Reproductive Function In Patients Research Articles

Consideration Of the Peculiarities of Non-Drug Rehabilitation Treatment After an Ectopic Pregnancy

The features of the application of physical rehabilitation after undergoing an ectopic pregnancy and conducted surgical treatment of severe gynecological pathology requiring emergency care are considered. The program of physical rehabilitation in the early and late postoperative periods, aimed at restoration of reproductive function in patients conducted after surgery tubal ectopic pregnancy options.

Carcinogenesis and epidemiology of cervical cancer: The hallmark of human papillomavirus-associated cancer.

Cervical cancer affects women worldwide and is the most common human papillomavirus (HPV)-associated cancer. Carcinogenesis caused by HPV results in specific cancer behavior because of the underlying viral infection. The mechanism and timing of the transformation from viral infection to cancer cells have been elucidated in detail. Treatments for this cancer are based on its characteristics and are being implemented. Moreover, HPV infection is widespread worldwide and is transmitted through sexual activity. Although the HPV vaccination is the most effective strategy of preventing cervical cancer, it is not feasible to vaccinate the entire human population especially in low- and middle-income countries. In order to consider the next step for HPV vaccination, we need to understand the characteristics of HPV carcinogenesis and cervical cancer. Additionally, treatment aimed at preservation of reproductive function in patients with cervical cancer is often required, as the cervix is a reproductive organ and because the disease is more prevalent in the adolescent and young adult generation. Thus, there are still many challenges in the diagnosis, treatment, and prevention of cervical cancer.

Research progress on mechanism of follicle injury after ovarian tissue transplantation and protective strategies.

Ovarian tissue cryopreservation and transplantation is the only way to preserve fertility for female cancer patients in prepubertal ages and those who cannot delay radiotherapy or chemotherapy. However, the success rate of cryopreservation and transplantation of ovarian tissue is still low at present due to the risk of ischemia and hypoxia of the grafted tissues. Abnormal activation of primordial follicles and ischemia-reperfusion injury after blood supply recovery also cause massive loss of follicles in grafted ovarian tissues. Various studies have explored the use of different drugs to reduce the damage of follicles during freezing and transplantation as well as to extend the duration of endocrine and reproductive function in patients with ovarian transplantation. For example, melatonin, N-acetylcysteine, erythropoietin or other antioxidants have been used to reduce oxidative stress; mesenchymal stem cells derived from different tissues, basic fibroblast growth factor, vascular endothelial growth factor, angiopoietin 2 and gonadotropin have been used to promote revascularization; anti-Müllerian hormone and rapamycin have been used to reduce abnormal activation of primordial follicles. This article reviews the research progress on the main mechanisms of follicle loss after ovarian tissue transplantation, including hypoxia, ischemia-reperfusion injury and associated cell death, and abnormal activation of follicles. The methods for reducing follicle loss in grafted ovarian tissues are further explored to provide a reference for improving the efficiency of ovarian tissue cryopreservation and transplantation.

КЛИНИЧЕСКИЙ СЛУЧАЙ УСПЕШНОЙ РЕАЛИЗАЦИИ РЕПРОДУКТИВНОЙ ФУНКЦИИ У ПАЦИЕНТКИ С ДИСГЕНЕЗИЕЙ ГОНАД

An important problem is the problem of implementing reproductive function in patients with forms of infertility caused by genetic abnormalities. Previously, the prognosis for their reproductive function was considered unfavorable. In modern conditions, by improving IVF techniques using oocyte donation, treatment of infertility in these patients becomes possible. Therefore, studying the features of the tactics of managing such patients at the stage of preconception preparation, the features of IVF protocols, as well as the features of managing pregnancy and labor and delivery is relevant. The purpose of the study is to substantiate the possibility of successful implementation of reproductive function in a patient with gonadal dysgenesis. A clinical case of pregnancy and childbirth in a patient with a typical form of gonadal dysgenesis (karyotype 45 X0) is presented. The diagnosis was made at the age of 15 during a comprehensive examination for primary amenorrhea, and hormone replacement therapy was prescribed. The patient's pregnancy occurred after preparation of the endometrium with estrogens and gestagens as a result of the fourth IVF attempt with the donation of an egg fertilized by her husband's sperm, and was complicated by the threat of termination at 8 and 19 weeks. At 36 weeks, the pregnancy was complicated by severe preeclampsia, which required emergency caesarean section. The course of the postoperative period was uneventful with continuation of therapy for complications of gestation. It is recommended after cessation of lactation - HRT using drugs with an estrogenic component similar in chemical structure to natural ones, gestagenic - metabolically neutral. The study of this clinical case is of undoubted interest, taking into account the peculiarities of management tactics. It is necessary to implement a multidisciplinary approach to the management of such complex patients. Taking into account the peculiarities of the body condition in patients with gonadal dysgenesis and the absence of hormonal ovarian function, it is necessary to ensure optimal preconception preparation, the use of an individual approach to the implementation of the IVF protocol, and the prevention of complications during pregnancy. Fulfillment of these conditions will ensure a positive result of infertility treatment in patients with gonadal dysgenesis who previously did not have the opportunity to realize reproductive function.

FERTILITY FACTORS. D-HORMONE IN PREVENTION OF REPRODUCOPATHIES CAUSED BY BENIGN PROSTATIC HYPERPLASIA (Literature review)

In accordance with the statistical data, the spreading of benign prostatic hyperplasia (BPH) is increasing, because modern stressful lifestyle causes sex hormones disbalances and other dyshormonal conditions which lead to pathologies’ development at younger ages. The pathogenesis of BPH is connected with disturbances of regulation in the hypothalamo-hypophyseal system and with the changes of the regulatory signals intensity which go to the reproductive organs. The central pathogenic links of this pathology’ development are: the declining of efficacy of hypothalamus functioning regulation which carries out on the basis of feedback; the changes of the pituitary gland cells sensitivity to the releasing hormones of hypothalamus and disbalance of sex hormones. In addition to gonadotropins prolactin has a significant impact on the BPH development. Its hypersecretion causes the development of hyperplastic age-related changes in prostate gland. The introduction of dopamine receptors antagonists such as sulpiride causes the increasing of prolactin concentration and declining of gonadotropins releasing. “Sulpiride model” is broadly used in the experimental endocrinology for studying prostate-active drugs and is characterized by sex hormones disbalance' and inflammation processes’ development. The development of the pathology is linked with the disturbance of testosterone synthesis in the testicles, insufficiency of prostate gland functioning and increasing of prolactin and estradiol concentrations which provoke proliferative changes. The androgens disbalance is the main cause of BHP development, therefore, the “Testosterone model” based on testosterone’ and estradiol’ slow releasing implants is broadly used for modeling of urination disturbance in rats which imitates the same condition in elderly men with benign prostatic hyperplasia. The prostatitis, which developed under the condition of BHP, causes the disturbances of spermatogenesis during experimental modeling and in the clinical practice when spermatopathies, sexual disturbances and hypofertility are diagnosed in patients. The traditional BHP therapeutic methods are not always effective and the new therapeutic approaches of hypofertility caused by prostate gland pathologies are developed by investigators. Thus, there are data about correlation between increased vitamin D consumption and decreasing of BHP spreading, between gland volume and cells proliferation in patients with this pathology. Vitamin D level influences the quantity and quality of ejaculate. The deficiency of vitamin D is associated with lower proportion of sex hormones in young men and choriogonin sensitivity of Leydig's cells to be diminished. It has been experimentally shown that cholecalciferol regulates steroid hormones genesis, mitigates the age-related declining of testicles activity, protects the testicles in old animals and the unchanged spermatogenesis in normal males which received vitamin D3 can be considered to be the result of estrogens and androgens balance. The androgens receptors as well as vitamin D receptors have been found in prostate gland in health males and in those with hyperplasia. In addition to its classical function in calcium homeostasis and bones health, vitamin D inhibits tumor growth in different tissues including prostate gland. Vitamin D metabolites have been determined to be anti-inflammatory, proapoptotic and antiproliferative. D-hormone application potentiates the specific properties of prostate gland protectors, recovers reproductive capacity under the condition of experimental chronic prostatitis of inflammatory genesis as well as traumatic. All facts listed above allow to confirm the positive role of D-hormone in the regulation of prostate gland and reproductive function in patients with BHP and recovering of fertility under the condition of this pathology. The literature search for this review has been carried out on databases PubMed, Science Direct, Europa PMC, BMC, MedLine etc.

Psychosomatic correlations in mentally ill and mentally healthy women with infertility

The issue of the influence of women's mental state on their reproductive function has not been adequately addressed and requires further research.Objective: a comparative evaluation of individual indicators of menstrual and reproductive function in mentally healthy and mentally ill women with infertility.Material and methods. We studied 348 women aged 21 to 40 years with primary and secondary infertility, 120 of whom had been treated for a mental disorder in a psychiatric hospital prior to the present study. The patients' condition was assessed by a clinical method using a specially designed questionnaire card.Results. Reproductive function of patients in the studied groups differed significantly in several indicators. Mentally ill women with primary infertility are characterized by the following features: later onset of menstruation, scanty or heavy menstrual flow (p<0.05), irregularity or absence of menstruation during the period of exacerbation of the disease, insufficient emotional response to menarche (p<0.05), irregularity of sexual life and dissatisfaction with it (p<0.01). Spontaneous miscarriages and stillbirth occurred more frequently in mentally ill women, especially in women with endogenous disorders (schizophrenia, affective disorders), while abortions and gynecological surgeries were more frequent in mentally healthy women (p<0.001). Predictors of infertility on the part of mental health are the early onset and chronic course of a mental disorder, the severity and duration of an exacerbation of the illness, brief and incomplete remissions, the development of personality changes or a defect (schizophrenic) as a result of a mental illness.Conclusion. Menstrual and reproductive functions of women depend on their mental state. In women with mental disorders, menstrual dysfunction together with psychopathological symptoms of illness (decrease in libido, communication, emotional numbness), decrease in social and family adaptation leads to impairment of reproductive function.

Immune checkpoint inhibitor effects on male reproduction.

e16528 Background: Immune checkpoint inhibitors (ICI) have been shown to improve overall survival (OS) in patients with metastatic renal cell carcinoma (RCC) as compared to previous therapy with multi-kinase inhibitors (MKI). However, little is known about the effects of these drugs on male reproductive capacity and the current data regarding effects of MKI and ICI therapies on gonadal function and fertility are both limited and conflicting. We sought to evaluate effects of MKI and ICI on male reproductive function in patients with RCC. Methods: Male patients with RCC receiving MKI or ICI for a period of at least 3 months were identified. Inclusion criteria included age ≤ 50 years, no prior history of chemotherapy, and no prior history of medical or surgical conditions that would affect spermatogenesis such as hypogonadism, Klinefelter syndrome, or vasectomies. Patients were instructed to abstain from ejaculation 2 to 7 days prior to study collection. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), morning testosterone, and a semen analysis was obtained for each patient and analyzed. Results: Of 10 patients, 5 (50%) were on ICI and 5 (50%) were on MKI. Of the patients on ICI, 2 (40%) exhibited abnormal semen morphology, motility, and sperm concentration. Of the patients on ICI, one exhibited elevated LH and FSH levels and one exhibited elevated LH levels only. Of the patients on MKI, 2 (40%) exhibited abnormal semen morphology, motility, and sperm concentration. One patient on MKI exhibited elevated LH and FSH levels. All patients had normal testosterone levels. Conclusions: Our preliminary descriptive data analysis suggests that both ICI and MKI may affect semen morphology and motility, sperm concentration, and LH and FSH levels, but does not affect testosterone levels. Due to the currently limited sample size, abnormal semen analysis and hormone levels may be attributable to confounding factors, such as performance status, the metastatic disease itself, comorbidities, etc. Study recruitment and analysis are ongoing.

Perspectives and possibilities of preserving reproductive function in patients receiving antitumor treatment. Clinical observation

Currently, treatment of patients with early primary operable BRCA mutation-associated breast cancer requires integrative approach. A mutation in BRCA1/2 genes is a prognostically unfavorable factor increasing the risk of cancer of the contralateral breast, as well as ovaries, pancreas, fallopian tubes, and primary peritoneal cancer. In this clinical observation, an integrative multidisciplinary approach to treatment of a young patient with luminal B breast cancer is described which allowed to preserve the patient’s fertility and achieve pregnancy using assisted reproductive technologies.High effectiveness of the chosen treatment tactics in the framework of integrative approach in a specialized medical facility with experience in treatment of oncological diseases and preservation of reproductive function confirmed by clinical data and results of laboratory and instrumental exams is demonstrated.

Epidemiology of female infertility and the experience of recovery of reproductive function in patients with chronic endometritis in the tyumen region

Epidemiology of female infertility and the experience of recovery of reproductive function in patients with chronic endometritis in the tyumen region

Оценка транскриптома эндометрия при повторных неудачах имплантации в программах вспомогательных репродуктивных технологий

Objective of the Review: A review the results of published scientific research on the special characteristics of endometrium in women with recurrent implantation failures. Key points. Endometrial receptivity and the importance of its analysis in women with recurrent implantation failures undergoing assisted reproductive treatment were considered. We analysed the current literature data confirming that various pathological conditions of the woman’s body may disturb the implantation process. Timely identification of such conditions may help clinical physicians to better understand and improve the state of the woman’s organism during the implantation window. Relevant published articles by Russian and international authors in the eLIBRARY and PubMed search systems from 2011 to 2021 were analysed. The following key words were used in the search: “endometrial receptivity”, “recurrent implantation failures”. Within the analysed timeframe, 294 articles were published in eLIBRARY and 1,537 articles were published in PubMed. Literature review covered the research on finding the causes of recurrent implantation failures and studying endometrial receptivity characteristics with the use of the molecular genetic test (ERA–test). The impact of organic and somatic pathology in the woman’s body (in particular, endometriosis, chronic endometritis, obesity) and its affect on the endometrial receptivity were described. Conclusions. Мodern molecular and genetic technologies combined with a comprehensive treatment approach may be the method of choice in certain clinical situation. Further studies have to be done to identify possibilities of transcriptomic analysis for the implementation of reproductive function in patients with recurrent implantation failures. Keywords: endometrial receptivity, recurrent implantation failures, implantation window, ERA–test.

The reproductive function of patients with prior atypical endometrial hyperplasia and endometrial cancer treatment: cohort study

Aim. To define the management of realization of reproductive function implementation in patients experienced atypical endometrial hyperplasia and endometrial cancer IA stage.
 Materials and methods. 150 patients aged 2142 years were included. Among them 78 patients with atypical endometrial hyperplasia (group 1) and 72 with endometrial cancer IA stage (group 2). General clinical, anamnestic and laboratory examination and follow-up with monitoring of gonadotropins and steroid hormones, as well as pelvic ultrasound supplemented with outcomes of reproductive function and in vitro fertilization (IVF) programs.
 Results. It was shown a possibility of spontaneous pregnancy in young patients with regular cycles without other infertility factors with pathomorfosis 23 stages and the endometrial receptivity. The practicability of IVF-programs with frozen oocytes and embryo transfer in young women with a lower ovarian reserve and high-risk cancer relapse was demonstrated when their reproductive plan was uncertain.
 Conclusion. The reproductive function in patients who experienced atypical endometrial hyperplasia and endometrial cancer IA stage might be realized through a personified approach using assisted reproductive technologies and modified IVF-programs with frozen oocytes and embryo transfer.

Sodium-glucose cotransporter 2 inhibitor ameliorates high fat diet-induced hypothalamic-pituitary-ovarian axis disorders.

High-fat diet (HFD) consumption is known to be associated with ovulatory disorders among women of reproductive age. Previous studies in animal models suggest that HFD-induced microglia activation contributes to hypothalamic inflammation. This causes the dysfunction of the hypothalamic-pituitary-ovarian (HPO) axis, leading to subfertility. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of lipid-soluble antidiabetic drugs that target primarily the early proximal tubules in kidney. Recent evidence revealed an additional expression site of SGLT2 in the central nervous system (CNS), indicating a promising role of SGLT2 inhibitors in the CNS. In type 2 diabetes patients and rodent models, SGLT2 inhibitors exhibit neuroprotective properties through reduction of oxidative stress, alleviation of cerebral atherosclerosis and suppression of microglia-induced neuroinflammation. Furthermore, clinical observations in patients with polycystic ovary syndrome (PCOS) demonstrated that SGLT2 inhibitors ameliorated patient anthropometric parameters, body composition and insulin resistance. Therefore, it is of importance to explore the central mechanism of SGLT2 inhibitors in the recovery of reproductive function in patients with PCOS and obesity. Here, we review the hypothalamic inflammatory mechanisms of HFD-induced microglial activation, with a focus on the clinical utility and possible mechanism of SGLT2 inhibitors in promoting reproductive fitness.

The role of new medical technologies in the relief of chronic pelvic pain and the rehabilitation of reproductive function

The low efficacy of ongoing conventional therapy and a significant decrease in the quality of life in patients with reconstructive plastic surgery (RPO) on the pelvic organs (PO) due to tubal-peritoneal infertility (TPI) and chronic nonspecific salpingo-oophoritis (CNSO) requires searching for new, promising methods of non-drug treatment, in particular, taking into account the regional characteristics of the Republic of North Ossetia-Alania and its natural resources. One of the main ways to increase the efficacy and intensify the treatment of this category of patients is the use of natural factors, namely, sulfide waters of the local Redant-4 deposit, which have a number of anti-inflammatory effects. Purpose of the study is to assess the role of non-drug technologies using magnetic infrared-laser therapy and balneological factors of the local deposit in the rehabilitation of the reproductive function in patients undergoing reconstructive plastic surgery due to TPI and CNSO. Material and methods. 235 women with impaired reproductive function, who underwent laparoscopic reconstructive plastic surgery on the pelvic organs (RPO on PO) due to tubal-peritoneal infertility (TPI) and CNSO, whose average age was 28 + 7 years, were examined. 2 groups were formed by the method of blind sampling: the main group consisted of 139 women with RPO on the pelvic organs due to TPI and CNSO, who, along with conventional therapy, received magnetic IR-laser therapy and had hydrogen sulfide baths; the comparison group included 96 women with RPO on PO due to TPI and CNSO, whose treatment was carried out by conventional methods of drug therapy. The conventional treatment included along with antibiotic therapy the use of ecological adaptogens (aloe, apilac), immune modulators (polyoxidonium), vitamin therapy (vitamin E 100 mg / day for 3 months and B vitamins), drugs to eliminate disorders in the intestinal and vaginal flora (antifungal agents: fluconazole, tergynan, acylact for 7-14 days). The patients of the studied groups were observed before their treatment and 1-12 months after the treatment. All patients underwent a clinical and functional examination. Statistical processing of the material was carried out using the package Statistica for Windows. Results. A control examination of patients of both groups showed a more pronounced positive effect on the course of a number of clinical symptoms in the postoperative period in the main group of patients who received magnetic IR laser therapy and had sulfide baths of the North Ossetian deposit in the complex of therapy. As a result of the physiotherapy treatment, the pain syndrome was eliminated in 107 of 139 patients (77%) who complained of pain before their treatment. A decrease in pelvic pain after the course of treatment was noted in 46 patients (33%). It should be noted that in the majority of patients 94 (68%), who received sulfide balneotherapy, a decrease in the formation of repeated adhesions of the pelvis was revealed during the procedures, the effectiveness of the regression of the adhesive process was found throughout the observation. It was detected that against the background of the proposed non-drug technology in the rehabilitation treatment of patients with RPO on PO due to TPI and CNSO, a significant increase in the effectiveness of treatment of this pathology (89%), improvement in the quality of life of patients as well as restoration of fertility has been achieved. Conclusions. The use of the method of sulfide balneotherapy in patients with RPO on PO due to TPI and CNSO allows shortening the duration of their next treatment and achieving the maintenance of positive dynamics and duration of regression of the adhesive process of the pelvis.

Clinical effect of the combination of myoinositol and D-chiroinositol in the ratio 5:1 with manganese and folic acid on female reproductive function in patients with anovulatory infertility in patients with abnormal menstrual cycles and obesity

Aim. Effect of daily use of the combination of myoinositol and D-chiroinositol with manganese and folic acid (Dikirogen) on the onset of a regular menstrual cycle, ovulation, pregnancy, tolerance and satisfaction of the study participants.
 Materials and methods. The study involved 60 women aged 40 years and younger, the average age was 30,933,79 years. Duration of taking Dikirogen was 1703 days, participants observation was 1803 days. Body mass index, waist circumference (WC), ultrasound of the pelvic organs and ovaries, assessment of hirsutism (Ferryman-Gallway scale), acne severity (Cook questionnaire), depressive symptoms (Hamilton scale), quality of life (SF36 questionnaire) were performed during the study.
 Results. The pregnancy rate at the end of the study was 31.7%. During the daily using of the Dikirogen, there was a decrease in WC (p=0,007), the severity of acne (p=0,002) and the number of points on the Hamilton scale (p=0,04). Also there was a increase in the number of points on the SF36 questionnaire (p=0,0001). 93.33% of the woman has been reported that the Dikirogen was well tolerated.
 Conclusion. Dikirogen is an optimal doses chemical composition, selected taking into account the synergism of the components and the daily requirement, and it is effective in treatment for women with anovulatory infertility.

Restoration of endometrial receptivity and reproductive function in infertile women with excess body weightand complex non-atypical endometrial hyperplasia

To date, there are several approaches to the treatment of endometrial hyperplasia, but it is quite unclear which approach provides a higher clinical response with a lower recurrence rate, in addition to preservation and restoration of fertility in infertile women with complex non-atypical endometrial hyperplasia (NEH) and excess body weight. The purpose of the study was to evaluate the effectiveness of the restoration of reproductive function in patients with infertility, complex NEH and with excess body weight according to the proposed method. Material and methods. 74 women of reproductive age with complex NEH, infertility and excess body weight were under observation, of which 34 patients of the main group after hysteroscopic resection of the lesion at the first stage of treatment, at the second stage of treatment received gonadotropin-releasing hormone agonists (aGnRH) and adjuvant therapy with drugs indole-3-carbinol, metformin, fenofibrate for three months, and then at the third stage of treatment dydrogesterone, metformin, a vitamin-mineral complex that included myo-inositol, banaba leaves, extract of 1% corosolic acid, vitamin D3, methylfolate-quatrafolic, chromium for 6 months. 40 patients of the control group after hysteroscopic resection of the lesion at the first stage of treatment were prescribed aGnRH for 3 months in the second stage of treatment, then methylfolate-mvatrafolic for 6 months. Anthropometric data, echometric and morphofunctional characteristics of the endometrium during the expected window of implantation, hormonal profile and levels of peripheral blood lipokines in the dynamics of treatment were studied. Reproductive results were evaluated within a year after the end of treatment. The results. Treatment of complex NEH in the main group led, compared to the control group, to a decrease in body mass index, improvement in echometric and morphofunctional characteristics of the endometrium, its receptivity during the expected window of implantation, hormonal profile and lipokines level in peripheral blood, a decrease in insulin resistance, and an increase in the frequency of pregnancy. Conclusion. The proposed scheme for the treatment of complex NEH in infertile women with excess body weight allowed to improve their reproductive results, is effective and can be recommended for implementation in wide clinical practice.

Reproductive function in patients with disorders of sex development (literature review)

Reproductive function in patients with disorders of sex development (literature review)

Comparative effectiveness of endometriosis-associated infertility therapy

Endometnosis is not a disease of individual organs and systems, but of the whole organism, the treatment of which requires complex action. The effect of all drugs used to treat endometriosis is to suppress growth factors and the development of pathological implants at different levels of the system - from the hypothalamus to target organs. The problem of restoring reproductive function in patients with endometriosis-associated infertility remains very urgent at the present time. This is due to the prevalence of this pathological process - in the structure of female infertility, endometriosis is about 50%.

Current methods to realize the reproductive function in patients with polycystic ovarian syndrome and chronic endometritis

Literature review indicates that both polycystic ovary syndrome (PCOS) and chronic endometritis (CE) have a significant role in implantation disorders, one of the main causes of infertility and unsuccessful outcomes of assisted reproductive technologies.
 Study aim was to analyze the literature on current methods to recover reproductive function in patients with polycystic ovary syndrome and chronic endometritis.
 Materials and methods. The review analyzed scientific literature published in the past decade, as well as relevant research publications available in the online databases, which were searched using the key words "polycystic ovary syndrome", "endometritis", "comorbidity", and "infertility".
 Results. While the evidence of positive effects of lifestyle changes on fertility is inconclusive, weight loss is a first-line treatment option recommended for women with PCOS. International guidelines for women with anovulatory PCOS consistently recommendas a second-line option gonadotropin therapy to induce ovulation if oral first-line induction ovulatory therapy, including aromatase inhibitors and selective estrogen receptor modulators, fails. In regards to the treatment of CE, research supports the use of antibiotic therapy which increases the incidence of pregnancy in women with CE and repeated unsuccessful implantation, infertility of unknown ethoilogy or recurrent miscarriage.
 Conclusions. Current methods of restoring reproductive function in patients with PCOS and chronic endometritis include a wide range of non-pharmacological and pharmacological treatments of PCOS in combination with antibiotic therapy of chronic endometritis, but their effectiveness remains low, which requires the use of assisted reproductive technologies.

ОПТИМИЗАЦИЯ ТЕРАПИИ ТРУБНО-ПЕРИТОНЕАЛЬНОГО БЕСПЛОДИЯ, ОБУСЛОВЛЕННОГО ХРОНИЧЕСКИМ САЛЬПИНГИТОМ

The outpatient stage of therapy is the primary and very responsible link in the introduction of patients with chronic forms of VZOMT, since this pathology has a significant impact on such indicators as perinatal, maternal morbidity and mortality. In addition, VZOMT directly affects the development of infertility, ectopic pregnancy, habitual miscarriage, as well as a decrease in the ovarian reserve after unsuccessful attempts of in vitro fertilization, surgical interventions on the appendages of the uterus. To preserve the reproductive function in patients with VZOMT, an important stage is the implementation of a number of therapeutic and rehabilitation measures. The problems of treatment and rehabilitation of patients with VZOMT undoubtedly remain relevant, since cases of relapses and chronization of inflammatory processes significantly worsen the prognosis for a woman's reproductive function. These problems are both social and economic. Taking into account the wide range of infectious agents of VZOMT, it is recommended to use a complex of antibacterial drugs that cover as many varieties of pathogenic and conditionally pathogenic flora as possible. Moreover, an important aspect of the treatment of inflammatory diseases of the female reproductive system is the use of different forms of drugs and ways of their administration. It is rational to combine oral or parenteral with intravaginal. This combination makes it possible to increase the effectiveness of treatment and contributes to the prevention of relapse of the disease. The inclusion of prednisolone – 21 phosphate in the therapy complex also contributes to increasing the effectiveness of therapy, since it creates favorable conditions for the vital activity of normal microflora and unfavorable conditions for conditionally pathogenic microflora. The results obtained in the study indicate a good clinical effectiveness of complex therapy with the inclusion of Elzhina in the treatment regimen for the treatment of fibrotic processes in the fallopian tubes. The use of a combined drug for intravaginal use containing ornidazole-500 mg, prednisolone-3 mg, econazole-150 mg, neomycin 65000ME (Elzhina drug) allows optimizing the management tactics of patients with tubal – peritoneal infertility caused by chronic salpingitis and increasing the fertility rates in this group of patients.

Influence of nodular and severe forms of diffuse adenomyosis on reproductive function: a review of reproductive outcomes of surgical interventions and IVF

This review includes an analysis of clinical studies evaluating the effect of adenomyosis on reproductive function, as well as a review of studies on the relationship between surgical treat-ment options for adenomyosis and reproductive outcomes. Different studies of women populations after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) and after surgical treatment of deep adenomyosis have shown that adenomyosis in both cases has a negative effect on the reproductive outcome, although there are significant differences in these populations. In the literature, there are relatively few data on the degree of influence of the depth of the lesion on the realization of the reproductive function, however, a significant correlation was revealed between them. The positive effect of treatment with gonadotropin-releasing hormone agonists, followed by surgical treatment of adenomyosis, has also been described in several literary sources, but there have been no controlled studies on this topic. Many studies do not meet the validity criteria due to the lack of clear criteria for inclusion and exclusion from the study. The choice of the optimal treatment options for adenomyosis based on the actual data is difficult due to the lack of reliable evidence of the relationship between fertility and the degree of adenomyosis. However, it is known that adenomyosis can reduce the likelihood of successful implantation so ramatically that surgical or other treatment options are reasonably recom-mended. At the same time, it is necessary to assess the possible positive effect of the treatment options available in the doctor’s arsenal. Thus, timely referral to specialized treatment of ade-nomyosis may be crucial for the successful implementation of reproductive function in patients with suspicion or with an established diagnosis of adenomyosis in combination with recurrent miscarriage, who refuse to use assisted reproductive technologies, medical institutions. This review will analyze the relationship between infertility and adenomyosis, as well as review studies of reproductive outcomes in different options for surgical treatment of adenomyosis in infertile patients.