.3%) women in the main group, and 37 (44.0±5.4%) women in the control group. A total of 152 (67.9±3.1%) patients of the main group were of reproductive age, 72 (32.1±3.1%) patients were of perimenopausal age.In patients with adenomyosis disorder of the menstrual cycle in the form of hyperpolymenorrhea was found in almost every third patient, and algomenorrhea – in almost every second person. The diagnosis was established for the first time in 8.49±2.7% of patients in Group I (9 women) and 3.38±1.8% in Group II (4 women).Less than 5 years of the disease was observed in 34.91±4.6% of patients of the Group I (37 women) and in 51.69±4.6% of the Group II (61 women). From 5 to 10 years, the disease was observed in 56.60±4.8% of patients of the Group I (60 women) and in 44.93±4.6% of the Group II (53 women). Affective stress (up to 15.50%), sleep disorders (up to 20.22%), anxiety-phobic disorders (up to 11.18%) were determined most often.Conclusions. In the vast majority of patients of reproductive age who have adenomyosis with pain syndrome, the personal characteristics are dominated by symptoms such as anxiety-phobic and depressive disorders, affective tension, sexual, obsessive and anankastic disorders.

Экспрессия ARID1a в эндометрии женщин репродуктивного возраста с аномальными маточными кровотечениями и ожирением

Objective. The aim of the study was to evaluate the expression of the proliferative marker ARID1a in endometrial biopsies of patients with abnormal uterine bleeding (AUB) and obesity and its role in the pathogenesis of endometrial dysfunction. Materials and methods. The study included 40 endometrial samples from patients of reproductive age with AUB-E: 20 from patients with AUB-E and obesity (group 1) and 20 from patients with normal body mass index (BMI) and AUB (group 2). 10 endometrial samples were obtained from healthy women of reproductive age, taken on the 2nd-3rd day of the menstrual cycle. All patients underwent histological examination according to the standard procedure. At the second stage, an immunohistochemical study of the ARID1a proliferation marker was performed using polyclonal rabbit antibodies to Anti-ARID1a (clone EPR13501-73) in standard dilution (1:500) according to the protocol of the manufacturer Abcam (Great Britain). The IBM SPSS Statistics v.26 program (IBM Corporation, USA) was used for statistical data analysis. To determine statistically significant differences between quantitative parameters with a normal distribution, one-factor analysis of variance (ANOVA) was used with the calculation of a 95% confidence interval followed by the post-hoc Games-Howell test for multiple comparisons. The differences were considered significant at p&lt;0.05. Results. ARID1a expression was evaluated in the glandular and stromal compartments of the endometrium. In the endometrial glands, the expression of ARID1a was statistically significantly higher in the first group of obese patients compared with the normal and control groups. In the endometrial stroma, the expression of the proliferative marker was higher in the main group compared with the control group. However, when comparing between groups within the main group, statistical significance in the level of expression was not achieved. Conclusion. The results obtained demonstrate the possible pathological effect of obesity on the structural and functional properties of the endometrium, which leads to delayed regeneration of the endometrium due to the glandular component and, consequently, to AUB-E.

Cervical Cancer Visual Screening Experience in the Republic of Tajikistan

OBJECTIVES: To study the results of the first pilot study of organized visual cervical cancer (CC) screening for the detection of precancerous pathology of the cervix in two pilot districts of the Republic of Tajikistan. STUDY DESIGN: In this cross-sectional study, the target group included healthy women of reproductive age (30-49 years) from Kushoniyon and B. Gafurov Districts who underwent visual screening. The total study population was 72,574 out of which 68,391 (94.3%) visited primary healthcare facilities for visual inspection with Lugol’s Iodine (VILI). A total of 2958 women with suspicious tests for cervical intraepithelial neoplasia (CIN) were identified (4.3%) and sent to the reproductive health care centers for further diagnostics. Post-screening diagnostic tests were performed to specify cervical lesions, which included colposcopy with acetic acid (VIA) visual inspection, cytology, and biopsy with histological examination. HPV testing wasn’t included in the diagnostic protocol due to its high cost. RESULTS: A total of 164 histologically confirmed cases of CIN were identified (0.25% of number of women screened). The detection rate of precancerous pathology was 26.9 per 100,000 female population, which is 8.2 times higher than the detection rate of CC. All patients regardless of CIN degree underwent loop electrosurgical excision (LEEP)/conization. In the follow-up period (6-48 months), complete recovery after 136 LEEP, 21 conizations, and 7 hysterectomies were observed in 97% (5 recurrences of non-invasive disease). CONCLUSION: The visual screening showed high efficiency in detecting CIN. The positive experience suggests the implementation of this program nationwide.

Особливості розширеного гінекологічного обстеження в жінок із рецидивним вульвовагінальним кандидозом

The aim of the study - to determine the features of extended gynecological examination in patients with recurrent vulvovaginal candidiasis (RVVC): data from gynecological history, examination, colposcopy, cytological and histological examination to increase the effectiveness of prevention of recurrences in these patients. Materials and methods. A prospective study and clinical-statistical analysis of gynecological history, examination, colposcopy, cytological and histological examination in patients with RVVC was carried out. The main group (MG) consisted of 70 women of reproductive age with RVVC and 40 healthy women of reproductive age, who made up the control group (CG). Results. The most frequent complaint was itching in the vagina - in 32 (45.7%) and itching in the area of the external genitalia, which bothered 29 (41.4%) patients; complaints of dysuric disorders in 19 (27.1%) patients became the reason for an earlier visit, usually to a urologist; dyspareunia occurred in 24 (34.3%) patients. Cervical ectopy with signs of exocervicitis and endocervicitis was found in 20 (28.6%) patients with RVVC; an atypical transformation zone was noted in 15 (21.4%) and was represented by an acetowhite epithelium with clear contours in the transformation zone in 37 (52.8%) p&lt;0.05. At the same time, acetobilious epithelium with punctation was found in 19 (27.1%) patients, acetobilious epithelium with mosaic in 12 (17.1%), simultaneously with punctuation and mosaic in 6 (8.6%) patients. In CG, ectopy without signs of exo- and endocervicitis was observed in 7 (17.5%) patients. A rather high percentage of CIN attracts attention - in 37 (52.8%) of 70 women of MG: of them, CIN I - in 26 (37.1%) women, CIN II - in 9 (12.8%) patients, CIN III - in 2 (2.9%) patients. Conclusions. Subjectively, RVVC was characterized by mild clinical symptoms, at the same time marked inflammatory changes in the lower parts of the genital tract with involvement in the pathological process of the cervix. Every third patient had dysuric disorders against the background of chronic inflammatory diseases of the pelvic organs, which are present in the anamnesis. In most patients, the long recurrent course of the disease was accompanied by psychosomatic disorders, emotional lability. 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.

Роль ангиогенного фактора в развитии эндометриальной дисфункции у женщин репродуктивного возраста с аномальными маточными кровотечениями и ожирением

The steady increase in the number of patients with abnormal uterine bleeding (AUB) has a negative impact on a woman's reproductive health. Obesity is defined as one of the risk factors for AUB and its role in the development of AUB-M and AUB-O has been studied to date. However, our earlier analysis of the results of histological examination of endometrial biopsies showed that in obese women with AUB, the desquamation phase (AUB-E) is significantly more common in the endometrium than in normal-weight women. One of the possible pathogenetic mechanisms may be abnormal endometrial vascularization due to systemic proinflammatory status and local tissue hypoxia. Aim. To identify the features of the expression of endothelial markers CD34+ and eNOS in endometrial biopsies of patients with AUB and obesity and their role in the pathogenesis of endometrial dysfunction. Materials and methods. A prospective randomized cohort study included 40 patients of reproductive age with AUB-E. Depending on the presence of obesity, women were stratified into 2 groups: 20 patients with AUB-E and obesity (group 1) and 20 normal-weight patients with AUB-E (group 2). 10 healthy women of reproductive age were included as a control group. All patients underwent endometrial biopsy followed by histological examination according to the standard procedure. At the second stage, an immunohistochemical study of CD34+ and eNOS angiogenesis markers was performed using monoclonal mouse antibodies in standard dilution. The IBM SPSS Statistics v.26 program (IBM Corporation, USA) was used for statistical data analysis. Results. CD34+ expression in patients with AUB and obesity was significantly higher than in normal-weight patients with AUB and healthy women (2,5±0,2, respectively; 95% CI 2,1–2,8 vs. 1,8±0,2; 95% CI 1,5–2,2 and 0,5±0,1; 95% CI 0,4–0,6; p1-2=0,03; p1-3&lt;0,001; p2-3&lt;0,001), as well as eNOS expression (respectively 8,7±0,6; 95% CI 7,3–10,0 vs. 4,0±0,5; 95% CI 3–5 and 1,3±0,2; 95% CI 0,9–1,7; p1-2&lt;0,001; p1-3&lt;0,001; p2-3&lt;0,001). Conclusion. Patients with AUB-E and obesity are characterized by increased expression of CD34+ and eNOS in endometrial tissue, which indicates pathological activation of neoangigenesis. Perhaps one of the mechanisms of pathogenesis is the formation of a proinflammatory profile against the background of obesity, which contributes to the pathological hypervascularization of the endometrium. Effective weight loss measures can probably reduce the incidence and recurrence of AUB-E.

Overcoming poor ovarian response in assisted reproductive technology programs in patients of late reproductive age

Objective: to increase the effectiveness of in vitro fertilization in patients of late reproductive age by optimizing prepregnancy preparation for the IVF program.Materials and methods: The study included 67 patients of late reproductive age with a history of unsuccessful IVF attempts, divided into two groups at the second stage of the study, depending on the volume of prepregnancy preparation: group 1 (33 patients), group 2 (34 patients). The control group (50 patients) were healthy women of reproductive age. Immunohistochemical examination of the endometrium and microbiological examination of the uterine cavity, hormonal status of peripheral blood, study of the concentration of melatonin in peripheral blood and follicular fluid, antioxidant status of follicular fluid, expression of leukemia inhibitory factor (LIF) in the cervical secretion were performed.Results: in patients with age-related dysregulation of the hypothalamic-pituitary-ovarian axis and impaired fertile function, a systemic and local (in follicles) decrease in melatonin levels was revealed. The studied effects of melatonin suggested that its use in patients of late reproductive age with reduced follicular reserve and a "poor" response to ovarian stimulation may increase the effectiveness of in vitro fertilization (IVF).Conclusions: The inclusion in the pre-gravidar preparation of a complex of water-soluble polypeptide fractions of the epiphysis, stimulating the production of endogenous melatonin, made it possible to increase the effectiveness of IVF in patients by an average of 3.1 times according to the criterion of "clinical pregnancy" and 4.1 times according to the criterion of "live birth".

A Review: Biomechanical Aspects of the Fallopian Tube Relevant to its Function in Fertility.

The fallopian tube (FT) plays a crucial role in the reproductive process by providing an ideal biomechanical and biochemical environment for fertilization and early embryo development. Despite its importance, the biomechanical functions of the FT that originate from its morphological aspects, and ultrastructural aspects, as well as the mechanical properties of FT, have not been studied nor used sufficiently, which limits the understanding of fertilization, mechanotrasduction, and mechanobiology during embryo development, as well as the replication of the FT in laboratory settings for infertility treatments. This paper reviews and revives valuable information on human FT reported in medical literature in the past five decades relevant to the biomechanical aspects of FT. In this review, we summarized the current state of knowledge concerning the morphological, ultrastructural aspects, and mechanical properties of the human FT. We also investigate the potential arising from a thorough consideration of the biomechanical functions and exploring often neglected mechanical aspects. Our investigation encompasses both macroscopic measurements (such as length, diameter, and thickness) and microscopic measurements (including the height of epithelial cells, the percentage of ciliated cells, cilia structure, and ciliary beat frequency). Our primary focus has been on healthy women of reproductive age. We have examined various measurement techniques, encompassing conventional metrology, 2D histological data as well as new spatial measurement techniques such as micro-CT.

Features of the vagina microbiotope in patients with adenomyosis

The objective: to assess the composition of the vaginal microbiota in women of reproductive age with adenomyosis.Materials and methods. A comprehensive clinical-laboratory and instrumental prospective examination of 224 patients aged 30 to 50 years (average age – 42.0±1.8 years) with adenomyosis, who were included in the main study group, was conducted. The patients of the main group were divided into 2 subgroups depending on the form of adenomyosis – I group (diffuse form) included 106 women, II group (nodular form) – 118 persons. The control group included 84 healthy women of reproductive age with a regular ovulatory menstrual cycle and no history of gynecological diseases.Patients underwent microscopic examination of vaginal secretions, bacterioscopic examination of vaginal smears, stained according to Gram. Lactobacillus cultures were identified by polymerase chain reaction (PCR) and 16S ribosomal ribonucleic acid analysis.​Results. During the microscopic examination of the vaginal secretion, more than 15 leukocytes in the field of view were detected in 84 (37.5±3.2%) patients of both groups: in 40 (47.9±3.3%) patients of the I group and in 44 (52.1±3.3%) – II group. During the bacterioscopic examination of vaginal swabs, stained according to Gram, no gonococci and trichomonads were found in the main group. Candida fungi were detected microscopically in 158 patients (70.5±3.1%) of the main group: in 71 (66.9±4.6%) of the I group and in 87 (33.1±4.3%) of II group.Genotyping results showed that lactobacilli isolated from women with adenomyosis belonged to seven species: Lactobacillus fermentum, Lactobacillus iners, Lactobacillus gasseri, Lactobacillus amnionii, Lactobacillus jensenii, Lactobacillus crispatus, and Lactobacillus delbrueskii. The majority of lactobacilli strains have high inhibitory activity against all test strains, except for Candida albicans (39 cases, 46.4%). High adhesion to human erythrocytes was determined by 54.7% (46 cases) of the studied cultures.All lactobacilli strains were resistant to metronidazole, 83.3% (70 cases) to kanamycin, 57.1% (48 cases) to vancomycin, all strains were sensitive to roxithromycin, amoxiclav, and ampicillin. Moderate sensitivity to gentamicin and cefazolin was found in 51.9% (43 cases) of cultures, peroxide-forming activity in 80.9% (68 cases).The use of quantitative diagnostic thresholds has led to significant improvements in diagnostic performance. PCR showed 88% sensitivity and 95% specificity for Gardnerella vaginalis and 96% sensitivity and 97% specificity for Atopobium vaginae.Conclusions. It has been established that bacterial vaginosis and microorganisms associated with bacterial vaginosis are independently associated with adenomyosis. The results of the study confirmed that vaginal microorganisms, which are usually diagnosed in women with adenomyosis, ascend to the endometrium from the vagina vertically, which leads to infection of the upper parts of the genital tract.

Impact of a hypocaloric dietary intervention on antral follicle dynamics in eumenorrheic women with obesity.

Do antral follicle dynamics change in women with obesity and regular ovulatory cycles after a 6-month hypocaloric dietary intervention? After a 6-month hypocaloric dietary intervention, women with obesity and regular ovulatory cycles displayed evidence of improved antral follicle dynamics defined by the emergence of more dominant follicles, larger ovulatory follicle diameter at selection, and increased luteal progesterone concentrations compared to pre-intervention. Precise events in antral folliculogenesis must occur in order for natural and regular monthly ovulation. In healthy women of reproductive age, antral follicles are recruited for growth in a wave-like fashion, wherein a subset of follicles are selected for preferential growth, and typically, one dominant follicle culminates in ovulation. Women with obesity and regular ovulatory cycles display evidence of suppressed antral follicle development, as evidenced by fewer recruitment events, fewer selectable and dominant follicles, smaller diameter of the ovulatory follicle at selection, and a higher prevalence of luteal phase defects. While improvements in gonadotropin and ovarian steroid hormone concentrations after weight loss have been documented in eumenorrheic women with obesity, the precise impact of weight loss on antral follicle dynamics has not been evaluated. A pre-post pilot study of 12 women who participated in a 6-month hypocaloric dietary intervention. Twelve women with obesity (total body fat ≥35%) underwent transvaginal ultrasonography and venipuncture every-other-day for one inter-ovulatory interval (IOI) both before (baseline) and during the final month (Month 7) of a six-month hypocaloric dietary intervention. Participants were aged 24-34 years and had a self-reported history of regular menstrual cycles (25-35 days). Follicle number and diameter (≥2 mm) were quantified at each study visit, and individual growth profiles for all follicles ≥7 mm were determined. Blood samples were assayed for reproductive hormones. Follicle dynamics and reproductive hormone concentrations were compared pre- and post-intervention. Further, post-intervention follicle and endocrine dynamics (Month 7 IOI) were compared to an age-matched reference cohort of lean women with regular ovulatory cycles (total body fat <35%, N = 21). Participants lost an average of 11% of their original body weight with the hypocaloric dietary intervention. More dominant follicles were detected (≥10 mm) at Month 7 compared to baseline (0. 3 ± 0.4 versus 0.4 ± 0.5 follicles, P = 0.001), and ovulatory follicles were selected at larger diameters post-intervention (7.3 ± 2.0 versus 10.9 ± 2.6 mm, P = 0.007). Luteal progesterone concentrations were increased at Month 7 compared to baseline (5.3 ± 3.65 versus 6.3 ± 4.74 ng/ml, P < 0.0001). However, risk for luteal phase dysfunction as judged by the prevalence of a luteal phase length <10 days, integrated luteal progesterone levels <80 ng/ml or peak progesterone <10 ng/ml did not differ pre- versus post-intervention (all, P > 0.05). In Month 7, follicle dynamics and endocrine profiles were similar to the reference cohort across all measures. This study does not inform on the earliest stages of ovarian follicle development and is limited to providing knowledge on the later stages of antral follicle development. This study cannot fully address causation between weight loss and sustained improvements in antral follicle dynamics. The data cannot be extrapolated to comment on potential improvements in fertility and fecundity with weight loss. The small group sizes limit statistical power. The increasing prevalence of obesity necessitates an understanding of the mechanisms that underlie potential improvements in reproductive health outcomes with weight loss. Women with obesity and regular ovulatory cycles who undertook a 6-month hypocaloric dietary intervention demonstrated improvements consistent with benefits of lifestyle intervention on reproductive health even in those without overt signs of reproductive dysfunction. Potential improvements in the cellular makeup of follicles, which may underlie the restoration of normal follicle development and amelioration of subfertility, require further investigation. Cornell University, President's Council of Cornell Women, United States Department of Agriculture (Grant No. 8106), and National Institutes of Health (R01-HD0937848). B.Y.J. and H.V.B. were supported by doctoral training awards from the National Institutes of Health (T32-DK007158) and Canadian Institutes of Health Research (Grant No. 146182), respectively. The authors have no competing interests. NCT01927432 and NCT01785719.

Premenstrual Syndrome: Awareness and Oral Manifestations in Patients Attending Dental Hospital in Pune

ABSTRACT Fluctuations in androgenic hormonal levels are noticeable through women’s menstrual cycle. Changes in estrogen and progesterone have been shown to affect periodontium. Many women report an increase in gingival inflammation and discomfort associated with their menstrual cycle, most commonly before the menstrual period. Approximately 80% of women experience complaints of premenstrual syndrome (PMS) 7 to 10 days before menstruation. Therefore, the present study was carried out to check prevalence of PMS and its oral and periodontal manifestations in patients attending dental hospital. For the study, 100 systemically healthy women of reproductive age attending dental hospital were selected. Thorough recording of oral discomfort and associated symptoms during late luteal phase was done. Clinical parameters such as plaque index and gingival index were recorded.Thirty-seven females reported complaints suggestive of PMS. Oral changes during PMS were experienced by 59 females. Halitosis and oral ulcers were more frequent. Findings of the present study showed the possibility of influence of sex hormones on oral manifestations during premenstrual period.