Older Reproductive Women Research Articles

Frequency of internet use and hypertension risk among men and women in Kenya: an analysis of the 2022 demographic and health survey

BackgroundThe proliferation of internet use in the 21st century has brought about a pluralistic effect on health. Users of the internet are more exposed to health information, thus, making them more health literate and more likely to adopt healthy behaviors. However, frequent use of the internet has been found to adversely affect mental health (e.g., depression), social wellbeing, and obesity. Yet, the link between internet use and physical health outcomes such as hypertension remains less explored. We examined the association between frequency of internet use and hypertension risk among women and men in Kenya using data from the 2022 Kenyan demographic and health survey.ResultsOverall, the prevalence of hypertension was higher among women (1,398 [8.69%]) compared to men (504 [3.49%]). Those who reported using the internet often reported higher prevalence of hypertension (women: n = 638 [10.49%]; men: n = 279 [3.98%]). The mean age was 29.3 years (SD = 9.6) for women and 29.9 years for men (SD = 10.9). After adjusting for potential confounders, women who reported often using the internet also demonstrated a significant association [AOR = 1.21; 95%CI: 1.03–1.43]. However, we found no significant association between frequency of internet use and hypertension among men after adjusting for confounders.ConclusionOur study concludes that frequent use of internet is positively associated with hypertension risk among women but not men. Policymakers may consider implementing guidelines or regulations to promote healthy internet usage habits and encourage breaks or limits on screen time, especially for individuals at risk of hypertension (i.e., older women of reproductive age, women with higher education, married and previously married women, those in affluent households, parous women, those who consume alcohol and those overweight/obese). Healthcare providers should educate patients about the potential health consequences of prolonged internet usage and incorporate discussions about screen time management into routine clinical encounters.

When one door closes: a qualitative exploration of women’s experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria

BackgroundCOVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources.MethodsThe study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software.ResultsWomen reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women’s SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies.ConclusionCOVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Chromosomal Abnormalities in Early Pregnancy Losses: A Study of 900 Samples.

Chromosomal abnormalities are the most common causes of early pregnancy losses (EPLs). In this study, we aimed to evaluate the incidence and spectrum of chromosomal abnormalities in EPLs and correlate them with different clinical characteristics. We performed Quantitative Fluorescent PCR (QF-PCR), followed by subtelomeric Multiplex Ligation Probe Amplification (MLPA) analysis to detect chromosomal abnormalities in 900 products of conceptions (POCs) from EPLs collected over a period of 10 years. Chromosomal abnormalities were present in 56.25% of uncontaminated EPLs, with significantly higher incidence in women ≥36 years (71.37%, p<0.0001) in comparison to women ≤30 years of age (43.40%). Trisomies were also more common in women ≥36 years (79.68%, p<0.0001) than in those ≤30 years of age (48.70%). In contrast, triploidy and monosomies were more prevalent in women ≤30 years of age (26.09%, p<0.0001 and 16.52%, p=0.0066 respectively) than in women ≥36 years of age (6.42% and 6.42% respectively). Trisomy 16 was more common in women ≤30 (39.29%, p=0.0009) than in those ≥36 years of age (16.78%), while trisomy 22 was predominant among women ≥36 (23.49%, p=0.013), and was not present in the group of women ≤30 years of age. The frequency of chromosomal abnormalities in POCs from women with sporadic (61.19%) was higher than in those with recurrent EPLs (55.21%). This difference, however, was not statistically significant (p=0.164). Although some differences in the chromosomal aneuploidy rates among women with different ABO blood groups, as well as among 6-8 and 9-11 gestational week EPLs were observed, further larger studies are required to confirm these findings. In conclusion, our study enriches the knowledge about chromosomal abnormalities as a cause of EPLs and confirms the higher incidence of foetal chromosomal abnormalities in EPLs in women of older reproductive age. Furthermore, it shows that using QF-PCR and MLPA methodologies, a high detection rate of chromosomal abnormalities in EPLs can be reached.

Melatonin enhances the developmental potential of immature oocytes from older reproductive-aged women by improving mitochondrial function

AimsTo evaluate whether melatonin (MT) supplementation during in vitro maturation (IVM) of human oocytes can reverse the age-related decline in oocyte quality. Main methodsWe enrolled 172 patients aged ≥35 years (older reproductive-aged women) and 83 patients aged <35 years (young women) who underwent in vitro fertilization between 2019 and 2022. We conducted IVM with and without 10 μM MT in immature oocytes of different ages. Oocyte fertilization and embryo development were observed using a stereomicroscope. We assessed the immunofluorescence intensity of mitochondrial function, measured the copy number of mitochondrial DNA (mtDNA), and examined the spindle and chromosome composition in in vitro mature stage II (IVM-MII) oocytes using immunofluorescence and second-generation sequencing. Key findingsMT supplementation significantly improved the redox level in the IVM medium and IVM-MII oocytes in older reproductive-aged women. It also significantly increased the proportion of circular mtDNA and the adenosine triphosphate content in IVM-MII oocytes. In addition, the IVM-MII oocytes obtained with MT supplementation showed a significant improvement in the normal composition of the spindle and chromosomes. Thus, the aged immature oocytes also showed significantly improved maturation and blastocyst formation rates owing to the role of MT. SignificanceSupplementation with 10 μM MT in the IVM medium reverses the age-related decline in oocyte quality. Our findings provide a viable solution for enhancing fertility in older reproductive-aged women.

New therapeutic opportunities in improving the antenatal management of obese women

Research objectives: to assess the effectiveness of the developed treatment complex on the course of pregnancy and childbirth in obese women.Materials and methods. 135 pregnant women were examined depending on the degree of obesity and received treatment. The women were examined and treated in the Department of Pathology of Pregnancy and Childbirth, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine” during 2019–2021.The developed medical complex included: Miofolic 2 sachets/day 3 months before pregnancy and throughout the gestation period; in case of insufficiency or deficiency of vitamin D, this vitamin was prescribed in a dose of 4000 IU/day; magnesium citrate 250–300 mg/day during pregnancy; micronized progesterone vaginally 200–400 mg/day in the II phase of the menstrual cycle before conception and up to 34 weeks of gestation (if necessary); individual programs of prenatal psychological rehabilitation using psychophysical exercises were used depending on the psychosomatic disorders.Results. it was found that the number of pregnant women of older reproductive age is increasing. There was a decrease in pre-pregnancy weight (which was positively reflected in the subsequent course of pregnancy) at the 3 months before the onset of pregnancy in women with lifestyle modification (diet therapy, dosed physical activities) and who intake a developed treatment complex at the pre-gravid stage.A peculiarity of the somatic morbidity of pregnant women was the combination of various types of extragenital diseases. Significant differences were found between chronic diseases of the cardiovascular system and diseases of the gastrointestinal tract and liver compared to the control group. The course of pregnancy largely depended on the reproductive system status before fertilization – an increase in the frequency of infertility was noted with an increase in the woman’s body mass index.Pregnant women who received the developed treatment complex had fewer pregnancy complications, the frequency of which was not significantly different from the control group. At the same time, against the background of the treatment, their lipid profile and vitamin and mineral supply improved. All this had a positive effect on the pregnancy outcomes.Conclusions. Developed medical complex including myo-inositol, starting from the pre-gravid period and throughout pregnancy, helps to reduce insulin resistance in obese women, improve the lipid profile and normalize the leptin level, which has a positive effect on the course of pregnancy and childbirth and improves perinatal outcomes.

Patterns of contraceptive use through later reproductive years: A cohort study of Australian women with chronic disease.

Pregnancies among women with chronic disease are associated with poor maternal and fetal outcomes. There is a need to understand how women use or don't use contraception across their reproductive years to better inform the development of preconception care strategies to reduce high risk unintended pregnancies, including among women of older reproductive age. However, there is a lack of high-quality longitudinal evidence to inform such strategies. We examined patterns of contraceptive use among a population-based cohort of reproductive aged women and investigated how chronic disease influenced contraceptive use over time. Contraceptive patterns from 8,030 women of reproductive age from the Australian Longitudinal Study on Women's Health (1973-78 cohort), who were at potential risk of an unintended pregnancy were identified using latent transition analysis. Multinomial mixed-effect logistic regression models were used to evaluate the relationship between contraceptive combinations and chronic disease. Contraception non-use increased between 2006 and 2018 but was similar between women with and without chronic disease (13.6% vs. 12.7% among women aged 40-45 years in 2018). When specific contraceptive use patterns were examined over time, differences were found for women with autoinflammatory diseases only. These women had increased odds of using condom and natural methods (OR = 1.20, 95% CI = 1.00, 1.44), and sterilisation and other methods (OR = 1.61, 95% CI = 1.08, 2.39) or no contraception (OR = 1.32, 95% CI = 1.04, 1.66), compared to women without chronic disease using short-acting methods and condoms. Potential gaps in the provision of appropriate contraceptive access and care exist for women with chronic disease, particularly for women diagnosed with autoinflammatory conditions. Development of national guidelines as well as a clear coordinated contraceptive strategy that begins in adolescence and is regularly reviewed during care management through their main reproductive years and into perimenopause is required to increase support for, and agency among, women with chronic disease.

Immunological and immunohistochemical features of endometrial implantation factor in healthy patients of late reproductive age

Аbstract. Relevance. The number of women of older reproductive age is steadily increasing, and repeated failures of Assisted Reproductive Technologies programs during the transfer of high-quality embryos indicate the possibility of disruption of embryo implantation processes associated with impaired receptivity and functionality of the endometrium. Morphological, immunological and immunohistochemical changes in the endometrium associated with age factor may be decisive for the formation of the «implantation window» and correction of these changes and may improve the outcomes of Assisted Reproductive Technologies for a cohort of patients of older reproductive age. The aim of the study - to expand the pathogenetic understanding of the violation of the implantation ability of the endometrium in healthy patients of older reproductive age. Materials and Methods. A prospective sample study of 46 patients (group 1), aged 38 to 45 years with an officially registered diagnosis of infertility lasting no more than 4 years, with a successful gynecological and obstetric history, who were about to have their first IVF attempt, was conducted. The patients were examined according to Order № 803n of the Ministry of Health of the Russian Federation. Additionally, the level of peripheral blood melatonin, the determination of progesterone, estrogen, HLA-DR (MHC II), CD56 (NK cells), CD138, leukemia inhibiting factor receptors in the endometrium were studied. Concentrations of IL-6, IL-10, TGFß, and VGEF were determined in the cervical secretion, with the calculation of the pro-inflammatory index, as the ratio of IL-6/IL-10 cu and the ratio of TGFß1/VEGF. Statistical data processing was performed using the Statistica 10.0 application software package (StatSoft, Inc., USA). Results and Discussion. In the group of healthy patients of older reproductive age, there is an imbalance of steroid receptors and secretory transformation of the endometrium against the background of relative hyperestrogenism, with a decrease in the reception of own hormones in the endometrium. A decrease in melatonin signals a disorder of pineal and pituitary control over ovarian cycling. There is a decrease in the expression of leukemia inhibiting factor. Signs of inactive chronic endometritis with an autoimmune component are monitored, confirmed by a pro-inflammatory cytokine balance. The predominance of fibrosis processes over angiogenesis processes is confirmed by an increase in the ratio of TGFß1/VEGF and highly resistant blood flow in the uterine arteries. Conclusion. Standard pre-gravidar preparation cannot compensate for all factors that violate the implantation potential of the endometrium in this cohort of patients and requires the development of new complex techniques that directly affect the diversity of all factors that ensure the natural extinction of reproductive potential in order to increase the effectiveness of Assisted Reproductive Technologies programs.

Embryological Characteristics and Preimplantation Genetic Testing for Aneuploidy of Embryos Derived from Cryopreserved Oocytes of Women of Different Reproductive Ages.

Oocyte vitrification is widely used for female fertility preservation. However, the efficacy of this procedure may depend on the women's age. The aim of the study was to compare the morphology, viability of cryopreserved oocytes, and their fertilization outcomes (fertilization, blastulation rate, level of embryo chromosomal aneuploidy-preimplantation genetic testing for aneuploidy [PGT-A]) in women of different reproductive ages. The studied oocytes were divided into groups depending on the age of patients: up to 30 years (group 1), 30-35 years (group 2), 36-40 years (group 3), and older than 40 years (group 4). It has been shown that in women of older reproductive age, the number of oocytes with polymorphism of endo- and extracytoplasmic structures was higher compared with younger patients. This could reflect on their cryosurvival rate, which was the highest in group 1 (98.1%) and the lowest was in group 4 (47.4%). With increasing age, the fertilization rate of cryopreserved oocytes and subsequent blastulation was decreased. However, the number of embryos with an aneuploid chromosome set number was increased. The chromosome set number euploidy rate of the embryos obtained from cryopreserved oocytes of advanced age women (group 4) did not differ from the fresh group with the same age (31.2% vs. 24.4%, p > 0.05), but the number of euploid embryos per patient was less than one (0.8 ± 0.1). Therefore, the decision to cryopreserve the oocytes of a patient of older reproductive age should be made individually for each situation, taking into account the prospects of obtaining full-fledged embryos and the chances of pregnancy.

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.

PECULIARITIES OF INFERTILITY AND ITS TREATMENT BY ART METHODS IN OLDER REPRODUCTIVE AGE WOMEN

The mother's older reproductive age is an important social and clinical issue. Currently, the proportion of women who postpone childbirth until the end of the 3rd - beginning of the 4th decade of life has increased significantly, especially in Western societies. The success rate of in vitro fertilization (IVF) decreases significantly when women enter the 5th decade of life.&#x0D; The aim of the research: to determine the features of infertility and its treatment by ART methods in women of older reproductive age.&#x0D; Materials. An analysis of 658 patient histories of IVF programs for 2015-2019. Given the purpose and objectives of our research for further analysis, we divided patients into 2 groups: the main group - 333 women aged 35 and over and the control group - 325 women under 35 years. Additionally, in the main group there were 2 subgroups: the first - 199 women aged 35-39 years, the second - 124 women over 40 years.&#x0D; Results. There is a tendency to a gradual increase in the share of older women who want to become mothers: in 2019 the share of women aged 35 and over increased by 6.1% compared to 2015 (from 47.6% to 53.7%), the share of the oldest age group over 40 years is also growing (from 18.3% in 2015 to 21.6% in 2019), and the total share of such patients is quite significant (on average 20.4% in 5 years, which even higher than patients under 30 years of age - 18.5%), which corresponds to the global trend of «delayed motherhood».&#x0D; In recent years, intraplasmic sperm injection (ICSI) has been the most frequently used among ART methods in both the main and control groups: 42.2% in the main group and 47.7% in the control group (p&gt; 0.05), with the share of the oldest women age group was significantly lower than in the control (38.7%, p &lt;0.05). Women in the assisted reproductive technology (ART) programs of the older age group were much more likely to be forced to use oocyte donation (14.2% vs. 3.7% under 35 years of age). After 40 years, this method of ART was used by almost a quarter of patients (23.4%).&#x0D; The analysis revealed a significant discrepancy in the distribution of the etiology of infertility: if in the control the largest share fell on a combination of factors (31.1%) and tubal factor (25.2%), then half (48.0%) of older women are classified in the subgroup «only another female factor», which includes endocrinological disorders, ovarian insufficiency and others. After the age of 35 and 40, the share of women with primary infertility decreases (34.1% and 27.4% against 48.0% under the age of 35) and the share of those who suffer from infertility for more than 5 years increases. Decreased ovarian reserve was diagnosed in 48.0% of patients after 35 years, after 40 years this figure reaches 57.3%, which corresponds to the rates of increase in follicle-stimulating hormone and decrease in anti-mullerian hormone relative to age.&#x0D; A quarter (24.0%) of women over the age of 35 have already had one failed IVF attempt, and 12.6% had 2 or more attempts. After 40 years, the proportion of women with at least two IVF attempts increases to 16.9%.&#x0D; After 35 years, the share of clinical pregnancies per started cycle (30.0% vs. 39.1%) and live births (21.1% vs. 30.2%) significantly decreases. After 40 years, these 2 indicators fall sharply and are 21.8% and 13.7%.&#x0D; Conclusions. Given the increase in the proportion of women who resort to ART in older reproductive age, as well as a number of factors that worsen the prognosis of ART, among which the reduction of ovarian reserve is the least controlled, it is important to find methods to optimize approaches to preparing patients of late reproductive age quality mature oocytes.

Polycystic ovary syndrome and black race are associated with increased blood pressure

IntroductionPolycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive age women and is associated with comorbidities including obesity, type II diabetes and hypertension. Few studies have focused on older reproductive age women (i.e., &gt; 30 yrs) with PCOS, when blood pressure (BP) and cardiovascular disease (CVD) risks begin to increase. We tested the hypotheses that PCOS in older reproductive age women are associated with greater systolic, diastolic, and mean BP (SBP, DBP, &amp; MAP), and that the BP relationships are independent of BMI.MethodsWe used EHR data provided by the Joint Data Analytics Team (JDAT) at the Yale School of Medicine. We examined women evaluated for new‐patient diagnoses, follow‐op, or infertility evaluations/procedures by the same provider between 10/7/11 to 12/23/15. Of the 13,951 women, n=261 with PCOS and n=168 controls (diagnosed with tubal and/or male factor infertility) were identified. BP measurements were measured at the time of or following the diagnosis of PCOS or male factor/tubal infertility. We used t‐tests to determine group differences in BP and BMI, and multivariable linear regressions to determine associations. Regressions were adjusted for age, race, and BMI; the interaction between PCOS and BMI was examined using a BMI centered product term and accounted for in the final model. The data were then stratified by BMI (obese, BMI ≥ 30 kg/m2) vs non‐obese, BMI &lt; 30 kg/m2) and a multivariable linear regression model adjusted for age and race was used to examine PCOS as a predictor of BP indices in obese versus non‐obese women.ResultsAge and BMI were greater in PCOS, (36±3 yr; 33±9 kg/m2) versus Controls (37±3 yr; 28±7 kg/m2, p&lt;0.001), while racial breakdown was similar: PCOS: 72% white, 11% black, 4% Asian, 15% Hispanic, and Controls: 60% white, 18% black, 8% Asian, 20% Hispanic. Respectively, the SBP, DBP, &amp; MAP for PCOS (122±13; 77±10; 92±10) were greater vs Controls (116±15; 73±10, 88±11, p&lt;0.001). Our multivariable linear regression model demonstrated an interaction between PCOS and BMI with negative slopes (β), (r2=0.176, β= ‐0.216, p=0.030; r2=0.181, β=‐0.294, p=0.003; r2=0.203, β=‐0.282, p=0.004, for SBP, DBP, &amp; MAP respectively). When stratified by BMI, racial breakdown for groups was similar: N=242 obese group, 67% PCOS, BMI=38 ±6 kg/m2, age=36±3 yr, 65% white, 19% black, 20% Hispanic, and N=187 non‐obese group, 52% PCOS, BMI=24±3 kg/m2, age=36±3 yr, 70% white, 7% black, 13% Hispanic. In a model adjusted for age and race, PCOS predicted SBP, DBP, and MAP in the obese group (r2=0.073, p&lt;0.001; r2=0.061, p=0.001; r2=0.073, p&lt;0.001) but not in the non‐obese group (r2=0.018, p=0.269; r2=0.034, p=0.050; r2=0.025, p=0.078). Additionally, in the obese‐group, black race significantly predicted SBP (r2=0.073, p=0.018) and MAP (r2=0.073, p&lt;0.028), although race was not a significant factor in the non‐obese group.ConclusionThese data show that in older reproductive age women with obesity, PCOS and black race are independent predictors of worsening BP indices. NIH 5 T35 HL 7649‐35.

The Course of Pregnancy and the Outcome of Childbirth in Women of Older Reproductive Age

The purpose of the study was to determine the frequency and structure of complications of pregnancy and childbirth in pregnant women of the older age group according to the history data. Materials and methods. We examined 90 pregnant women aged 35-44 years. The groups were divided as follows: the main group (I) consisted of 30 patients, the comparison group (group II) – 30 patients and the control group (group III) – 30 patients. All patients, according to the existing standards of obstetric examination, underwent clinical and laboratory tests. Randomization was carried out according to age, social factors, concomitant gynecological and extragenital diseases. For the study, a questionnaire was developed, which, along with the social characteristics of women (age, education level, marital status), included questions about women's employment, reproductive behavior, the presence of sexually transmitted diseases, and inflammatory diseases of the female genital organs. Results and discussion. In women of older reproductive age, the course of the gestational period is reliably more often complicated by gestosis – (40.0-46.7%), the threat of termination of pregnancy (36.7-5%), premature childbirth (26.7-33.3%). In childbirth, this contingent of women is more likely to have weakness in labor (10.0-13.3%). The results of the study show that in women of the main group, pregnancies ended with spontaneous abortions significantly more often – 9 (30%), the number of operative deliveries was significantly higher – 4 (13.3%), in the comparison group there were 9 (30%) and 2 (6.7%) such women, respectively. The main complaints in previous pregnancies were pain in the lumbar region and lower abdomen – 53.3% and 46.6% among pregnant women in the main group and the comparison group. Nausea and vomiting were observed in 9 (30%) and 8 (26.6%) women, respectively, in both groups, however, in the control group, the incidence of this complaint was also quite high (16.6%). In 5 (16.6%) and 7 (23.3%) women, bloodstroke from the in vitro fertilization was revealed. In all three groups, the most common complaint was neurovegetative symptoms: sleep disturbance (8-26.6%, 10-33.3% and 4-13.3%), and appetite disturbance (10-33.3%, 6.0-20%, 9-30%). Also, 5 (16.6%) pregnant women of the main group and 6 (20%) of the comparison group complained of increased blood pressure from 8-10 weeks of pregnancy. Pregnancy in patients aged 35 years and older should be classified as pathological already in the pregravid period. Conclusion. Thus, pregnant women aged 35 and older have an extremely unfavorable background from the obstetric-gynecological history and the frequency of abdominal delivery is by 2.5-3 times higher than in the control group

Isolated Fallopian Tube Torsion in an Adolescent - A Case Report

Introduction: Isolated fallopian tube torsion is rare and can be challenging to diagnose given its non-specific presentation. Although this condition is often associated with older women of reproductive age, young adolescents are not spared. Despite advances in imaging, the diagnosis is almost exclusively made by direct visualization during surgery, as occurred with this case. Clinical Findings: The patient’s initial presentation mimicked appendicitis, and subsequent imaging led us to prioritize diagnoses other than fallopian tube torsion. Although ovarian torsion was high on the differential, we did not make the correct diagnosis—isolated left fallopian tube torsion—until direct visualization in the operating room. Clinical Course: Due to the extent of necrosis, the fallopian tube could not be salvaged, and the patient underwent an uncomplicated unilateral salpingectomy. Her recovery was uncomplicated, and her future fertility outcomes are unknown. Conclusions: In hindsight, earlier surgical exploration could have led to a timelier diagnosis and preservation of the affected fallopian tube.

Obesity and efficacy of in vitro fertilization programs in older women of reproductive age

Obesity and efficacy of in vitro fertilization programs in older women of reproductive age

Pregnancy women in older of reproductive age: the state of the problem, features of the course, perinatal consequences

In today's world, the trend towards later childbirth is increasingly common in developed countries. In the age structure of pregnant women there was a significant shift towards an increase in the share of women of older reproductive age (over 35 years) compared to young pregnant women against the background of a decrease in the total number of births. Purpose: the identification of the main risk factors for obstetric and perinatal complications in women of older reproductive age (35+) in modern realities. Materials and methods of research. In the dynamics of pregnancy was examined 75 pregnant women over the age of 35, who were treated and delivered in the Department of Pathology of Pregnancy and Childbirth SI “Academician O.M. Lukyanova IPOG of the NAMS of Ukraine”. The distribution of women by age category was as follows: 1st group – 43 women aged 35–39 years, 2nd group – 43 women aged 40 years and older (3 women were aged 45, 50 and 56 years). The comparison group consisted of 39 pregnant women under the age of 35 with a physiological course of pregnancy (group 3). Research results. All women in groups 1 and 2 had low levels of vitamin D – deficiency was found in 55.6 % of women in group 1, 41.7 % of women in group 2 and 73.7 % – in the control group. The optimal indicators of estradiol levels were in women of the control group – (67.4 ± 1.1) nmol/l, which is 6.1 % more than in pregnant women of group 1 and 15.8 % more than in group 2. The concentration of progesterone in the serum of women over 40 years was reduced and amounted to (433.2 ± 9.2) nmol/l, which was significantly different from the women of group 1 and control group: (467.2 ± 13.2) nmol/l and (553.2 ± 14.6) nmol/l, respectively. Placental dysfunction was observed in every second pregnant woman (55.0 %) of group 2, fetal distress – in every fourth pregnant woman of groups 1 and 2. Anxious variant of the psychological component of gestational dominance was observed in 25.0 % of pregnant women in group 2 and in 14.3 % of women in group 1. Urgent childbirth among both groups of respondents occurred in 36.7 % of women, in group 3 urgent childbirth occurred in 84.2 % of women. In group 1 there were significantly more urgent births compared to group 2 – 55.5 % and 8.3 %, respectively (p &lt; 0.05); in the control group there were also more urgent births, compared with group 2 – 84.2 % and 8.3 % (p &lt; 0.05). Conclusions. The number and severity of complications of gestation is directly proportional to the age of the pregnant woman. There are greater manifestations of obstetric pathology in older women and firstborns. These women have a history of many inflammatory diseases, especially of the genital area; more women were overweight (33.3 %). As a prevention of complicated pregnancy and childbirth in women of older reproductive age, it is proposed to further develop a comprehensive system of pre-pregnancy training. Key words: late reproductive age, pregnancy, childbirth, complications, obesity, micronutrient metabolism, hormonal homeostasis, fetoplacental complex, prevention, pre-pregnancy training.

Do Older Women of Reproductive Age Have Better Diet Quality than Younger Women of Reproductive Age?

There is increasing recognition of the importance of nutrition for reproductive health, but little is known regarding the diet quality of younger vs. older reproductive aged women, and how their intakes relate to dietary recommendations. The purpose of the study was to examine the diets of younger (19–35 years old) compared to older (35–50 years old) reproductive aged women, and how they align with dietary recommendations. Women aged 19–50 years from the 2011–13 Australian National Nutrition and Physical Activity Survey were included (n = 2323). Dietary intakes were assessed by a single 24-h dietary recall and were compared to (i) Australian Dietary Guidelines; (ii) Acceptable Macronutrient Distribution for protein, carbohydrates, and fat; and (iii) Dietary Guideline Index (DGI). Regression analyses comparing younger and older women against recommendations were undertaken, with confounders determined a priori. There was no difference between older and younger women in meeting food group recommendations, with 26% of all women meeting recommendations for fruit, and meat and alternatives, and <20% meeting recommendations for vegetables and alternatives, grains, and dairy. Although there was no difference between older and younger women in total DGI score (mean (SE) 75.6 (1.7) vs. 74.5 (2.5), p > 0.05), older women had higher component scores in limiting saturated fat, consuming low-fat milk, and limiting adding salt during cooking. Continued health promotion for women of reproductive age should be a key priority to improve their own health and that of future generations.

ADDITION OF RAPAMYCIN AND YOUNG GRANULOSA CELLS TO IMPROVE IN VITRO OOCYTE MATURATION AND EUPLOIDY RATES IN OLDER REPRODUCTIVE AGE WOMEN: A PROSPECTIVE RANDOMIZED STUDY

The bi-directional communication between the oocyte and the granulosa/cumulus cells plays a key role in follicle and oocyte maturation. Rapamycin (sirolimus) is a macrolide immunosuppressant that inhibits the mechanistic target of rapamycin (mTOR) protein kinase, which is a regulator of lifespan, aging, and cellular senescence. Recent studies suggested that rapamycin may help improve oocyte development in aging women. In this study, we aimed to determine whether the incubation of immature (germinal vesicles (GV) stage) oocytes from older reproductive age women with rapamycin and/or granulosa cells (GCs) from young donors would affect maturation and euploidy rates.

Environmental exposures and anti-Müllerian hormone: a mixture analysis in the US based Nurses’ Health Study II (NHSII)

BACKGROUND AND AIM: Previous studies have linked exposures such as air pollution and greenness with anti-Müllerian hormone (AMH), a marker of ovarian reserve. However, the association of multiple environment factors has not been addressed. We aimed to assess the impact of a mixture of environmental exposures on AMH. METHODS: A total of 2,449 premenopausal women in the NHSII, a US nationwide prospective cohort who provided blood samples for AMH assay were included. Exposure to greenness, particulate matter, noise, outdoor light at night (LAN), ultraviolet radiation, and 6 hazardous air pollutants (HAPs) (1,3-butadine, benzene, diesel particulate matter, formaldehyde, methylene chloride, and tetrachloroethylene) were available at all residential addresses since 1989. We first estimated associations with AMH in single exposure models adjusting for relevant covariates and then explored patterns of exposure using principal component analysis (PCA). Hierarchical Bayesian kernel machine regression (BKMR) was used to select key exposures and estimate the joint associations. We further conducted subgroup analyses by age at blood draw. RESULTS:Median age at blood collection was 40. Single exposure models showed negative associations of AMH with benzene (percentage reduction in AMH per interquartile range (IQR) increase = 5.44%, 95%CI=1.05, 9.62) and formaldehyde (percentage reduction in AMH per IQR increase = 6.04%, 95%CI=1.72, 10.17) but not the other exposures. PCA identified four major exposure patterns and only the one with high exposure to HAPs and LAN was associated with lower AMH. Hierarchical BKMR selected benzene, formaldehyde, and greenness as important exposures, and suggested an inverse joint association with AMH (percentage reduction comparing all exposures at the 75th percentile to median= 8.12%, 95%CI=0.54, 15.12). The observed associations were mainly found among women aged above 40. CONCLUSIONS:We found exposure to benzene and formaldehyde to be consistently associated with lower AMH levels. Older reproductive aged women were the most susceptible, suggesting these exposures may accelerate reproductive aging. KEYWORDS: multi-pollutant, mixtures analysis, reproductive outcomes

Influência da paridade no desenvolvimento da depressão em mulheres brasileiras

Objetivo: Analisar a relação entre paridade e depressão em mulheres em idade reprodutiva entrevistadas na Pesquisa Nacional de Saúde, 2013. Metodologia: Estudo transversal, de base populacional realizado com base nos dados da Pesquisa Nacional de Saúde Brasileira (PNS) – 2013. Foram incluídos registros de mulheres em período reprodutivo, com idade entre 18 e 49 anos, totalizando a amostra com 15.344 mulheres. Resultados: Observou-se associação bruta estatisticamente significante entre a paridade e depressão (RP= 1.32; IC 95%: 1.20 - 1.46). Houve também associação entre ter filhos com baixo peso e depressão (RP= 1.64; IC 95%: 1.24 - 2.18). Mostrando que mulheres em idade reprodutiva mais velhas e com 3 filhos ou mais apresentam 36 vezes mais chances de referir diagnóstico médico de depressão, e aquelas que tiveram filho com baixo peso essa probalidade quase se duplicou. Conclusão: Mulheres em idade reprodutiva mais avançada, que tiveram maior paridade, tiveram mais chances de apresentarem depressão, havendo uma potencialização dessa condição quando tiveram filhos de baixo peso. Assim, ressalta-se a importância de conhecer e compreender os determinantes e condicionantes da saúde que estão associados ao processo de vulnerabilização e adoecimento feminino, para implementar estratégias de intervenção pertinentes no manejo da depressão, em todos os níveis de atenção à saúde.

Predictors of genitourinary syndrome in women of elderly reproductive age after hysterectomy

The article presents an analytical assessment of risk factors for distant postoperative urogenital disorders in women of older reproductive age after radical surgical treatment for uterine fibroids. The aim of the study was to optimize the diagnostic algorithm of genitourinary syndrome in women of older reproductive age after hysterectomy for uterine fibroids. Materials and methods – 80 women aged 40 to 50 years were examined: 40 patients after vaginal and laparoscopically assisted vaginal hysterectomy, 40 patients with abdominal hysterectomy, control – 30 relatively healthy women with asymptomatic fibroids. The examination was performed at the stage of preoperative observation and for 3 years after surgery. Research methods: data on the assessment of pelvic floor and urogenital dysfunction using a standardized POP-Q system, physical examination, the ICS classification was used to assess the severity of urinary incontinence; quality of life assessment using the MOS SF-36 questionnaire; standard methods of variation statistics. Research results and their discussion. The most important risk factors for genitourinary syndrome have been identified. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth trauma, high birth parity, ovarian surgery, the use of gonadotropin-releasing hormone agonists), chronic diseases accompanied by increased intramuscularly; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. Conclusions. In the case of surgical treatment of uterine fibroids, it is advisable to take into account not only the presence of vaginal prolapse and initial dysuric manifestations, but also their predictors in the preoperative stage of the examination, as this may affect the choice of method and access in the case of surgical treatment of uterine fibroids. rehabilitation program and will obtain the expected effect of surgical recovery.