Women Of Late Reproductive Age Research Articles

Accelerated bone loss in late reproductive-aged and perimenopausal women with vitamin D insufficiency.

The association between serum vitamin D levels and bone mineral density (BMD) varies by race and gender. This study aimed to evaluate this relationship between serum vitamin D levels and BMD, and changes of BMD over time in Korean women. We analyzed data from 586 generally healthy Korean women aged 29-79 who underwent health check-ups at Seoul National University Gangnam Center between 2010 and 2011 (baseline measurement) and 2015-2016 (follow-up). Dual energy X-ray absorptiometry (DEXA) and serum 25-hydroxyvitamin D (25OH-D) level measurements were conducted. We assessed the association between serum 25OH-D levels and BMD, as well as changes in BMD over time. The mean age of participants was 51.3 ± 7.9years, with a mean follow-up interval of 4.6 ± 0.7years, and mean serum 25OH-D level of 20.6 ± 8.5ng/ml. Baseline serum 25OH-D levels did not correlate with BMD values at the lumbar spine, femoral neck, or total femur, nor with changes in BMD over time. A significant negative association was found between perimenopausal status and BMD changes at all sites, and between premenopausal status and lumbar bone mass, compared to postmenopausal status in the 25OH-D < 20ng/ml group. This association was not observed in women with higher serum 25OH-D levels. Serum 25OH-D levels did not correlate with BMD levels or changes in BMD overall. However, in late reproductive-aged and perimenopausal women with serum 25OH-D insufficiency, there was a significant association with accelerated bone loss.

Immunotherapy is a new opportunity for managing patients with “thin” endometrium in cycles of transfer of thawed embryos

The trend of recent decades has been the search for therapeutic effects on the so-called “thin” endometrium. However, to date there is no optimal management scheme for patients with “thin” endometrium in assisted reproductive technology programs. Aim: to evaluate the effectiveness of using recombinant IL-2 before cryotransfer in women of late reproductive age with “thin” endometrium and repeated implantation failure after transfer of good quality embryos. The study included 63 patients of late reproductive age with “thin” endometrium. The first group consisted of 25 patients of late reproductive age with a history of unsuccessful in vitro fertilization programs with good quality embryos. Cryotransfer to the patients of the first group was carried out in a modified natural cycle. The second group included 38 women of late reproductive age with a history of unsuccessful in vitro fertilization programs with good quality embryos. Cryotransfer for women of the second group was carried out in a cycle with hormone replacement therapy. Recombinant IL-2 in the cycle before cryotransfer were prescribed to all women. In both groups, implantation, clinical pregnancy, and live birth rates following administration of recombinant IL-2 were valuable. In both groups, the implantation rate, clinical pregnancy rate and live birth rate were assessed after administration of recombinant IL-2. Statistical data processing was performed using application software package Statistica 6.0 (StatSoft, Ink. 1994-2001), adapted for biomedical research. p 0.05 was considered significant. After recombinant IL-2 treatment of patients with infertility and thin endometrium, endometrial thickness increases statistically significantly in the first two menstrual cycles after treatment, so transfer of thawed embryos should be planned in the first two menstrual cycles after immunotherapy. In order to increase the thickness of the endometrium during cryotransfer in a modified natural cycle, as well as in a cycle with replacement hormone therapy, recombinant IL-2 can be used in women with “thin” endometrium with repeated unsuccessful implantation attempts when transferring good quality embryos. Cryotransfer should be performed in the first two menstrual cycles after immunotherapy.

Assessment and correction of local antimicrobial protection factors in women with chronic recurrent vulvovaginal candidiasis and type 2 diabetes mellitus

Aim. Evaluation and correction of local antimicrobial protection factors in women with type 2 diabetes mellitus (DM 2) and chronic recurrent vulvovaginal candidiasis (rVVC). Materials and methods. The study involved 100 women undergoing outpatient follow-up at the age of 40.9±5.8 years, with a body mass index of 29.8±3.5. The period was 2022–2023. The examination included anamnesis, collection of anthropometric data, calculation of body weight, microscopic examination of smears from the cervical canal and vagina, Gram-stained before treatment, in the 1st and 3rd months after its completion, identification pathogenic microorganisms using PCR, colposcopy, ultrasound of the pelvic organs. Indicators of glycosylated hemoglobin in the subjects at the control points of the study: at 1 month the average values were 5.9±2.9%, at 3 months – 5.9±3.0%, the average value was 5.9±3.1%. Candida species were identified by the bacteriological method using Sabouraud dextrose agar (growth of colonies of fungi of the genus Candida in an amount of more than 103 CFU/ml). Immunological methods for studying antimicrobial protection factors included studying the number of neutrophil granulocytes (NG) on the surface of the mucous membranes of the vulva and vagina, their phagocytic and NBT-reducing activity in a latex test. Randomization of patients into groups: group 1 included 50 (50%) women with DM 2 who, as part of complex therapy for rVVC received the drug Genferon® 1 intravaginal suppository of 500 thousand units 2 times a day for 10 days and fluconazole 150 mg orally three times with an interval of 72 hours at the first stage of treatment; group 2 included 50 (50%) women who received therapy with fluconazole 150 mg three times with an interval of 72 hours. The maintenance anti-relapse course therapy in both groups included the use of fluconazole 150 mg once a week for 6 months. In group 1st anti-relapse therapy was supplemented by the administration of the drug Genferon® 1 intravaginal suppository of 500 thousand units at night 3 times a week for 3 months, after which the vaginal microbiota was corrected for 2 weeks using vaginal suppositories, containing Lactobacillus acidophilus in an amount of at least 108 CFU. In group 2nd, basic anti-relapse antimycotic therapy was not accompanied by the prescription of any immunomodulatory or probiotic drugs. Results. The etiological agents of rVVC in women of late reproductive age in 79% (n=79) и 28% (n=28), respectively, were C. albicans and C. glabrata, which during the period of acute of the disease were detected by culture in the vaginal discharge at more than 104 CFU/ml. Chronic recurrent course of vulvovaginal candidiasis in women with DM 2 was characterized by exacerbations 4 or more times a year, accompanied by the corresponding clinical picture: white or yellowish-white cheesy discharge from the genital tract, itching or burning in the anogenital area, discomfort in the external genital area, dyspareunia, dysuria, decreased phagocytic activity of NG in vaginal secretions by 25.8%, impairment of their spontaneous and latex-induced NBT-reducing activity by 35.2%, functional reserve by 23.0% relative to reference values. The use of the drug Genferon® as part of complex therapy for rVVC contributed to a decrease in the number of Candida spp. in 1st and 3d months of observation after completion of anti-relapse therapy, normalization of cellular factors of innate immunity of the mucous membranes, faster resolution of the clinical manifestations of an episode of the disease. The decrease in the number of relapses over a 12-month observation period compared to the control group was also facilitated by an increase in the protective properties of the vaginal mucosa due to the restoration of the vaginal microbiota with the help of lactobacilli acidophilus. Conclusion. The etiological agents of rVVC in women of late reproductive age are C. albicans and C. glabrata. Subcompensated DM 2 is a risk factor for rVVC, which requires additional monitoring of microbiological parameters of the vaginal microbiota. rVVC in women with DM 2 is associated with an increase in the number of NG in the vaginal secretion, a decrease in their phagocytic activity and functional reserve compared to the reference values. Combination therapy of rVVC with topical recombinant interferon α2b, benzocaine and taurine in the formulation of Genferon® (suppositories) is an effective method to improve the clinical and immunological efficacy of therapy.

Changes in the Transcription of Proliferation- and Apoptosis-Related Genes in Embryos in Women of Different Ages under the Influence of Extracellular Vesicles from Donor Follicular Fluid In Vitro.

We studied the influence of extracellular vesicles from the follicular fluid of a young donor on gene expression (MKI67, MYBL2, CCNB1, CCND1, CCNE1, CALM2, BAX, NDRG1, TP53I3, VEGF, VCAN, HAS2, CTSL2, PIBF1, RPL37, PFKP, GPX3, and AQP3) in embryos of women of different ages. According to nanoparticle tracking analysis data, the concentration of extracellular vesicles was 3.75±0.47×1011 particles/ml and the mean particle size was 138.78±9.90 nm. During co-culturing of the follicular fluid extracellular vesicles with blastocysts of young women, we observed significantly increased expression of mRNA for genes CTSL2, CCND1, CCNE1, VEGF and reduced expression of BAX gene mRNA in comparison with embryos in women of late reproductive age. We hypothesized that addition of extracellular vesicles of the oocyte follicular fluid from a young donor to the culture medium of embryos could slow down apoptosis process typical of blastocyst cells in women above 36 years.

Relationship between pelvic floor dysfunction and proctologic diseases in women of late reproductive age

Relationship between pelvic floor dysfunction and proctologic diseases in women of late reproductive age

Визначення особливостей перебігу вагітності та пологів, стану плода і новонародженого у вагітних після застосування допоміжних репродуктивних технологій (дані ретроспективного аналізу)

The rapid growth in the number of infertile couples leads to the development of assisted reproductive technologies (ART). Among the most common forms of infertility are tubo-peritoneal, endocrine, and caused by the male factor, and prevention of pregnancy complications caused by ART treatment cycles becomes one of the main tasks of practicing clinicians. Purpose - to determine the features of the course of pregnancy and childbirth; to assess the condition of the fetus and newborn in pregnant women after the application of ART to improve the perinatal outcomes of pregnancy and childbirth. Materials and methods. A retrospective clinical and statistical analysis of 334 histories of pregnancy and childbirth of women, as well as medical records of newborns from women, was conducted over the past five years, which formed the ART group - 221 history of pregnancy and childbirth, and the group of spontaneous pregnancy - 113 history of pregnancy and childbirth. Results. The structure of the subjects was statistically significant dominated by pregnant women over the age of 35 years and pregnant women in late reproductive age. The main characteristics of women after the ART application were a statistically significant predominance of somatic and gynecological pathology. The structure of pregnancy complications in women after ART application was dominated by threatening late spontaneous miscarriages, isthmic-cervical insufficiency and vaginitis, and in the structure of labor complications - anomalies of labor activity and premature rupture of fetal membranes. Among newborns from women in the ART group, perinatal mortality was 18.0%. Conclusions. The revealed features of somatic and gynecological anamnesis, as well as aspects of the course of pregnancy and childbirth and the condition of newborns in women after ART application are the basis for an in-depth examination of this category of pregnant women in order to improve approaches to predicting, diagnosing and optimizing preventive measures, as well as to improve the perinatal consequences of pregnancy and childbirth. 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. No conflict of interests was declared by the authors.

Репродуктивные исходы женщин, страдающих аденомиоз-ассоциированным бесплодием

Relevance. The identification of the relationship between adenomyosis and infertility, as well as the possible overcoming of the consequences, is one of the main tasks of reproduction. Despite the fact that adenomyosis is more often detected in women of late reproductive age, issues related to its effect on the frequency of pregnancy have not yet been studied. It is also worth noting that the average age of pregnancy among women in developed countries tends to late reproductive age, which is of greater interest for solving the problems of adenomyosis-associated infertility. In this article we present an analysis of the literature data on the effect of adenomyosis on fertility. Objective. Based on the analysis of scientific publications, to consider adenomyosis as a cause of infertility from a contraversion position and to describe the reproductive outcomes in this cohort of patients. Results. A search of literature, publications from Pubmed, Embase and Cochran databases for the last 5 years has been carried out. Molecular studies have provided a deep understanding of the pathogenesis of adenomyosis over the past few years, but there is a huge discrepancy between in vitro research and practice. Radical treatment: endometrial ablation and hysterectomy, used to relieve pain caused by adenomyosis, exclude pregnancy planning. Conclusion. Adenomyosis is a common gynecological disease with an unclear etiology that leads to impaired fertility. The presence of different approaches to the treatment of adenomyosis did not contribute to an increase in the effectiveness in achieving fertility. Since there is still the main problem – time. For example, how long should pregnancy be postponed after treatment and whether hormonal treatment improves the outcome of fertility after surgery, such questions still remain controversial and debatable. Despite numerous studies of the pathogenesis of fertility decline in adenomyosis, their results do not correlate with treatment. We also concluded that adenomyosis has an adverse effect on the clinical results of in vitro fertilization. This reduces the frequency of pregnancy and live birth and increases the frequency of miscarriages. Thus, it is very important to study new, more effective, safer and less invasive strategies for managing women with infertility due to adenomyosis.

COCs with estradiol valerate/dienogest vs 17β-estradiol/nomegestrol acetate: effects on metabolism and body composition in menopausal transition women

Context: Women during the menopausal transition (MT) have reduced fertility, and yet frequency of pregnancy in the absence of contraception is about 30%. Late reproductive age women are at a higher risk of adverse pregnancy outcome, and thus require effective contraceptive methods if pregnancy is to be avoided. The use of combined oral contraceptives (COCs), in addition to highly effective pregnancy prevention, is associated with important non-contraceptive benefits for perimenopausal women, such as an improved bleeding pattern, particularly in the setting of irregular or heavy menses, alleviation of vasomotor symptoms. The main requirements in choosing СOCs for women during the MT are their safety, metabolic neutrality, and no weight gain, because during the MT occurs adverse changes in metabolic profile and body composition.

Effect of contraceptive hormonal therapy on mammographic breast density: A longitudinal cohort study

PurposeEvaluate the longitudinal relationship between mammographic density and hormonal contraceptive use in late reproductive-aged women. MethodsPatients aged 35–50 years old who underwent 5 or more screening mammograms within a 7.5-year period between 2004 and 2019 in a single urban tertiary care center were randomly selected. Patients were categorized into four cohorts based on hormonal contraceptive exposure during a 2-year lead-in period and a 7.5-year study period: 1) never exposed, 2) always exposed, 3) interval hormonal contraceptive start, and 4) interval hormonal contraceptive stop. The primary outcome was difference in BI-RADS breast density category between initial and final mammograms. ResultsOf the 708 patients included, long-term use of combined oral contraceptives or a levonorgestrel intrauterine device were not associated with an increase in breast density category over the 7.5-year study period, compared to those with no hormonal contraceptive exposure. Initiation of combined oral contraceptives was associated with an increase in breast density category (β = 0.31, P = 0.045); however, no difference in initial density category was noted between those exposed and those never exposed to combined oral contraceptives during the 2-year lead-in period, and discontinuation was not associated with a decrease in breast density category when compared to those with continuous exposure. Conclusion(s)Long-term use of combined oral contraceptives or a levonorgestrel intrauterine device was not associated with an increase in BI-RADS breast density category. Initiation of a combined oral contraceptive was associated with an increase in breast density category, although this may be a transient effect.

Lower anti-Müllerian hormone levels are associated with HIV in reproductive age women and shorter leukocyte telomere length among late reproductive age women.

We sought to better understand factors associated with ovarian aging in women with HIV (WWH). HIV has been associated with diminished fertility, younger age at menopause, and shorter leukocyte telomere length (LTL), a marker of cellular aging. We herein examine cross-sectional and longitudinal associations between LTL, anti-Müllerian hormone (AMH), and HIV. We included WWH and HIV-negative women 12-50 years of age in the CARMA cohort with one or more study visit(s). LTL and AMH were measured by qPCR and ELISA, respectively. Women were analyzed in peak reproductive (<35 years) vs. late reproductive (≥35 years) life phases. Using multivariable mixed-effect linear or logistic regressions, we assessed factors associated with AMH and ΔAMH/year while adjusting for relevant confounders. WWH had shorter LTL and lower AMH levels compared to HIV-negative controls despite being of similar age. After adjusting for relevant factors, HIV was associated with 20% lower AMH levels in women under 35 years of age and shorter LTL was associated with AMH levels below 2 ng/ml among women aged 35 years or older. Longitudinally, ΔAMH/year was largely related to initial AMH level among older women, and to age in younger women. Factors associated with AMH change across women's reproductive lifespan. Lower AMH among peak reproductive aged WWH suggests that HIV may have an initial detrimental effect on ovarian reserve, an observation that may warrant counseling around pregnancy planning. In women aged 35 years or older, the association between shorter LTL and lower AMH suggests that the immune and reproductive aging connections are more important in this age group.

Impact of Adenomyosis on Infertile Patients-Therapy Options and Reproductive Outcomes.

Adenomyosis is associated with a negative impact on reproductive outcomes. Although adenomyosis is detected more frequently in women of late reproductive age, its impact on pregnancy rates is important because, in today's world, family planning has shifted towards the late reproductive phase of life for many women. Although the diagnostic indications for imaging studies are well-known, we lack strict diagnostic criteria and classification systems concerning the extent of the disease. Selecting the optimal evidence-based treatment option for adenomyosis is difficult because of the paucity of evidence concerning the association between fertility and the degree and composition of adenomyosis. Furthermore, the treatment of infertility might interfere with the treatment of adenomyosis due to the presence of pain. The aim of this review is to analyze the association between adenomyosis and infertility, and describe treatment options to enhance reproductive outcomes. The following aspects will be addressed in detail: (a) prevalence and causes of adenomyosis, (b) diagnostic tools with imaging techniques, (c) clinical symptoms, (d) proposed pathomechanism of adenomyosis and infertility, and (e) different treatment approaches (pharmacological, surgical, others) and their impact on reproductive outcomes.

Markers of ovarian reserve as predictors of future fertility

To determine the association between ovarian reserve biomarkers and future fertility among late reproductive-age women. Cohort study of participants enrolled in Time to Conceive (TTC), a time-to-pregnancy cohort study of the ovarian reserve biomarkers. Community. Women aged 30-44 years without a history of infertility who provided a blood sample at enrollment in TTC and who agreed to future follow-up. Not applicable. The primary outcomes were probability of achieving a live birth >3 years after enrollment in TTC, diagnosis of infertility at any time, and time-to-pregnancy in future pregnancy attempts. Women with diminished ovarian reserve, defined as those with an antimüllerian hormone (AMH) level <0.7 ng/mL or follicle-stimulating hormone (FSH) level ≥10 mIU/mL, did not have low risk of future live birth (relative risk [RR], 1.32; 95% confidence interval [CI], 0.95-1.83 and RR, 1.28; 95% CI, 0.97-1.70, respectively) compared with women with normal ovarian reserve after adjusting for age at blood draw, race, obesity, use of hormonal contraception, and year of enrollment in original study. Among women in the cohort that attempted to conceive, there was not a significant association between diminished ovarian reserve, as measured by AMH or FSH, and risk of future infertility (RR, 0.65; 95% CI, 0.21-2.07 and RR,1.69; 95% CI, 0.86-3.31, respectively). Similarly, there was no association between AMH and FSH levels and future fecundability (fecundability ratio, 0.97; 95% CI, 0.59, 1.60; and fecundability ration, 0.86; 95% CI, 0.55-1.36, respectively). Diminished ovarian reserve is not associated with reduced future reproductive capacity. Given the lack of association, women should be cautioned regarding use biomarkers of ovarian reserve as predictors of their future reproductive capacity.

Перспективи використання sFlt-1, PlGF як біомаркерів прееклампсії, що приєдналася до хронічної гіпертензії

Chronic hypertension during pregnancy has recently shown a significant increase, which is most likely due to the growth in the number of first pregnancies in women of late reproductive age, with chronic hypertension, obesity and other extragenital diseases, as well as an increase in the number of pregnancies as a result of in vitro fertilization. Preeclampsia complicates chronic hypertension in 20-40% of cases, more often associated with early onset (before 34 weeks) and leads to an increase in complications in the mother, fetus and newborn. Currently, there are no reliable biomarkers that make it possible to predict the development of superimposed preeclampsia, but their search is underway. In the general obstetric population, the use of PlGF and sFlt-1 tests has shown to be promising for predicting preeclampsia in women with singleton pregnancies. PlGF and sFlt-1 based tests have begun to appear in clinical guidelines in addition to regular clinical and laboratory testing. But data on the effectiveness of these tests for predicting preeclampsia in groups of pregnant women with chronic diseases, including those with chronic hypertension, is still being collected. Purpose - to evaluate the prospects of using angiogenic factors as biomarkers of superimposed preeclampsia; search for publications in electronic databases (Medline, Embase) from the earliest to January 2023. Conclusions. Changes in angiogenesis markers may indicate the start preeclampsia in pregnant women with chronic hypertension. The values of angiogenesis markers in pregnant women with preeclampsia on the background of chronic hypertension may differ from those in pregnant women with preeclampsia, but without concomitant diseases. In addition, abnormalities in values of angiogenic markers in pregnant women with chronic hypertension compared to normotensive pregnant women may occur without the addition of preeclampsia. The reason may be the effect of chronic hypertension on the development and functioning of the placenta or an altered response of the endothelium to angiogenesis factors. No conflict of interests was declared by the authors.

Drug-Induced Liver Injury after IVF: comorbidity, forced polypharmacy

The growth of liver tests in the second half of pregnancy is most often caused by two reasons - Intrahepatic Cholestasis of pregnancy (ICP) and rarely diagnosed Drug-Induced Liver Injuries (DILI). In Assisted Reproductive Technology (ART)-induced pregnancies that are accompanied by powerful drug support, the incidence of drug-induced cholestasis increases. This is due to the combined use of gestagens and other drugs that have hepatotoxic potential for the prevention of miscarriage. The article reveals the risks of IVF, which is often performed for women in late reproductive age, accompanied by multiple pregnancies, somatic pathology, thrombophilia and forced polypharmacy. The article presents an analysis of the clinical observation of a pregnant woman as a result of IVF, who developed acute drug hepatitis against the background of polypharmacy, and its examination according to the criteria of the European Association for the Study of the Liver (EASL) and the RUCAM algorithm. The author believes that the limitation of the RUCAM scale is manifested by insufficient consideration of the effect of pregnancy and polypharmacy on the development of DILI. According to the author, it is necessary to differentiate the DILI from ICP in connection with the peculiarities in the management tactics, despite their probable genetic affinity and clinical and laboratory similarities. The author suggests that DILI during pregnancy is a reservoir for the subsequent development of chronic diffuse liver diseases in women. In this regard, such patients need the observation of a therapist for 6-12 months after childbirth.

MARKERS OF OVARIAN RESERVE AS PREDICTORS OF FUTURE FERTILITY

Ovarian reserve biomarkers have been shown to be poor predictors of current reproductive capacity. However, their value predicting future reproductive capacity is uncertain. This study sought to determine the association between ovarian reserve biomarkers and future fertility among late reproductive-age women.

Evaluation of ovarian reserve at late reproductive age

Although follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), antimullerian hormone (AMH), and ovarian volume are commonly used to assess ovarian reserve and ovarian response to stimulation, no test directly indicates this. We aimed to observe how ovarian reserve tests help us in the diagnosis and treatment of women of late reproductive age. We included 190 patients in this prospective cohort study. We took FSH, LH, E2 and AMH blood samples on the third day of menstruation to biochemically evaluate the ovarian reserve of the patients who were planned for hysterectomy and bilateral salpingo-oopherectomy at late reproductive age. We recorded antral follicle counts (AFC) and ovarian volumes by transvaginal ultrasonography for ultrasonographic evaluation and weighed ovarian weights postoperatively. The data of 190 women aged 39-44.9 years revealed that AMH and ovarian volume, ovarian volume and AFS show significant positive correlations, whereas FSH, LH, and E2 levels do not indicate a significant relationship with AFS. AMH, ovarian volume and ovarian weight, and AFC may show us the ovarian reserve with the highest reliability in women of late reproductive age.

Management of pregnancy, delivery, and postpartum in patients of advanced maternal age with pregnancies obtained by assisted reproductive technologies

The objective: to reduce the frequency of obstetrical and perinatal complications in women of late reproductive age, whose pregnancy occurred with the help of assisted reproductive technologies (ART).Materials and methods. 150 nulliparous women of late reproductive age with a singleton pregnancy and fetal head presentation without severe somatic and gynecological pathology and fetal malformations, were examined. All patients were randomly divided into three groups: the main group (50 pregnant women after the ART program (n1), who received the developed algorithm – diagnosis, prevention and therapy of gestational anemia, diagnosis and prevention of intranatal complications, prevention of prolonged pregnancy, prevention of hemorrhagic complications, screening, prevention and therapy of perinatal psychological disorders; comparison group (50 patients with ART pregnancy, n2), and control group (50 patients with spontaneous pregnancy, n3). Pregnancy, childbirth and the postpartum period in the patients of the comparison group and the control group were conducted in accordance with the orders of the Ministry of Health of Ukraine. All women had a complete clinical and laboratory examination during pregnancy, childbirth and in the postpartum period, as well as a study of the level of anxiety, sleep quality, and assessment of the development of postpartum depression. Results. During the pregnancy course the percentage of patients with gestational anemia significantly decreased in the main group and was 2.0% versus 30.0% in the comparison group and 18.0% in the control group (р1.2;р1.3&lt;0.05). In the postpartum period, the rate of anemia was also significantly lower in the main group than in the comparison and control groups.26% of patients in the comparison group and 14% – in the control group had labor induction in the term of 40–41 weeks, in the same gestational term 20% of patients in the main group were delivered by the plan caesarean section because of the absence of spontaneous onset of regular labor activity. There was no significant difference in the frequency of normal delivery and cesarean section between the main and comparison groups, but the extensive frequency of urgent cesarean section was significantly lower in the main group and it was 52% versus 83.3% in the comparison group and 86.7% – in the control group (р1.2;р1.3&lt;0.05). The mean volume of blood loss in the main group was significantly less than in the comparison group – 300.0 (250.0; 642.5) ml versus 690.0 (300.0; 800.0) ml (р1.2&lt;0.001) and did not significantly differ from this indicator in the control group - 300.0 (250.0; 600.0) ml. Mean volumes of blood loss separately during vaginal delivery and caesarean section in the main group were also significantly lower than in the comparison group, and were 250.0 (200.0; 280.0) ml versus 300.0 (255.0; 350.0) ml (р1.2=0.004) and 650.0 (610.0; 740.0) ml versus 750.0 (700.0; 800.0) ml (р1.2=0.01), respectively . As pregnancy progressed, the patients in the comparison and control groups were more prone to high anxiety and sleep disturbances. For the patients of the comparison group, in contrast to the women of the main group, there was a significant increase in the time required to fall asleep, the frequency of awakenings during the night, women more often needed to use sleeping pills and complained of excessive sleepiness during the day and, accordingly, had significantly lower indicators of subjective evaluation sleep quality. At 35–37 weeks of pregnancy, the rate of patients with high levels of state and trait anxiety was significantly lower in the main group than in the comparison group (28.0% vs. 66.0% and 14.0% vs. 52.0% , respectively; p1,2&lt;0.05). Immediately after delivery, levels of both state and trait anxiety decreased slightly in all study groups, but the validity of the differences remained constant. The frequency of patients with a moderate risk of the postnatal depression development was 16% in the main group, 36% – in the comparison group (p1.2&lt;0.05) and 20% – the control one. In 6-8 weeks after childbirth, on the background of gaining the necessary experience, there is a moderate improvement in the quality of sleep and a significant decrease in anxiety levels in all groups. The rate of patients with a moderate risk of depression development in this term remained lower in the main group than in the comparison group (12% vs. 38% ; p1.2&lt;0.05), in the control group this indicator was 18% . Conclusions. The study proved the feasibility, efficacy, and safety of the treatment and diagnostic algorithm for prevention the obstetrical and perinatal complications in patients in late reproductive age who became pregnant after the use of ART.

Hormonal and genetic causes of poor response to controlled ovarian stimulation in women of late reproductive age

Objectives: to investigate the hormonal and genetic determinants of the poor response to controlled ovarian stimulation (COS) in women of late reproductive age.Materials and methods. 130 patients from assisted reproductive technology programs were examined. The main group of 80 older reproductive aged patients (35 years and older) was divided into 2 subgroups according to the POSEIDON criteria. Subgroup 1 included 34 women with a predicted poor response to COS, subgroup 2 – 46 patients with a predicted normal response to COS. The comparison group consisted of 50 patients under the age of 35 with a predicted normal response to COS.The pituitary hormones (luteinizing, follicle-stimulating hormones, prolactin), steroid hormones (testosterone, estradiol, progesterone), cortisol, anti-Mullerian hormone (AMH) and inhibin B values was determined in blood serum by the ELISA. Blood was taken on the third day of the menstrual cycle. A molecular genetic study of FSHR gene polymorphism (Ala307Thr, Ser680Asn) was performed.Results. AMH decrease, estradiol increase and inhibin B decrease in potentially poor responders to COS may be an additional indication of reduced ovarian reserve. The level of follicle-stimulating hormone increases with age, but does not have high specificity as a marker of ovarian reserve. Elevated levels of cortisol emphasize its role in reproduction and correspond to increased stress value. The effectiveness of IVF if there were 4 or more mature oocytes obtained is associated with higher levels of AMH and inhibin B, and lower estradiol and cortisol values. The multifaceted dependence of the COC effectiveness in women of older reproductive age on the parameters of the hormonal profile, confirmed by correlation analysis, reflects the complexity of the reproductive function implementation with the use of auxiliary reproductive technologies in such patients. The combination of AA/SS genotypes for the Thr307Ala and Asn680Ser polymorphisms of the FSHR gene can be an additional marker of COC inefficiency.Conclusions. Determination of the hormones levels (inhibin B, estradiol and cortisol), the study of Thr307Ala and Asn680Ser polymorphisms of the FSHR gene can provide additional information for predicting the response to COS in women of older reproductive age.

Медико-соціальні особливості пацієнток пізнього репродуктивного віку зі зниженим оваріальним резервом

Purpose - to determine medical and social features of patients of late reproductive age with reduced ovarian reserve. Materials and methods. 130 patients with assisted reproductive technologies (ART) programs were divided into groups according to POSEIDON criteria. The main group of 80 patients of older reproductive age (35 years and older) is divided into 2 subgroups according to the POSEIDON criteria. Subgroup 1 consisted of 34 women with a predicted poor response to controlled ovarian stimulation (COS) - group 4 according to POSEIDON. Subgroup 2 - 46 patients with a predicted normal response to COS (POSEIDON group 2). The comparison group consisted of 50 patients under 35 years of age with a predicted normal response to COS (POSEIDON group 1). The quality of life was assessed according to the FertiQoL questionnaire, the presence and degree of depression according to the method of V. Zung. Results. The share of women aged 40 and older among patients with ART programs with a predicted poor response to COS is 3 times higher than the predicted normal respondents (32.4% vs. 10.9%), which reflects the decisive role of women’s age in reducing ovarian reserve. A significant proportion of women in this category report such a bad habit as smoking (17.6%), the third - a sedentary lifestyle (32.4%) and stress (29.4%), 26.5% - a violation of the daily routine and work. Problems with reproduction affect the quality of life of women and cause psychological changes. More than a third of women (35.3%) rate their health as poor and very poor, and more than half (53.0%) are dissatisfied with their quality of life. The emotional sphere suffers the most from fertility problems (score - 45.3±2.2), and the assessment of mental and physical health and social functioning is reduced. Although patients appreciate the quality of treatment, its tolerability is worse in these women. At the same time, the psychological state of half of women is assessed as subdepressive or masked depression (52.9%), and depression was diagnosed in 14.7% of respondents. Conclusions. Established medical and social characteristics of women of late reproductive age with reduced ovarian reserve (smoking, daily and work disorders, sedentary lifestyle, stress, low quality of life, subdepressive and depressed state) indicate the need for additional inclusion in ART training programs lifestyle and methods of psychocorrection. 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 authors. Keywords: infertility, older reproductive age, reduced ovarian reserve, assisted reproductive technologies, quality of life, depression.

108 Uterine myoma and pregnancy in late reproductive age women: What to do?

Introduction and aims: of the study: Fibroids are one of the most common benign uterine tumors in women of reproductive age, occurring in 20-50%. The presence of fibroids not only affects a woman's chances of becoming pregnant, but can also lead to complications during gestation, childbirth and the postpartum period. Studydesign: The clinical case from our practice is considered. Woman U., 45 years old 2 years ago applied for a consultation about menorrhagia, lower abdominal pain and infertility during the year.