Reproductive Function In Women Research Articles

P-281 Surgery and IVF for diagnosed ovarian endometriosis and deep infiltrative endometriosis

Abstract Study question To evaluate the effectiveness of surgical treatment of endometrioid cysts and deep infiltrative endometriosis before an IVF program Summary answer Laparoscopic excision of deep infiltrative endometriosis has a positive effect on the reproductive function of women What is known already One of the most severe and aggressive manifestations of endometriosis is deep infiltrative endometriosis. Endometriosis is a socially significant disease that reduces a woman’s quality of life and affects reproductive health. Women with endometriosis often experience severe menstrual and non-menstrual pain affecting the lower abdomen, pelvis or lumbosacral region, profound dyspareunia, dyschezia and dysuria (Uimari et al., 2021) and infertility in 30–50% of cases (Prescott et al.., 2016). Patients with endometriosis suffer from chronic fatigue (Ramin-Wright et al., 2018) and have a higher risk of mental health problems (56.4%) than patients without endometriosis (43.6%) (Pope et al., 2015) Study design, size, duration The our institute is conducting a controlled, non-randomized, retro- and prospective study on genital endometriosis. The study period is from 2012 to the present. Participants/materials, setting, methods The study included 450 women with deep infiltrating endometriosis in combination with infertility All patients were divided into 4 groups Group 1 – 128 patients with deep infiltrative endometriosis, sent for IVF without surgery Group 2 – 297 patients with deep infiltrative endometriosis, initially referred for surgery Group 2a – 156 patients with ovarian cysts, sent for preliminary collection of eggs before surgery Group 2c – 141 patients with ovarian cysts, referred for surgery without prior egg retrieval Main results and the role of chance In group 1, the number of pregnancies occurred was 65.6% (84 women), in group 2a - 71.7% (112 women), in group 2 - 53.9% (76 women). Pregnancy occurred spontaneously in 18 (4.2%) women from group 2 after surgery. In group 2, four women, after three unsuccessful attempts at in vitro fertilization, became pregnant after using donor eggs - the results were excluded from the final pregnancy calculations. In terms of pregnancy, IVF with preliminary surgery (Me: 2.10; Q1-Q-3:0) had a statistically significant advantage compared to IVF without surgery (Me: 5.00; Q1-Q-3:0), and IVF with surgery without egg retrieval (Me:3.0; Q1-Q-3:0). The lowest statistically significant pregnancy rate was recorded during laparoscopic surgery without prior egg retrieval (Me: 6.95; Q1-Q-3:1). When performing a post-hoc analysis, a statistically significant shorter pregnancy time was also found when performing IVF with preliminary laparoscopy and egg freezing: group 1 (M: 126.25; SD111.1), group 2a (M: 79.97; SD: 19.785 ), group 2c (M: 130.50; SD: 82.149) (p = 0.000). During the period of observation of women for twelve years after surgery, 93% of patients noted an improvement in the quality of life and 63.7% of women on average achieved reproductive function after the IVF program for endometriosis. Limitations, reasons for caution no restrictions Wider implications of the findings The results of the IVF program for deep infiltrative endometriosis are statistically higher after surgery, but with preliminary cryopreservation of oocytes. The question of radical resection of the rectum in comparison with shaving when planning an IVF program remains open, which forms the planning of further research in this area. Trial registration number not applicable

The effect of antitumor therapy on the reproductive system, the possibility of preserving female fertility

The influence of malignant neoplasms and their treatment methods on the reproductive function of women is one of the significant problems of oncogynecology. The mechanisms of ovarian follicle loss caused by chemotherapy have their own characteristics depending on the characteristics of the cytotoxic agent and act differently on different populations of ovarian cells. The toxic effect on fertility of the main groups of antitumor drugs is considered. Reproductive dysfunction has negative consequences for a woman’s physical and mental health. The use of methods that reduce the effect of cytotoxic agents on the ovary helps to prevent premature ovarian insufficiency, leading to infertility. The article discusses modern methods of fertility preservation using assisted reproductive technologies. All cancer patients of reproductive age should receive full oncofertility counseling as early as possible, during the treatment planning process, regardless of the type and stage of the disease.

Clinicopathological Evaluation of Thyroid Dysfunction in Women with Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding describes any variation from normal bleeding patterns in nonpregnant, reproductive-aged women beyond menarche lasting for at least 6 months. Regular cyclic menstruation results the choreographed relationship between the endometrium and its regulating factors. Any type of disturbance between the regulatory mechanism of pituitary ovarian axis or pelvic diseases results in abnormal uterine bleeding. Thyroid hormones play a key role in the menstrual and reproductive function of women. It is recognized universally that menstrual disturbances may accompany clinical alterations in thyroid function. Objectives: To evaluate the thyroid dysfunction in patients with abnormal uterine bleeding. Materials and Methods: This cross sectional study was conducted in Department of obstetrics & gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from April 2023 to December 2023. Women with abnormal uterine bleeding were included in the study. Sample was selected by purposive sampling. Sample size was 100. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Data was collected by using a semi-structured questionnaire. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Result was presented in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc. Results: In this study, the maximum numbers of cases (43.0%) were between 26-35 years age group. Mean age was 29.57 ± 8.27 years. Large numbers of respondents came from urban area (58%). On evaluation of types & causes of AUB, maximum patient belongs to AUB-L (leiomyoma) group (53%) followed by AUB-A (adenomyosis) (28%); AUB-P (polyp) (8%); AUB-O (ovulatory) (9%) and AUB-M (malignancy) (2%). Present study showed that prevalence of thyroid disorders is 26% in AUB patients. The prevalence of Hypothyroidism was 18% and Hyperthyroidism was 8%. Thyroid dysfunction is associated with menstrual abnormalities in females of all age groups. Conclusion: Abnormal uterine bleeding has a strong association with thyroid disorders. The most common type of disorder is subclinical hypothyroidism. Thus, all patient of AUB must be evaluated for thyroid dysfunction. Medicine Today 2023 Vol.36 (1): 1-6

The role of kisspeptin in female and male reproduction

Kisspeptin is a neuropeptide responsible for controlling the synthesis of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). The G-protein-coupled receptor 54/kisspeptin 1 receptor (GPR54/KISS1R) is involved in its action. The comprehension of kisspeptin and its actions represents a significant breakthrough in the field of reproductive biology. Kisspeptins play a crucial role in the development and optimal functioning of the reproductive system in both female and male. Additionally, it contributes to the onset of puberty, regulating feedback processes, and influencing sexual desire and arousal. It regulates a number of reproductive functions in women, including ovulation, lactation, ovarian development, follicle development, oocyte maturation, and pregnancy via the hypothalamic-pituitary-gonadal (HPG) axis. Spermatogenesis, sperm function, Leydig cells, and reproductive behaviour are all impacted by it in men. Infertility and polycystic ovarian syndrome (PCOS) are among the diseases linked to kisspeptin dysregulation, according to the research. For potential future use in diagnosing and treating problems, it may be helpful to understand the mechanisms behind kisspeptin's effects on the reproductive system. This review focuses on the regulatory function of kisspeptin on the HPG axis and the impact of kisspeptin on reproductive processes in both female and male.

ASSOCIATION OF I/D POLYMORPHISM OF THE ACE GENE WITH THE PRESENCE/ABSENCE OF UTERINE BLEEDING AND THE CHARACTERISTICS OF LEIOMYOMATOUS NODES IN PATIENTS WITH A COMORBID COURSE OF UTERINE LEIOMYOMA AND GENITAL ENDOMETRIOSIS

Uterine leiomyoma (UL) is the most common benign tumor, which leads to reduced work capacity and loss of reproductive function in women of childbearing age.The aim of the study – to investigate the presence of probable associations of the polymorphic variant I/D of the angiotensin-converting enzyme (ACE) gene with the presence/absence of uterine bleeding and the characteristics of leiomyomatous nodes in patients with a comorbid course of intramural UL and genital endometriosis.Study methods. The molecular genetic study of the polymorphic variant I/D of the ACE gene was applied to 33 patients with a comorbid course of intramural UL and genital endometriosis and 30 patients with isolated intramural UL (at the same time, 5 patients had a medical history of cycles of controlled ovarian stimulation with the help of assisted reproductive technologies and a diagnosis of infertility) according to the standard operating procedure developed in the interdepartmental educational and research laboratory of the Ternopil State Medical University named after I.Ya. Horbachevskyi of the Ministry of Health of Ukraine. Study results. In patients with isolated intramural UL, uterine bleeding probably prevails in individuals with the DD genotype of the polymorphic variant of the ACE gene relative to individuals with the ID and II genotypes (χ2=7.07; p=0.029). At the same time, the presence of the D allele increases the risk of uterine bleeding by 5.8 times. Analysis of the dominant pattern of inheritance of the ACE gene showed that carriers of the D allele (genotype ID+DD) among patients with isolated intramural UL have a 6.3-fold increased risk of uterine bleeding. Analysis of the relationship between the maximum diameter of the leiomyomatous node in patients of the studied groups and the I/D polymorphism of the ACE gene in the group with isolated intramural UL revealed that the maximum diameter of the node in carriers of the DD genotype exceeds the corresponding indicator in carriers of the II genotype by 28.89% (p <0.001), and the maximum node diameter in ID genotype carriers exceeds the corresponding indicator in II genotype carriers by 9.43% (р=0.032). In addition, the maximum node diameter is 14.29% greater in carriers of the D allele than the corresponding indicator in carriers of the I allele. As for the relationship between the number of leiomyomatous nodes in the patients of the studied groups and the I/D polymorphism of the ACE gene, probable differences were established only in the group with a comorbid course of intramural UL and genital endometriosis. At the same time, the individuals with a solid node predominate among carriers of the II and ID genotypes, while the individuals with multiple nodes predominate among carriers of the DD genotype; the distribution of persons with a solid node or multiple nodes is even among carriers of the D allele, and a solid node was found in 72.41% of individuals (р=0.045) among carriers of the I allele. In addition, the presence of the D allele increases the risk of multiple nodes by 3.09 times. Conclusions. It was found for the first time in the Ukrainian population, that the I/D polymorphism of the ACE gene (the presence of the D allele (genotype ID+DD)) is probably associated with an increased risk of multiple leiomyomatous nodes in patients with a comorbid course of intramural UL and genital endometriosis and with an increased risk of uterine bleeding and the size of the leiomyomatous node in patients with isolated intramural UL. The results of the logistic regression analysis show that the presence of the DD genotype of the ACE gene is associated with the development of uterine bleeding and the occurrence of multiple leiomyomatous nodes in patients with intramural UL, regardless of the presence of comorbid genital endometriosis.

Behavior Of Rural Women Of Special Region Of Yogyakarta (Diy) In An Effort To Prevent Menopausal Complaints And Weight Gain

Periodically, a woman's reproductive function will experience significant changes with age. Various complaints are experienced at this time ranging from mild to severe somatic complaints and even an increase in Body Mass Index (BMI). This study aims to identify increases in weight, blood pressure, menopausal complaints and complaint control behaviors experienced during menopause in 70 menopausal women in DIY in 2020. It was found that as many as 65.7% of women had menopause in the age group of 53-55 years, the highest level of education (72.8%) in the low category (elementary, junior high), working mothers (84.3%), the age of marriage was ≤ 20 years (81.4%) and had children > 2 people (72.9%). It was found that as many as 28 people (40%) had BMI in the fat and obesity categories, 42 people (60%) had blood pressure in the prehypertensive to hypertensive categories, had the heaviest menopausal complaints in complaints of discomfort in the joints and muscles (pain in the joints, rheumatic complaints) and behavior towards efforts to control menopausal complaints in the form of frequency and regular eating patterns until physical activity was considered still low. Ongoing health education efforts are needed for women in rural areas related to the impact of menopause and efforts to prevent complaints and weight gain experienced after menopause.

Role of hysteroscopy in the diagnostics of endometrium pathology and in the application of auxiliary reproductive technologies

Abstract. The introduction of endoscopic technologies made it possible to significantly expand diagnostic possibilities and clarify the nature of intrauterine pathology when using assisted reproductive technologies. Hysteroscopy allows you to take material for examination from the uterine cavity, and also ensures the carrying out of this procedure for diagnostic purposes as much as possible. Treatment of infertility by hysteroscopy plays a very important role in restoring a woman's reproductive function. The aim of the study was to improve the diagnosis of endometrial pathology through the use of hysteroscopy and targeted biopsy in the restoration of fertility and the use of assisted reproductive technologies. Materials. A clinical and statistical analysis of the results of 88 operative hysteroscopies in patients with infertility, which were divided into two groups, was carried out. The first group included 80 patients (90.91 %) with genital and extragenital pathology. The second group included 8 patients (9.01 %) who did not have concomitant gynecological and extragenital pathology. Hysteroscopy was performed with the equipment and tools of the «KARL STORZ» company. Monopolar and bipolar coagulation was used for hemostasis. Taking into account that pathology of the uterine cavity and endometrial are frequent causes of impaired reproductive function, it was proposed to use hysteroscopy to restore reproductive function. The results. The condition of the mucous membrane of the uterus with the help of hysteroscopy was studied in all clinical observations, since this method of instrumental research allows primarily to examine and evaluate the structural features of the endocervix and endometrial. In observation groups I and II, hysteroscopy was performed in all 88 patients: group 1 in 80 patients (90.91%) with pathological changes of the uterine mucosa and group 2 – in 8 patients (9.01 %) without pathology of the uterine mucosa. At the same time, 4 (3.52 %) women of 2 groups were diagnosed with extragenital pathology, and gynecological pathology was eliminated. The most common were endometrial polyps, chronic endometritis, cervical canal stenosis, and synechiae in the uterine cavity. Endoscopic technologies have expanded the diagnostic capabilities of investigating intrauterine pathology at the stage of fertility restoration and preparation for in vitro fertilization (IVF) and overcoming the causes of infertility. Conclusions. Hysteroscopy with morphological examination of the endometrial remains the main method of diagnosing intrauterine pathology. The obtained data will help the clinician to make the correct diagnosis in a timely manner and develop optimal and individual patient management tactics.

Evaluation of vitamin E levels, antioxidant enzymes and malondialdehyde in women with unexplained infertility

Unexplained infertility is a perplexing disorder. 30% of infertile couples are diagnosed with unexplained infertility with all standard fertility investigations normal. Oxidative stress has been shown to have a negative impact on reproductive function in women with endometriosis and (PCOS) polycystic ovarian syndrome. In another study antioxidant supplementation improved OS induced infertility. Many studies have demonstrated an increase in Malondialdehyde in serum of women with infertility and vitamin E as a protective antioxidant in the body with positive effect on the fertility. There is growing evidence linking OS and unexplained infertility.Based on this knowledge the specific group of unexplained infertile women were chosen to assess their levels of serum antioxidant enzymes, Vitamin E and lipid peroxidation marker. To compare the Levels of Malondialdehyde, Antioxidant enzymes and Vitamin E in the serum of women with unexplained infertility and control group.: Case control study.70 normal ovulatory women who conceived within 12 months of contraceptive free intercourse, and with no history of miscarriage were recruited in the control group. 70 women with unexplained infertility were recruited as study group. All participants included in the study were between 28 and 38 years of age. Serum levels of MDA, Antioxidant enzymes (GST, SOD, Catalase) and Vitamin E concentrations were compared between two groups. Vitamin E concentrations were determined by using High performance liquid chromatography. Antioxidant enzymes and MDA were measured by standard spectrophotometric assay.: Data was analysed using SPSS Software. Continuous parameters were analysed using Mann Whitney U test. There is a significant decrease in the vitamin E levels 3.80 ug/ml) in the unexplained infertile group as compared to controls 6.0 ug/ml). All women in the study group showed significantly (P<0.05) higher levels of MDA and lower levels of antioxidant enzymes such as GST, SOD and Catalase as compared to the fertile women. This decrease was found to be significant with p value of <0.05. The study group have a higher oxidative stress status and low level of antioxidants compared to control group. Serial measurement of oxidative stress biomarkers and their defense system may help to understand the aetiology of unexplained infertility and to enhance their chances of conception.

Causes of Infertility in Women with Diabetes: Literature Review

Diabetes Mellitus (DM) is a serious chronic disease, resulting from long-term hyperglycemia can lead to various complications. Complications of DM are associated with changes occurring in blood vessels and nerve fibers. Diabetes can affect a woman's reproductive function and lead to infertility. Decreased fertility in women with DM can be caused by various factors related to this disease. To date, the final mechanisms of reduced reproductive function in these women have not been fully elucidated, but it is known that the leading role belongs to chronic hyperglycemia. Purpose: Based on these literature sources, to investigate the possible causes of infertility in women with diabetes. Object: reduced fertility in women as a result of diabetes. Research methods: a review of literary sources. Results: There are quite a few causes of infertility and reduced fertility in women with DM, these include complications of diabetes (diabetic polyneuropathy); insulin resistance and, as a result, polycystic ovary syndrome; obesity; autoimmune and genetic factors; disorders of the menstrual cycle and hormone balance; low quality of egg cells due to oxidative stress and the formation of glycation products; reduction of cervical mucus due to hormonal disbalance, dehydration and inflammatory processes of the genital organs; psychogenic factors (phobias, fear of childbirth, future changes both in the body and in life). Conclusions: Based on the study of literary data, it can be said that the main causes of infertility in women with DM are caused by chronic hyperglycemia, and as a result, the development of pathological conditions that lead to disorders in the reproductive system. In addition, the causes of infertility in women with DM include disorders of the menstrual cycle and hormone balance, polycystic ovary syndrome, obesity, and autoimmune and genetic mechanisms. Taking this into account, glycemic control, prevention and treatment of diabetes complications, lifestyle modification, nutrition, and psychological health support are necessary.

Menstrual Tampons Are Reliable and Acceptable Tools to Self-Collect Vaginal Microbiome Samples.

Many women report embarrassment as the cause for their avoidance of routine gynaecological screening appointments. Methods of self-collection of bio samples would perhaps encourage women to participate in routine screening programs. The vaginal microbiome plays a key role in women's health and reproductive function. Microbial disturbances can result in the loss of lactobacillus dominance, also known as dysbiosis, associated with an increased risk of contracting sexually transmitted infections (STIs), pregnancy complications and infertility. Our primary aim was to determine if vaginal microbiome screening results are comparable between two methods for self-collected sample acquisition: tampons and lower vaginal swabs (LVSs). Secondary aims included the assessment of the effect of pre-analytic storage on the data (to streamline processing), the prevalence of dysbiosis and the acceptability of the tampons to the participants. Statistical analysis revealed no significant difference in the microbiome data, from tampons versus LVSs or fresh versus frozen samples. The prevalence of dysbiosis in this population of healthy volunteers was 42.9%. The questionnaire data revealed that 52.4% of volunteers use tampons every period, and the majority of volunteers rated the tampons as 5 on a 1-5 Likert scale regarding their perceived comfort using tampons. All (100%) of volunteers were happy to provide a tampon as a sample for testing. The findings from this study show that tampons and LVSs were comparable when analysing the vaginal microbiome, with potential superiority of the tampon with regard to patient acceptability. Self-collection of vaginal secretions for gynaecological screening using tampons warrants further research as this could change the screening landscape, ensuring wider participation and increasing efficacy.

Dynamics of matrix metalloproteinases and their tissue inhibitors in patients with herpesvirus and papillomavirus infection

Sexually transmitted infections are of great importance for the proper reproductive function in women. Chronic inflammatory process leads to reproductive disorders. A special role in the chronic inflammatory process is attributed to papillomavirus (PVI) and herpetic infection. MMP-2 and MMP-9 enzymes cleave type 4 collagen which makes the scaffold of basement membranes and contributes to the separation of endothelial cells from the membranes, followed by their further migration and direct participation in angiogenesis thus affecting the growth of tumors, in particular cervical cancer. Tissue inhibitors of matrix metalloproteinases are known to limit the collagen breakdown. However, the imbalance of MMP and TIMP is accompanied by accumulation of extracellular matrix and increased risk for reproductive disorders. The aim of our study was to evaluate the dynamics of acute-phase proteins affecting the state of intercellular matrix (MMP-2, MMP-9 and MMP tissue inhibitors (type 1, 2) in blood serum of patients with PVI or coinfection of PVI and HSV before and after therapy with drugs exhibiting antiviral and immunomodulatory effects, i.e., a synthetic compound (Inosine pranobex) and vegetable substance (Solanum tuberosum). We have examined 141 patients with papillomavirus and herpetic infections treated with Inosine pranobex and Solanum tuderosum. Determination of MMP-2, MMP-9 and TIMP-1, TIMP-2 levels of in blood serum was carried out using specific reagents from RD Diagnostics Inc. (USA). The drug therapy with active substances of Inosine pranobex and Solanum tuberosum was associated with positive dynamics of the level of MMP-2, MMP-9 and tissue inhibitors of types 1 and 2 in all groups under studies. However, Inosine Pranobex exerts more pronounced changes, especially in subgroups with viral coinfections.

Pathophysiological Insight into Fatty Acid-Binding Protein-4: Multifaced Roles in Reproduction, Pregnancy, and Offspring Health.

Fatty acid-binding protein-4 (FABP4), commonly known as adipocyte-fatty acid-binding protein (A-FABP), is a pleiotropic adipokine that broadly affects immunity and metabolism. It has been increasingly recognized that FABP4 dysfunction is associated with various metabolic syndromes, including obesity, diabetes, cardiovascular diseases, and metabolic inflammation. However, its explicit roles within the context of women's reproduction and pregnancy remain to be investigated. In this review, we collate recent studies probing the influence of FABP4 on female reproduction, pregnancy, and even fetal health. Elevated circulating FABP4 levels have been found to correlate with impaired reproductive function in women, such as polycystic ovary syndrome and endometriosis. Throughout pregnancy, FABP4 affects maternal-fetal interface homeostasis by affecting both glycolipid metabolism and immune tolerance, leading to adverse pregnancy outcomes, including miscarriage, gestational obesity, gestational diabetes, and preeclampsia. Moreover, maternal FABP4 levels exhibit a substantial linkage with the metabolic health of offspring. Herein, we discuss the emerging significance and potential application of FABP4 in reproduction and pregnancy health and delve into its underlying mechanism at molecular levels.

Restoration of reproductive function in women with uterine septum and reproductive disorders using different types of metroplasty techniques and different types of electric

The purpose: to compare the effectiveness of restoring reproductive function in women with uterine septum and reproductive disorders with various metroplasty techniques using monopolar and bipolar surgical energy. Material and methods. 153 patients with a uterine septum (group US) and reproductive disorders were under prospective observation, of which 75 patients (group M) underwent metroplasty using a monopolar hysteroresectoscope, 78 patients (group B) underwent a bipolar hysteroresectoscope. In groups M and B, 2 groups were allocated: group MD - 39 women who underwent hysteroscopic monopolar dissection of the uterine septum; group MR - 36 women who underwent hysteroscopic monopolar resection of the uterine septum; BD group - 37 women who underwent hysteroscopic bipolar dissection of the uterine septum; group BR - 41 women who underwent hysteroscopic bipolar resection of the uterine septum. The observation of operated women was carried out for 2 years after metroplasty. Results. When using various types of electrical surgical energy and various techniques for performing metroplasty in women with reproductive disorders against the background of the uterine septum, when using bipolar removal of the septum, the overall frequency of pregnancy termination by childbirth and term delivery was the highest and exceeded similar indicators: with monopolar incision 2.20 times (OR 13.30 [3.95–44.72], p<0.01) and 2.85 times (OR 16.20 [5.10–51.50], p < 0.01), with unipolar septum removal – 1.20 times (OR 2.40 [0.64-9.02], p > 0.05) and 1.37 times (OR 3.44 [1.06-11.20], p < 0.04), with bipolar incision of the septum - by 1.26 times (OR 3.43 [0.97-12.09], p < 0.05) and 1.35 times (OR 3.90 [1, 23-12.36], p < 0.02). The overall frequency of childbirth in women with initial infertility was the highest among patients with bipolar removal of the septum - 95.24% and exceeded the same indicator in women with monopolar incision of the septum (35.29%) by 2.70 times (OR 36.67 [3, 90-344.85], p < 0.01) and with bipolar dissection of the intersection (66.67%) by 1.43 times (OR 10.00 [1.07-93.44], p<0.04) and had no probable differences with those in patients with monopolar septum removal (81.25%) (p > 0.05). The total number of births in women with initial miscarriage after bipolar incision was 2.17 times higher than that after unipolar incision (78.95% vs. 36.36%; OR 4.50 [1.13-17.99], p < 0.04), with bipolar resection was 2.34 times greater than that with monopolar incision (85.00% versus 36.36%; OR 6.80 [1.54–30.08], p < 0.02). Conclusion. The technique of choice when performing hysteroresectoscopic metroplasty in women with uterine septum and reproductive disorders is bipolar removal of the septum, which leads to a probable increase in the termination of pregnancy by urgent delivery and live births both in the general group and in the group of patients with initial infertility.

The reproductive function of women with infertility after suffering COVID-19 infection

The aim was to assess the status of reproductive function of infertile women after COVID-19 infection. Materials and methods. The thorough examination included 120 patients who appealed to the reproductive clinic for infertility treatment. These women were divided into 2 groups: the main group - 80 women after COVID-19 infection (exclusion criteria - patients solely with the male factor of infertility), and the comparison group included 40 patients without COVID-19 infection in anamnesis. Results. Patients with infertility and "long-COVID" have more pronounced disorders of the reproductive function compared to women without history of COVID-19 infection, namely: a decrease in the ovarian reserve (28.8% vs. 10.0%; p<0.05), various menstrual disorders (35.0% vs. 12.5%; p<0.05), including amenorrhea, irregular menstrual cycle and luteal phase insufficiency, high prevalence of genitourinary infections (37.5% vs. 17.5%; p<0.05). Against these disorders background, patients with "long-COVID" have significantly inferior results of in vitro fertilization programs: one in five has "poor ovarian response" (21.3% vs. 2.5%; p<0.05). Clinical pregnancy was diagnosed in 22.5% of patients versus 40.0% (p<0.05), and 2 women had a pregnancy loss in the 1st trimester, while all 16 women in the comparison group carried fetuses to live birth, i.e., the live birth rate was 20.0% versus 40.0% (p<0.05). Conclusions. Determined changes in reproductive function may be directly or indirectly related to the "long-COVID" consequences, namely, a high level of stress, anxiety and depression, pernicious habits, general fatigability that leads to a sedentary lifestyle, sleep disturbances, the developing or exacerbation of somatic pathologies, among which stand out metabolic disorders and pathology of the liver and gastrointestinal tract. This study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the abovementioned institution. Informed consents of the women were obtained for participation in this study. The author declares no conflicts of interest.

Results of surgical treatment of polycystic ovarian syndrome in women of reproductive age

BACKGROUND: Polycystic ovarian syndrome (PCOS) is one of the most common and to some extent mysterious diseases falling under the competence of gynecologists. PCOS occurs in 510% of women of reproductive age. This paper presented the long-term results of surgical treatment of patients with PCOS.
 AIM: This study aimed to determine the efficiency of surgical treatment of the ovaries to restore reproductive function in women with PCOS.
 MATERIALS AND METHODS: The initial diagnosis of PCOS was made at the outpatient examination. The study included 121 women of reproductive age diagnosed with PCOS when other factors of infertility and menstrual dysfunction were excluded. Patients with PCOS as an initial diagnosis for hospitalization and absence of tubal-peritoneal infertility and male infertility were included. All patients (n = 121) underwent surgical treatment and histological examination. Patients were referred for treatment to gynecological surgical hospitals. In particular, 54 (group 1), 48 (group 2), and 19 (group 3) women were treated in a municipal clinical hospital, research center, and commercial clinic, respectively. Statistical data analysis was performed with the STATISTICA Base software package using parametric and nonparametric methods. Arithmetic mean, standard deviations, medians, and percentiles of the indices were calculated. Confidence limits to the arithmetic mean were calculated based on Students distribution. The exact 95% confidence limits to frequencies and the reliability of differences in frequencies between the groups were determined using binomial distribution and the chi-square test, respectively. In addition, the MannWhitney (U) and Wilcoxon nonparametric tests were used because several indicators had significantly normal distributions. Differences were considered statistically significant at p 0.05.
 RESULTS: Of the total number of patients (n = 121), 108 (89%) became pregnant postoperatively, and 13 (11%) did not. Moreover, 47 (39%) of the total number of patients became pregnant for up to 1 year and 61 (50%) for over a year, and 48 (39.6%) of 108 patients became pregnant post-in vitro fertilization (IVF, 12 attempts in 37 (32%) and more than 3 attempts in 11, or 9% patients). PCOS was confirmed in 6 (14%) patients; of these, spontaneous pregnancy occurred in 5 (83%), including 4 patients in the first year and 1 in over a year. These patients had clinical and biochemical signs of hyperandrogenism and insulin resistance.
 PCOS-like conditions were diagnosed in 37 (86%) patients; of these, pregnancy occurred in 33 (89%), including spontaneous pregnancy in 10, or 27% (4 within 1 year and 6 over 1 year) patients. Post-IVF pregnancy was diagnosed in 23 (62%) patients (12 attempts in 20, or 54.1%, and more than 3 attempts in 3, or 8.1% women).
 CONCLUSIONS: Surgical treatment of patients with PCOS is an independent treatment of this gynecological and metabolically burdened disease. This method has both indications and contraindications, and it has specific types, which require certain patient preparations, such as weight loss, blood glucose control, hyperinsulinemia analysis, and compensation of arterial hypertension, to increase treatment efficiency.

Benefits of physical activity on reproductive health functions among polycystic ovarian syndrome women: a systematic review

BackgroundPolycystic ovary syndrome (PCOS) is among the predominant endocrine disorders of reproductive-aged women. The prevalence of PCOS has been estimated at approximately 6–26%, affecting 105 million people worldwide. This systematic review aimed to synthesize the evidence on the effects of physical activity on reproductive health functions among PCOS women.MethodsThe systematic review includes randomization-controlled trials (RCTs) on physical exercise and reproductive functions among women with PCOS. Studies in the English language published between January 2010 and December 2022 were identified via PubMed. A combination of medical subject headings in terms of physical activity, exercise, menstrual cycle, hyperandrogenism, reproductive hormone, hirsutism, and PCOS was used.ResultsOverall, seven RCTs were included in this systematic review. The studies investigated interventions of physical activity of any intensity and volume and measured reproductive functions and hormonal and menstrual improvement. The inclusion of physical activity alone or in combination with other therapeutic interventions improved reproductive outcomes.ConclusionThe reproductive functions of women with PCOS can be improved with physical activity. Furthermore, physical activity can also reduce infertility, as well as social and psychological stress among women.PROSPERO systematic review registrationCRD42020213732.

The influence of different methods of hysteroscopic metroplasty using a bipolar resectoscope on the restoration of reproductive function in women with a septate uterus

Uterine septum is the most common congenital anomaly of the uterus, accounting for 35% of all diagnosed malformations. Data on the effectiveness of restoring reproductive function in women with a septate uterus after hysteroscopic metroplasty are contradictory, there are no data on the comparison of reproductive results after removal and dissection of the septum using a bipolar hysteroresectoscope. The purpose of the study was to assess the effectiveness of reproductive function recovery after dissection and removal of the uterine septum using a bipolar hysteroresectoscope. Material and methods. 78 patients of group B with uterine septum, reproductive failure, bipolar hysteroscopic metroplasty were under observation. Among the examined patients, 39 suffered from miscarriage and 39 suffered from infertility. 37 women of the BI group underwent hysteroscopic bipolar dissection of the uterine septum; 41 women of the BII group underwent hysteroscopic bipolar resection of the septum. Results and their discussion. Within 2 years after metroplasty, pregnancy occurred in 86.49% of women in the BI group and in 100% of women in the BII group (p>0.05); the specific weight of miscarriages was 9.38% and 0.00%, respectively (p>0.05); childbirth - 58.88% and 70.97% (p>0.05); premature births – 17.65% and 6.45% (p>0.05); term deliveries - 38.24% and 64.52% (p<0.04, SD 0.34 [0.12-0.93]). In women with initial infertility, pregnancy occurred in 61.54% of women in the BI group (n=13) within 2 years after the operation, in 69.23% in the BII group (n=13) (p>0.05); the specific weight of miscarriages was 25.00% and 22.22%, respectively (p>0.05); childbirth - 75.00% and 77.78% (p>0.05); premature births – 12.50% and 11.00% (p>0.05); term deliveries - 62.50% and 66.67% (p>0.05). Analysis of recovery of reproductive function 2 years after surgery in women with initial miscarriage showed that 90.48% of women in the BI group became pregnant, 94.44% in the BII group (p>0.05); the specific weight of miscarriages was 31.58% and 11.76%, respectively (p>0.05); childbirth - 68.42% and 88.24% (p>0.05); premature births – 26.32% and 5.88% (p>0.05); term deliveries - 42.11% and 82.35% (p<0.02, SD 0.16 [0.03-0.73]). Conclusions. The use of the technique of removal of the uterine septum during bipolar hysteroresectoscopy compared to the technique of its dissection in women with a septate uterus and reproductive failure leads to a probable increase in the termination of pregnancy by term delivery both in the general group and in the group of patients with initial miscarriage.

The influence of concomitant extragenital pathology on the success of assisted reproductive technology procedures in women (according to clinics of the Volgograd region)

At the moment, the problem of infertility does not lose its relevance. In the structure of this disease, the violation of reproductive function in women is dominant. The present study is devoted to the study of the influence of concomitant extragenital pathology on the success of assisted reproductive technology procedures. The data of 184 women who underwent infertility treatment by ART methods in clinics of the Volgograd region in the period from 2015 to 2020 were analyzed. The following parameters of the patients were studied: age, gynecological history, the main cause of infertility, transferred diseases of non-productive organs, the protocol of ovarian stimulation with gonadotropins, the number of mature follicles by the end of stimulation, the number of received, fertilized eggs, the number of embryos by day 3, 5. It has been established that concomitant extragenital pathology affects the processes of folliculogenesis and qualitatively affects oogenesis.

Prevalence of thyroid dysfunction in women with dysfunctional uterine bleeding in Kano, North-Western Nigeria

Context: Thyroid hormones play a key role in the menstrual and reproductive functions of women. Thyroid dysfunction is marked by a large number of menstrual aberrations. Objective: To determine the incidence of thyroid dysfunction in dysfunctional uterine bleeding (DUB) and its correlation with menstrual patterns. Materials and Methods: The study population consisted of 64 DUB patients aged between 19 and 45 years and an equal number of age-matched women with a normal menstrual cycle. Plasma concentrations of thyroid-stimulating hormone (TSH), free thyroxine (T4), and free triiodothyronine (T3) of the participants were measured. Laboratory analyses were conducted on Elecsys 2010 immunology analyzer. Statistical analysis was performed with Microsoft Excel software, and the data were transferred into IBM SPSS version 21.0 for processing. A P-value of <0.05 was considered significant. Results: Among the 64 women with DUB, 21.9% had thyroid dysfunction, of which 14.1% had overt hypothyroidism, 6.2% had subclinical hypothyroidism, and 1.5% had overt hyperthyroidism. The main menstrual complaint among hypothyroid DUB patients was menorrhagia. The only presentation in hyperthyroidism was oligomenorrhea. Conclusion: The prevalence of abnormal thyroid function in this study was high; therefore, screening of DUB patients for thyroid function abnormalities is suggested.

НЕКОТОРЫЕ МОРФОФУНКЦИОНАЛЬНЫЕ ОСОБЕННОСТИ МИТОХОНДРИЙ, ИХ СВЯЗЬ С РЕПРОДУКТИВНОЙ ФУНКЦИЕЙ ЖЕНЩИН

Introduction. Mitochondrial morphology and metabolism can have a decisive influence on energy metabolism and reproductive function in women. The objective of this study is to characterize the metabolic and energy metabolism processes in women of reproductive age and those in perimenopause. Methods. The study involved 100 women divided into two equal groups: women of reproductive age and women in perimenopause. Results. All participants had regular menstrual cycles. The duration of menopause in the second group was 1-3 years, with an onset age of 45 years. In total, 64% of the women in group 2 had neurohumoral abnormalities and obesity. Moderate to severe menopause symptoms were detected in 56% of women. Group 2 had reduced activity of mitochondrial enzymes in lymphocytes, such as succinate dehydrogenase and α-glycerophosphate dehydrogenase, while protein, glucose, and uric acid were above normal. Conclusion. This finding suggests that mitochondrial enzymes in group 2 become less active with age. At the end of the reproductive age, the intensity of the energy processes decreases. Cell energy metabolism remains an important area as further research, as this process can shift the timing of reproductive aging in women.