Tubal-peritoneal Infertility Research Articles

Genital Tuberculosis as a Socially Significant Disease (Literature Review)

Globally, TB is the second leading cause of death from infectious diseases after COVID-19. Tuberculosis of the female genital organs is a type of extrapulmonary tuberculosis.It is known that both clinically pronounced and latent forms of this disease can cause both primary and secondary infertility due to pathogenetically caused disruption of the structure of the fallopian tubes and changes in the susceptibility of the uterine endometrium. It can be assumed that the problem of genital tuberculosis in Russia is still very relevant, although its true prevalence is unknown. This assumption is based on the facts of the projected growth of indicators the incidence of extrapulmonary tuberculosis, the obvious discrepancy between the real incidence and the official figures, as well as the increasing incidence of tubal-peritoneal infertility, which is often caused by genital tuberculosis. It is known that tuberculosis of the female genital organs is a difficult disease to diagnose. This is determined, in particular, by the fact that it does not have specific (so-called "marker") manifestations. Low rates of diagnosis of extrapulmonary forms of TB create a false sense of well-being, which does not reflect its true epidemiological picture. An obvious need today is the development of an optimal diagnostic complex, the use of which would contribute to accelerating the diagnosis of genital tuberculosis in women and, as a result, preventing the occurrence of irreversible changes in the female reproductive system caused by it. The authors used the scientific databases CyberLeninka, ELibrary and PubMed. Articles were searched for the following keywords: "tuberculosis", "genital tuberculosis", "infertility and tuberculosis". The paper analyzes articles published over the past 10 years.

Bacterial vaginosis and related sexually transmitted diseases as a risk factor for tubalperitoneal infertility (literature review)

The article presents a review of the literature on a pressing problem in clinical medicine — risk factors for tubo-peritoneal infertility. Bacterial vaginosis (BV) is one of the factors of increased risk of tubo-peritoneal infertility. Presumably, there are two mechanisms of tubo-peritoneal infertility associated with BV: firstly, the increased levels of proinflammatory cytokines, resulting in the attack of seminal fluid, and secondly, the cleavage of cervical mucus by bacterial mucinases, which improves adhesion by pathogenic microorganisms, contributing to colonization with a further tendency to diseases of the upper reproductive tract, including infertility. Women who have BV are more likely to suffer from inflammatory diseases of the pelvic organs caused by C. trachomatis and N. gonorrhoeae, which leads to tubo- peritoneal infertility. Therefore, timely detection and treatment of BV is crucial.

Стан локального цервікального імунітету в жінок із непліддям

Purpose - to study certain indicators of local immunity in women with infertility of various origins and early cervical lesions Materials and methods. The state of local cervical immunity was examined in 496 women, who were divided into groups depending on the cause of infertility, and each group was divided into subgroups A and B depending on the presence of cervical epithelial lesions. 128 women in the Group I had an endocrine cause, 122 patients in the Group II had a tubal-peritoneal factor of infertility, and 121 patients in the Group III had a male factor of fertility disorder. 125 healthy women formed the control group (CG). Subgroup A included women with NILM liquid cytology results: IA - 100 women, IIA - 70, IIIA - 68, GCA - 88. Subgroups B included women with ASC-US (atypical squamous cells of undetermined significance), LSIL (low-grade squamous intraepithelial lesion) and HSIL (high-grade squamous intraepithelial lesion): IB - 28 patients, IIB - 52, IIIB - 53, CGB - 37. In all patients, the content of interleukin-8 and -6 (IL-8, IL-6), lactoferrin and secretory leukocyte proteinase inhibitor in the material obtained for liquid cytology was determined by polymerase chain reaction. Results. In all patients with infertility, an increased concentration of secretory leukocyte proteinase inhibitor (from 314.1 to 398.7 pg/ml) and a decreased lactoferrin content (from 13.6 to 28.6 pg/ml) were found compared to the group of healthy women (114.8 and 64.8 pg/ml, respectively). In women with tubal and peritoneal infertility and male infertility, higher concentrations of IL-8 were found (659.9 to 878.8 pg/ml) than in the group of endocrine infertility (302.9 pg/ml) and in the group of healthy women (282.4 pg/ml). Conclusions. IL-8 content in cervical mucus is probably higher in women with tubal-peritoneal infertility (838 pg/ml) and male infertility (659.9 pg/ml) than in healthy women (289.4 pg/ml) and in women with endocrine infertility (302.3 pg/ml). The content of secretory inhibitor of leukocyte proteinase in cervical mucus was increased in all patients with infertility, regardless of its cause (from 314.1 pg/ml to 398.9 pg/ml), in the group of healthy women - 144.8 pg/ml. 3. The content of lactoferrin in the mucus of the cervical canal was reduced in all patients with impaired fertility (from 13.6 pg/ml to 28.6 pg/ml), in the group of healthy women - 64.8 pg/ml. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Implantation microenvironment in chronic endometritis

Objective. To study the immune patterns of the endometrium in women with infertility of uterine genesis in the phase of "implantation window". Materials and methods. Forty-two infertile women of reproductive age were prospectively examined. At the first stage, the contingent of women was divided into groups in accordance with the causes of infertility diagnosed before the current treatment: with chronic endometritis (CE) (n = 10); with tubal peritoneal infertility (TPI) (n = 32). A comprehensive examination of women included sonography of pelvic organs, hysteroscopy, examination of endometrial material in the period of the "implantation window" (morphological, immunohistochemical, real time (RT) PCR study,). The resulting for distinguishing molecular phenotypes of chronic inflammation (n = 30) and "normal" endometrium (n = 12) were the data of immunohistochemical studies of the immune profile (in the glandular epithelium and stromal cells (TNF-, IL-10, NRF2, GM-CSF and CXCL16), in the glandular epithelium BCA1, in the stroma TGF-) compared with the indicators of healthy fertile women (control group, n = 10). CE was verified based on pathomorphological and immunohistochemical studies (CD 138+). Results. Structural features of the endometrium in women with CE in the phase of the "implantation window" corresponded to the average stage of secretion in 36.4 %; variants of "out-of-phase" were identified in 63.6 % (late stage of the proliferation phase (16.7 %), dissociated development (13.3 %), early stage of the secretion phase (43.3 %)). Molecular characteristics of the immunologically tolerant endometrium, favorable for implantation, are determined by the balanced production of pro-and anti-inflammatory cytokines, growth factors and chemokines. Aggressive "microenvironment" in the endometrium of women with the phenotype of chronic inflammation was determined by the dominant of proinflammatory cytokines of the Th1/Th17 profile (an increase in comparison with the control of the expression level of TNF- and GM-CSF by 1.1 times and 1.2 times, in the glandular epithelium of chemokines CXCL16 and BCA1 by 1.2 times, CXCL16 in the stroma in 1.2 times) on the background of reduced production of protective factors (TGF- (1 point), IL-10 (in the glandular epithelium by 2 times, in the stroma by 1.8 times), NRF2. Conclusions. Different molecular characteristics of the endometrium in women with TPI and CE determine the heterogeneity of potencies for blastocyst implantation.

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.

Ефективність лікування трубно-перитонеального безпліддя в жінок репродуктивного віку

Purpose - to evaluate the effectiveness of the treatment of patients with infertility and tubo-peritoneal ruptures based on the analysis of long-term treatment results (occurrence of uterine pregnancy). Materials and methods. 132 women with tubo-peritoneal infertility were examined, who were divided into 2 groups: the Group 1 included 68 patients before and after operative laparoscopy, who received our proposed algorithm; the Group 2 included 64 patients before and after operative laparoscopy, who received generally accepted medical and preventive measures. The condition of the operated women was monitored for 1 year: 62 patients of the Group 1 and 57 patients of the Group 2. The frequency of pregnancy after treatment for 6 months and 6-12 months was evaluated. Results. Out of 62 women in the Group 1, 28 (45.2%) patients became pregnant within 6 months versus 11 (19.2%) in the Group 2 (p<0.05), and from 6 to 12 months - 13 (20.9%) patients versus 8 (14.1%) in the Group 2 (p<0.05). In 2 (3.5%) patients of the Group 2, the pregnancy was ectopic, which can be considered as a negative consequence of the treatment of adhesions and tubal-peritoneal infertility in general. If pregnancy did not occur in the examined women within a year, they were offered assisted reproductive technologies as the most effective method of pregnancy. Conclusions. The proposed pathogenetic prevention of recurrence of adhesive process in the pelvis of women of reproductive age is effective, can be reasonably used and allows to increase the frequency of pregnancy in the first 6 months of the postoperative period by 2.4 times in case of stage I-II prevalence of adhesive process. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

PECULIARITIES OF GENITAL ENDOMETRIOSIS ASSOCIATED WITH INFERTILITY

The aim of the study – to conduct a comparative retrospective analysis of the medical histories of patients with endometriosis associated with infertility and patients with tubo-peritoneal factor infertility Materials and Methods. A retrospective analysis of 485 patient’s medical histories, who applied to the medical centre “Yuzko Medical Center” regarding infertility for the period 2019–2022 was conducted. The main group (I) consists of 435 women with infertility, associated with endometriosis. The control group (II) consists of 50 women with tubal-peritoneal infertility factor. The obtained results were processed by the method of variational statistics. Results and Discussion. It has been founded that women with infertility associated with endometriosis, pain syndrome is noted for 305 patients (70.2 %). The dependence of the pain syndrome on menstruation was noted for 60.2 % of cases. Primary infertility was detected in 40.3 % of patients of group I and 84.6 % of group II, secondary infertility was diagnosed in 38 % of patients group I and 21 % of patients of group II. According to the results of the cytological examination, it was found that type II – 320 women (73.6 %) predominates and 10 women (21.3 %) of the control group. Type I – 114(26.4 %) women of the main group and 42 women (84.6 %) of the control group. Conclusions Thus, modern medicine should continue to study in detail the diseases that cause infertility. Scientists should investigate the causes of infertility formation in order to their further prevention and successful treatment. According to repeated ultrasound data, internal genital endometriosis is not suspected, therefore, it is not possible to rely on ultrasound data as an additional research method, and this requires the discovery of new diagnostic methods.

The Effect of Appendicular Peritonitis on the Reproductive Function of Girls

After surgery for gangrenous - perforated appendicitis, miscarriage occurs in 11%, infertility in 62% of cases. The aim of the study was to develop an algorithm for the diagnosis and treatment of reproductive dysfunction in women who underwent common appendicular peritonitis in childhood. 154 girls aged 3 to 15 years were examined. The results showed that various pathologies from the reproductive system (ovarian failure, inflammatory processes, tubal peritoneal infertility) were diagnosed in 47 (30,5%) patients, while more than half of them 28 (59,6%) did not show any complaints and pathology was identified during the examination. The developed algorithm allows for timely diagnosis and treatment of complications of reproductive function in girls after suffering from diffuse appendicular peritonitis.

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.

Features of hemodynamics of pelvic organs in women with tubal-peritoneal infertility

BACKGROUND: Insufficient effectiveness of modern methods of treatment of tubal-peritoneal infertility, including the use of in vitro fertilization, may be due to a persistent violation of the hemodynamics of the pelvic organs in patients.
 AIM: To identify the features of the hemodynamics of the pelvic organs in women with tubal-peritoneal infertility using the method of computer tetrapolar reopletismography.
 MATERIALS AND METHODS: The study included 53 women aged 25 to 35 years, according to the criteria for inclusion, non-inclusion in the study and exclusion from the study. The main group included 33 patients with secondary tubal-peritoneal infertility, confirmed by laparoscopy and chromohydrotubation. The control group consisted of 20 apparently healthy women with a history of spontaneous pregnancy, vaginal delivery and no abortions. The tetrapolar reopletismography study was performed on days 1921 of the ovulatory menstrual cycle. Statistical processing of the obtained results was carried out using the computer software package Statistica v. 11 (StatSoft, Inc., USA) using methods of parametric and nonparametric statistics.
 RESULTS: The study revealed a significant decrease in volumetric indicators of pelvic blood flow, systolic blood flow to the pelvic organs and blood circulation intensity, as well as significant changes in vascular tone and regional vascular resistance in the pelvic basin, in the main group patients compared with the control.
 CONCLUSIONS: Identified significant violations of the hemodynamics of the pelvic organs in tubal-peritoneal infertility can be regarded as an unfavorable factor that must be taken into account when choosing a treatment strategy. Therefore, the normalization of the hemodynamics of the organs of the female reproductive system using medical and efferent methods should be an important component in the complex treatment of tubal-peritoneal infertility, including before in vitro fertilization.

ЖЕНСКИЙ ГЕНИТАЛЬНЫЙ ТУБЕРКУЛЕЗ, БЕРЕМЕННОСТЬ ПОСЛЕ ЭКСТРАКОРПОРАЛЬНОГО ОПЛОДОТВОРЕНИЯ

The article describes a clinical observation of timely detected and treated female genital tuberculosis (FGTB) in an immunocompetent woman with tubal-peritoneal infertility before enrollment in the in vitro fertilization (IVF) programme. We have outlined diagnostic features of the disease, its association with the history of pulmonary TB, primary methods of examination, and treatment principles in FGTB. The examination included controlled simulation of ovulation, sonography, laparoscopy, hysteroscopy, pathomorphological studies, X-ray and computed tomography of the chest, endometrial biopsy. We also performed Ziehl–Neelsen microscopy of sputum, endometrium; luminescent microscopy; inoculation of endometrium, menstrual blood, and sputum onto solid and liquid nutrient media. We described successful pregnancy after IVF in a patient with tubal-peritoneal infertility due to FGTB after TB treatment. We concluded how important was to consider TB as a possible cause of bilateral fallopian tube blockage. Success and safety of IVF was preconditioned by timely detection and treatment of TB in the fallopian tubes, the endometrium, and the abdomen, as well as thorough monitoring of the reproductive organs.

Vitamin D indicators in pregnancy dynamics in women with different types of infertility in their history

The objective: to study the level of vitamin D in the dynamics of pregnancy in women with various types of infertility in history. Materials and methods. 127 women were examined: I group – 35 pregnant women who had a history of endocrine infertility; II group – 37 women with tubal-peritoneal infertility; III group – 30 pregnant women who had a history of tubal-peritoneal infertility with endocrine factor; IV (control) group – 25 healthy pregnant women without a history of infertility. To determine the level of 25-hydroxyvitamin D, a two-stage ELISA method was used. Results. Insufficiency and deficiency of vitamin D in the I trimester of pregnancy had 5 (20.0%) women without a history of infertility each, in the III trimester – 40% and 28% persons, respectively. Deficiency of 25-hydroxyvitamin D in the I group was detected in 15 (42.9%) patients in the I trimester and in 20 (57.1%) patients in the III trimester, in the II group – 10 (27.0%) and 17 (45.9%) persons, respectively, in the III group – 15 (50.0%) and 18 (60.0%) women, respectively.The number of patients with vitamin D deficiency during pregnancy in the groups of patients with a history of infertility was significantly higher compared with pregnant women without a history of infertility. Also, an increased rate of persons with vitamin D deficiency was determined among patients of the I, II and III groups compared with women of the IV group. Conclusions. In the dynamics of pregnancy an increase frequency of persons with insufficiency and deficiency of vitamin D was found among the women with a history of infertility, the largest rate of which was determined in pregnant women with endocrine infertility and tubal-peritoneal infertility in combination with an endocrine factor.

Prognostic value of determination of matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1 in follicular fluid in patients in vitro fertilization programs

Aim. To determine the prognostic significance of matrix metalloproteinase-1 (MMP-1) and tissue metalloproteinase-1 inhibitor (TIMP-1) in the follicular fluid (FF) in patients with infertility to improve the effectiveness of in vitro fertilization (IVF) programs.
 Materials and methods. A study of MMP-1 and TIMP-1 in the FF was conducted in 38 patients with infertility in IVF programs. According to the genesis of infertility, the patients were divided into 2 groups. The 1st (control) group included 20 patients with tubal-peritoneal infertility (code N97.1 according to the International Classification of Diseases of the 10th revision ICD-10). The 2nd group (the main one) included 18 patients with tubal-endocrine infertility (ICD-10: N97.1, N97.0, N97.8). The choice of the ovulation stimulation protocol was made taking into account the anamnesis, previously applied protocols, control over the outcome and final result of IVF programs was developed: a protocol with gonadotropin-releasing hormone agonists was used in 20 patients, and a protocol with gonadotropin-releasing hormone antagonists was used in 18 patients. The effectiveness of IVF programs was 26.3%, the frequency of live births was 26.3%. During the puncture of the follicles, FF was taken and the levels of MMP-1 and TIMP-1 were determined in it by the method of quantitative solid-phase enzyme immunoassay of the sandwich type on an automatic flatbed photometer MultiskanFC (2012). The obtained information was subjected to statistical analysis using the Statistica 10.0 application program.
 Results. The level of MMP-1 and TIMP-1 in the FF is an individual indicator and is associated with clinical and anamnestic characteristics. The average level of MMP-1 is 4.9 ng/ml. With negative IVF outcomes, it was 6.11.3 ng/ml, with positive outcomes 1.40.1 ng/ml. The content of MMP-1 in women with tubal-peritoneal infertility genesis of 7.91.7 ng/ml indicates a residual inflammatory process in the follicle. The average level of TIMP-1 was 2462.264.3 ng/ml. The indicator increases: with age (2535.0125.7 ng/ml), duration of infertility (2611.5126.7 ng/ml), due to surgical interventions on the reproductive organs (2800122.7 ng/ml) and in patients with tubal-endocrine genesis of infertility (2550126.7 ng/ml), which indicates fibrosclerotic changes in the follicles and ovarian tissue.
 Conclusion. The level of MMP-1 in the range of 1.31.4 ng/ml should be considered a criterion for the successful onset of pregnancy in IVF programs. The criterion of subclinical damage to the collagen matrix in the FF is the level of MMP-1 6.1 ng/ml or higher; it can be considered as an unfavorable prognostic factor for the outcome of IVF. The level of TIMP-1 in the range of 24002450 ng/ml should be considered a criterion for the successful onset of pregnancy in IVF programs. The probability of a negative outcome of IVF is in the range of 15002300 ng/ml (inability to level the effects of MMP-1 with these indicators), while the level of 2696 ng/ml and higher in tubal-endocrine genesis of infertility reflects a high degree of fibrosclerotic changes in ovarian tissue and can be considered as an unfavorable prognostic factor of IVF outcome.

Molecular Predictors of Effective Implantation and Live Birth in IVF Programs

The aim of the study was to improve the possibilities of predicting blastocyst implantation and live birth of ART programs in women of late reproductive age with tubal-peritoneal infertility based on immunohistochemical markers of the endometrium. Methods and Results: The results of IVF and IVF/ICSI programs were analyzed in 68 patients of late reproductive age (36-44 years of age) with tubal-peritoneal factor of infertility. Morphological examination of the endometrium was performed on Day 7 after confirmed ovulation in the cycle preceding ART. The expression of vitamin D receptors (VDR) and HOXA11 in endometrial stromal cells was assessed by immunohistochemical method. The effectiveness of using the endometrial markers VDR and HOXA11 as potential predictors of ART programs efficiency was confirmed by prognostic models. The levels of the stromal expression of VDR<8.7% and HOXA11<6.1% (probability >0.27) were determined to be favorable for successful blastocyst implantation. The expression levels of VDR<8.3% and HOXA11<6.1% in endometrial stromal cells are prognostically favorable for live birth (probability >0.19) in women of late reproductive age with tubal-peritoneal infertility who undergoing ART treatment with their own oocytes.

The anterior uterocervical angle as a new ultrasound marker of preterm labor in pregnant women with a history of endocrine and combined infertility

In women with endocrine and concomitant infertility there is a high frequency of the threat of termination of pregnancy at different periods, most often after stimulation of ovulation or as a result of assisted reproductive technologies, due to the formation of insufficiency of the luteal phase of the cycle in combination with hyperandrogenism and functional cervical insufficiency in every third pregnant woman. Regardless of the reasons, today there are no clear and early diagnostic criteria for this complication of pregnancy.Research objective: to determine the informational significance of the uterocervical angle for predicting premature birth in women with a singleton pregnancy and a history of infertility. Materials and methods. 127 women with singleton pregnancies aged 20–49 years underwent ultrasound at 12–14 and 16–20 weeks of gestation. The distribution of pregnant women into groups was based on the infertility factor: group I included 35 women with a history of endocrine infertility, group II included 37 pregnant women with a history of tubal-peritoneal infertility, group III included 25 women with a history of combined infertility (tubal-peritoneal infertility with endocrine), IV group (control) consist of 30 healthy pregnant women without a history of infertility.Results. The frequency of the uterocervical angle > 96° in the first half of pregnancy was in 31.4% of pregnant women with a history of endocrine infertility, in 10.8% of women with tubal-peritoneal infertility and in 32% of patients with a history of combined infertility. Preterm birth occurred in 45.4% of women with a history of endocrine infertility, in 75% of pregnant women with tubal-peritoneal infertility, in 62.5% of women with a history of combined infertility when the uterinecervical angle > 96° was detected in the first half of pregnancy.Conclusions. The uterocervical angle detected by ultrasound cervicometry in the first half of pregnancy in combination with other cervical parameters (length, state of the internal pharynx, etc.) improves the diagnosis of cervical insufficiency.

Peculiarities of gynecological history and reproductive status of women with psycho-emotional disorders related to prenatal stress

Persistent anovulation, menstrual disorders lead to the development of endocrine-dependent gynecological diseases, one of the manifestations of which is primary infertility. The aim of the study: to assess the clinical features of history and reproductive status in women with psycho-emotional disorders associated with prenatal stress. The study involved 120 patients, 80 of whom suffered prenatal stress: 1 – the main group, which is divided into 1A subgroup – women who underwent in vitro fertilization, and 1B subgroup – women who did not undergo in vitro fertilization. For comparison, a 2 – control group of 40 women without prenatal stress with exclusively tubal factor of infertility, in which the parameters of the functional state of the reproductive system corresponded to the normal ovarian reserve. The age of patients ranged from 22 to 45 years. Complaints, anamnesis of disease and life, gynecological anamnesis, level of education were studied in all patients, the causes of infertility were assessed. The results of the study were processed using the statistical package of the licensed program “STATISTICA® for Windows 13.0”. The normality of the distribution of indicators was established by the Shapiro-Wilk criterion. Descriptive statistics are presented as the arithmetic mean and standard deviation of M±SD or the median and quartile interval Me (Q1-Q2) depending on the distribution of the trait. It was found that in place of residence, social status, the presence of bad habits, gynecological history of infertile patients in in vitro fertilization programs do not differ from healthy women with tubal-peritoneal factor infertility. There was a significant difference between the indicators of the nature of the menstrual cycle in the comparison groups. It has been found that a menstrual cycle of less than 23 days is a predictor of reduced functional activity of the hypothalamic-pituitary-ovarian axis in women. Analysis of hormonal regulation of reproductive function of the examined groups of women found the prevalence of FSH in the main group over the control (9,611±0,212 vs. 6,221±0,113 mMod/ml, respectively, (p<0.05), and the level of TSH was not differences between comparison groups. We proposed to identify 3 states of ovarian reserve - normal, low and extremely low for women with a history of infertility and prenatal stress. Conclusion: timely comprehensive assessment of the endocrine system, ovarian status in relation to the state of regulatory mechanisms of psychoemotional adaptation of women with infertility associated with prenatal stress, which we studied, requires a partial revision of approaches to this group of patients and timely use of in vitro extracorporeal the effectiveness of infertility treatment.

Echohysterosalpingography: pros and cons. A systematic review

Background. Infertility is becoming ever more pressing a problem by year in Russia and worldwide. Tubal-peritoneal infertility is most frequent, with the prevalence of 42.5-80.5% in various estimates. Echohysterosalpingography is considered the today’s “gold standard” in tubal-peritoneal infertility diagnosis in women. This method is known to possess a series of limitations and adverse consequences due to painful sensations during and after check-ups that psychologically afflict women.Objectives. An overview of current methods for inspecting fallopian tubes in reproductively impaired patients to inform promising diagnostic research.Methods. Publications were mined and analysed in the PubMed, eLibrary, Web of Science, Cochrane Library and Cyberleninka electronic databases. The query terms were: echohysterosalpingography [эхогистеросальпингография], echohysterography [эхогистерография], infertility [бесплодие], pregnancy planning [планирование беременности], fallopian patency [проходимость маточных труб], ultrasonic diagnosis [ультразвуковая диагностика], submucous myomatous node [субмукозный миоматозный узел], incompetent uterine scar [несостоятельный рубец на матке], niche [ниша]. The topic selected was female infertility, particularly, the use of echohysterosalpingography in fallopian diagnosis in reproductively impaired women.Results. The review covers 52 sources of the total 118 analysed. Current published evidence and its review identify a notable success of imaging techniques in the fallopian tube diagnosis in women with reproductive problems. The continually developing echohysterosalpingography technique is considered more promising for routine use. Techniques gain more value in analyses of implantation failures. The main challenges in current radiodiagnosis and monitoring of fallopian lesions at a background therapy are the inspection standardisation, disease classification, imaging diagnostic accuracy and prognostic value evaluation in patients with reproductive loss and infertility.Conclusion. The prospective routes of research comprise the definition of optimal check-up terms, echohysterography and echohysterosalpingography diagnostic criteria descriptiveness, improving prognosis in the carrying of pregnancy and treatment efficacy control. A timely and accurate diagnosis of uterus and fallopian tubes is of paramount importance to sustain the women’s reproductive health.

Epithelial apical glycosylation changes associated with thin endometrium in women with infertility - a pilot observational study

BackgroundLow endometrial receptivity is one of the major factors affecting successful implantation in assisted reproductive technologies (ART). Infertile patients with thin endometrium have a significantly lower cumulative clinical pregnancy rate than patients with normal endometrium. Molecular pathophysiology of low receptivity of thin endometrium remains understudied. We have investigated composition of glycocalyx of the apical surface of luminal and glandular epithelial cells in thin endometrium of infertile women.MethodsThirty-two patients with tubal-peritoneal infertility undergoing in vitro fertilization (IVF) were included in the study. Endometrial samples were obtained in a natural menstrual cycle. Patients were divided into two groups: patients with normal endometrium (≥8 mm) and with thin endometrium (< 8 mm). Histochemical and immunohistochemical analysis of paraffin-embedded endometrial samples was performed using six biotinylated lectins (UEA-I, MAL-II, SNA, VVL, ECL, Con A) and anti-LeY and MECA-79 monoclonal antibodies (MAbs).ResultsComplex glycans analysis taking into account the adjusted specificity of glycan-binding MAbs revealed 1.3 times less expression of MECA-79 glycans on the apical surface of the luminal epithelial cells of thin endometrium compared to normal endometrium; this deficiency may adversely affect implantation, since MECA-79 glycans are a ligand of L-selectin and mediate intercellular interactions. The glycans containing a type-2 unit Galβ1-4GlcNAcβ (LacNAc) but lacking sulfo-residues at 6-OH of GlcNAcβ, and binding to MECA-79 MAbs were found; they can be considered as potential markers of endometrium receptivity.Expression of the lectins-stained glycans on the apical surfaces of the luminal and glandular epithelial cells did not differ significantly. Correlation between the expression of difucosylated oligosaccharide LeY on the apical surfaces of the luminal and glandular epithelial cells was found in patients with thin endometrium and recurrent implantation failure. A similar relationship was shown for mannose-rich glycans.ConclusionsSpecific features of key glycans expression in epithelial compartments of thin endometrium may be essential for morphogenesis of the endometrial functional layer and explain its low receptivity.

Threshold values of antibodies to estrogen, progesteron and benzo [a] pyrene as a risk factor for the development of endometriosis.

The objective of the study was to determine the level of antibodies (AB) of Ig classes A and G to estradiol (E2), progesterone (P)and benzo [a] pyrene (Bp) in patients with endometriosis of various severity and estimate their threshold values as a risk factor for the development of endometriosis. A retrospective case-control study was performed. The study involved 200 women. Group I: women with endometriosis (n=100), Group II: patients with tubal-peritoneal infertility (n=100). All patients underwent immunological studies of blood serum; and the levels of steroid hormones (P, E2), antibodies to them and Bp were determined. A ROC analysis was carried out to identify threshold values of antibodies levels. Women with endometriosis were found to have statistically significantly higher levels of antibodies IgA and IgG to E2, P and benzo [a] pyrene compared to women of Group II. The threshold levels of IgA-Bp, IgA-E2 and IgA-P are >5 CU (conventional unit), IgG-Bp, IgG-E2>9 CU and IgG-P>8 CU. The level of IgG-P in patients with severe forms of endometriosis is statistically significantly higher than in minor forms of the disease. In case of severe forms, there is a tendency to increasing other classes of antibodies. Patients with endometriosis usually have a higher level of IgA and IgG to Bp, E2, P. Their threshold values, which are risk factors for the development of the disease, are estimated.

Predictors of adverse outcome of in vitro fertilization programs

Identification of factors determining both adverse and favorable outcome of IVF will increase the effectiveness of this method and optimize infertility treatment. Objective. The aim of the research is to determine the relationship between hormonal and cytokine status indicators with an adverse outcome of the IVF procedure in women with tubal-peritoneal infertility. Patients and methods. The study involved 120 women with tubal-peritoneal infertility who underwent a “short” protocol of stimulation of superovulation in the IVF program. Depending on the result, women were divided into two groups: group 1 – with clinically confirmed pregnancy (n = 40), group 2 – non-pregnant women (n = 80). The content of IL-1α, IL-1β, IL-1Ra and hormones in serum were determined by ELISA. Genotyping of polymorphic markers rs1800587 (C/T) of the IL-1α gene, rs16944 (С511Т) of the IL-1β gene and rs2234663 (2/4) of the IL-1Ra gene was performed. Results. Markers of adverse IVF outcome that had prognostic significance were: C/C genotype of the IL-1α gene (OR = 2 [0.9–4.6], p = 0.043113), serum IL-1α concentration &lt;11.4 pg/mL (OR = 3, 2 [1.1-9.1], p = 0.025347), endometrial thickness on the 2nd day of the menstrual cycle was &gt;5 mm (OR = 3.2 [1.1–9.1], p = 0.025347), the concentration of prolactin on the 3rd day of the menstrual cycle was &gt;363.8 mU/mL (OR = 6.3 [1.8–22.2], p = 0.001745), genotype T/T of the IL-1β gene (OR = 15.8 [5.1–48.9], p &lt; 0.001), the concentration of progesterone was &lt;16 nmol/L (OR = 22.2 [2.3–170], p = 0.000057). Key words: cytokines, IVF, IL-1α, IL-1β, IL-1Rа, rs1800587, rs16944, rs2234663