Endometrial asynchrony in pathogenesis of implantation impairment in women with infertility associated with endometriosis.

There is a statistically significant difference in the frequency of implantation in the group of patients with endometriosis associated with infertility compared with the control group. This has been confirmed by a number of different studies. The aim of the study to expand the understanding of the pathogenesis of implantation failures in patients with infertility associated with endometriosisMaterials and research methods: The present study included 83 women aged 29 to 43 years (the average age was 33 ± 3.2 years) with a diagnosis of endometriosis (ICD10 code N80.9 Endometriosis, unspecified), as well as infertility (ICD10 code N 97.8, Female infertility of other origin) and repeated implantation failures. All patients of the studied cohort underwent an immunohistochemical study of endometrial biopsy samples taken by the pipel-biopsy of the endometrium during the period of the supposed "implantation window".Research results: Significant decrease in the immunological labeling of VEGF-A in samples from the ERIF group by ∼2.7 times in comparison with EF group (p < .05), the indices of expression of the proapoptotic protein CASP3 are increased in the samples of the ERIF group in comparison with the EF group (by ∼2.7 times, p < .05) and significant decrease in the expression of HOXA10 in the stromal and glandular compartments (2.4 times; 57.2 vs. 23.5%, p < .05).Conclusion: On the basis of the obtained results of the study, it should be concluded that the basis of implantation impairment in patients with repeated implantation failures associated with endometriosis lies in angiogenetic and apoptotic disorders and leads to implantation failure in the eutopic endometrium due to desynchronous transformation of the epithelial-mesenchymal compartment and disruption of endometrial trophism.

[Natural Childbirth after the Previous Caesarian Section is a Solved Problem].

Тhe rapid increase in the frequency of сesarian section (CS) observed in recent years (up to 60% in some countries) is alarming and reduces the reproductive potential of the population. The operated uterus remains the main indication for CS (up to 40%). This is the factor which may allow reducing the frequency of the CS by subsequent delivering through the birth canal. A comparative analysis of maternal and neonatal outcomes enabled the authors to develop a two-stage delivery technology for patients with a caesarean scar, including the usage of the programmed delivery method. The presented algorithm confirmed the validity of vaginal delivery in such patients, and reduced the number of complications up to 4 times. Neonatal morbidity in children born through the birth canal in such patients was comparable to physiological birth.

Combination therapeutic options in the treatment of the luteal phase deficiency.

Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. There is evidence that both follicular and luteal phase abnormalities can result in LPD cycles. The aim of this randomized prospective noncomparative study is to evaluate the effectiveness of combination therapy in patients with LPD. This prospective study included 35 women of the reproductive age. They were diagnosed with the LPD with sonographically and laboratory-verified methods. The age of patients was 36 ± 0.46 years. The results of the study sonographically demonstrated an increase in the diameter of the corpus luteum from 1.36 ± 0.32 (initially) to 2.16 ± 0.21 mm after combination therapy. In addition, there was a statistically significant increase in the level of estrogens and progesterone in the corresponding phases of the menstrual cycle. Thus, the combination therapy for patients with LPD contributes to the recovery of cyclic events in the hypothalamic-pituitary-gonadal system, which determines the restoration of the endocrine function of the ovaries and promotes adequate secretory rearrangement of the endometrium in women of reproductive age.

[Expression of vascular endothelial growth factor (VEGF) in uterine tissues as one of the mechanisms of algogenezis in adenomyosis, associated with chronic pelvic pain].

Methods. For morphological studies it were using fragments of walls 60 uterus, received after hysterectomy in patients with pelvic pain on a background of diffuse adenomyosis II-III degree, and 30 uterus of women with painless form of adenomyosis. Expression of vascular endothelial growth factor (VEGF) was measured in endometrial and myometrial tissues using immunohistochemistry. The results showed a significantly higher expression of VEGF in patients with adenomyosis pain phenotype compared to the same in women with silent form in the epithelial cells of ectopic endometrium (14,7 ± 1,6 vs. 10,7 ± 1,6%, p<0,01) in the smooth muscle cells of the myometrium (12,6 ± 1,4 vs. 9,6 ± 1,2%, p<0,01), in the stromal cells of the myometrium (10,1 ± 1,9 vs. 7,4 ± 1,8%, p <0,01).

[The role of inflammatory and immune reactivity in developing pain in adenomyosis ].

Objective: to analyze the role of inflammatory and immune reactivity in the development of adenomyosis and its associated pain. Methods. For morphological studies it were using fragments of walls of 56 uterus received after hysterectomy in patients with pelvic pain on a background of diffuse adenomyosis II-III degree, and 30 patients with painless form of adenomyosis. To identify, evaluate the amount and spatial distribution of macrophages, T-helper cells and natural killer cells it was using MAbs to CD68, CD4, CD56 respectively. The results of the study showed a significantly high expression of CD68 (49,3 ± 2,3 vs. 21,2 ± 1,7 conv. units, p<0,01), CD56 (47,4 ± 2,7 vs. 17.2 ± 1.8 conv. units, p<0,01, p<0,05) and CD4 (52,1 ± 2,2 vs. 19,9 ± 2,5 conv. units, p<0,01) in patients with painful form of adenomyosis in the regions of ectopic endometrium and in the regions of perivascular growth in myometrium compared to those areas in women with painless adenomyosis. Conclusions: Adenomyosis is a chronic inflammatory disease accompanied by dysfunction of the uterine immune reactivity. Inflammatory and immune processes in the uterus with adenomyosis contribute to the persistence and growth of endometrial implants. In adenomyosis, associated with chronic pelvic pain syndrome, there is increase in the number of activated macrophages, natural killer cells and T-helper cells in the perivascular regions and in areas of remodeling of the myometrium are carriers of the nerves, which leads to increased neurogenic inflammation and sensitivity of nociceptors, activation of peripheral nerve fibers and the generation of pain.

Reproductive health of adolescents in Russia: statistics, problems and prospects of improvement.

At the beginning of the 21st century we still face the problem of reproductive health of women, children and adolescents in Russia. Final overcoming of the "Russian Cross" primarily relates to preventing further decline of women in reproductive age and children aged 0-17 years.The following medico-social determinants of women's reproductive health are considered: family prosperity, somatic growth and sexual maturation, chronic extragenital diseases, sexual and reproductive behavior, environmental wellbeing of territory and gynecological care organization. Analysis of gynecological morbidity of Russian girls and adolescents at the beginning of this century spots an upward trend. The results of our anonymous questionnaire survey of socially adapted students among 3327 girls of 13-19 years testify that 59.9% of respondents in this age cohort do not practice daily genitalia toilet. According to our population-based studies, 24.0% of women have first pregnancy at the juvenile age followed by labor in 18.4% of young women, abortion in 81.6%. Menstrual disorders represent the most common symptoms and strong indications of reproductive health problems related, inter alia, to progesterone deficiency which can lead to serious consequences (infertility, miscarriage, breast disease). The choice of medication for the menstrual disorders treatment should consider instruction indications, the lack of limitations and contraindications, need for contraception, concomitant diseases and states, proved efficacy of the medication. Prospects of solving reproductive and demographic problems in the twenty-first century are largely beyond the control of clinicians being aggravated by unresolved environmental and social problems.