[Psychotherapeutic correction of affective disorders in women participating in the program of assisted reproductive technologies].

To study peculiarities of mental disorders in women during treatment of sterility using current reproductive technologies (extracorporeal fertilization), 512 women, mean age 33,6+3,7 years and sterility duration 3,1+/-2,2 years (from 1 to 5 years) have been examined. A number of attempts to treat sterility varied from 1 to 10. In 266 (52%) patients, borderline mental disorders have been found. Anxiety and depressive disorders made up 31,2%. A significant role of stress in their manifestation and a negative influence of mental disorders on treatment outcome and possibility of remission has been revealed. The use of cognitive-behavioral psychotherapy resulted in the decrease of expression of mental disorders and adequately prepared patients to the treatment thus improving its results.

[Methodological features of magnetic resonance imaging mammography].

By studying 211 females by currently available radiation techniques, such as X-ray study, ultrasonography, and magnetic resonance imaging mammography (MRIM), the authors consider that the specificity of contrast-enhanced MRIM (CE MRIM) is greater than that of MRIM without administering magnetic resonance contrast agents (MRCA). CE MRIM reveals clinically suspicious early-stage breast lesions and defines the stage of a tumorous process, the patients being unexposed to ionizing irradiation. CE MRIM as an auxiliary technique becomes one of the most informative ones, particularly in girls, early reproductive-age females with developed glandular tissue, and pregnant females. In the authors' opinion, the total algorithm of a breast study in this group of patients in specialized medical centers where trained physicians work should differ from the generally accepted algorithm: instead of applying X-ray mammography (XRM) as a basic method of primary diagnosis, ultrasound mammography using Doppler color mapping, followed by MRIM or XRM should be employed.

[Comparative assessment of urological, neurological, obstetric, and gynecological risk factors of urinary incontinence in women].

To compare the effects of urological, neurological and obstetricogynecological risk factors of urine incontinence (UI) in women, we made a questionnaire survey covering a representative sample of 4336 female residents of Moscow aged 25-74 years. We used standard epidemiological methods and unified criteria, descriptive statistics and modeling by means of logical regression in 6.12 version of SAS system. We revealed that chronic cystitis and other inflammatory urinary diseases provoke a 4-fold increase in the relative risk (RR) of UI in women being higher than obstetricogynecological risk factors (RR 1.5-2.8) and neurological risk factors (RR 1.3-2.0). UI in many cases is of stress type, but in urinary inflammation a mixed type occurs 1.8 times more frequently. Thus, chronic cystitis and other urinary inflammatory diseases are essential UI risk factors in women.

[Pharmacokinetics of mifepristone and kinetics of chorionic gonadotropin beta-subunit (beta-HCG) and progesterone in plasma of pregnant women during pharmacological interruption of early pregnancy]. / Farmakinetika mifepristona i kinetika beta-sub''edinitsy khorionicheskogo gonadotropina (beta-KhG) i progesterona v plazme krovi beremennykh zhenshchin pri medikamentoznom preryvanii rannei beremennosti.

Reliable correlations between the parameters of mifepriston pharmacokinetics describing the rate of drug elimination from the blood plasma and the levels of beta-human chorionic gonadotropin (beta-HCG) and progesterone reflecting the state of gestation in females have been established fore the first time. According to these relationships, the half elimination time, the mean retention time, and the plasma clearance of mifepriston can be considered as predictors of the clinical efficacy of this drug for the early pregnancy interruption.

[Magnetic resonance imaging in the diagnosis of different forms of endometriosis]. / Magnitno-resonansnaia tomografiia v diagnostike razlichnykh form éndometriozov.

The present paper examines the capacities of non-invasive MRI in the diagnosis of endometriosis. A standardized study algorithm is proposed, indications and methodology for MRI in different forms of endometriosis (EM) are specified. It is shown that in the diagnosis of different types of EM there are specific changes in the MR pattern of small pelvic organs, which allow one to make a differential diagnosis of this disease with a higher sensitivity (96%) and specificity (87%) as compared with ultrasound study. MRI makes it possible to assess the degree of invasion of endometrioid heterotopies into the wall of the intestine and cervix uteri with a high degree of accuracy and to judge the degree and extent of intestinal luminal narrowing. Diagnostic errors in solving these problems (as well as those associated with the detection of extragenital foci of EM in the small pelvis) are due first of all to movement artefacts a (respiration and intestinal motility) particularly in the presence of a significant adhesive process and/or after surgical intervention. MRI does not virtually yield false-negative conclusions in the diagnosis of different forms of genital endometriosis (less than 3%), which, in the authors' opinion, rather justifies some hyperdiagnosis (about 11%) made by this method in the diagnosis of endometriosis of the rectovaginal septum. MRI is a closing, specifying stage of instrumental diagnosis of not only EM, but also other small pelvic diseases.

Expression of cytokine genes in adhesions on uterine tubes.

We studied expression of genes of interleukins, interferon-gamma, tumor necrosis factor-alpha, and transforming growth factor-beta(2) in adhesions on uterine tubes. In tubal adhesions the intensity of production of mRNA for proinflammatory cytokines, antiinflammatory cytokine interleukin-10, and regulator of cell proliferation surpassed that in normal tissues by 2.5-7.4, 2.2, and 50.2 times, respectively. Correlations were found between production of mRNA for tumor necrosis factor-alpha and transforming growth factor-beta(2), interleukin-12, and interferon-gamma and interleukin-12 and transforming growth factor-beta(2). Our results suggest that expression of these genes during adhesion formation is regulated by the feedback mechanism.

Antisperm antibodies and sterility: insoluble problem or perspective trend of research?

Conflicting opinions about the effects of antisperm antibodies on fertilization can be due to inadequacy of experimental approaches in evaluating the antisperm immunity. Detection of antisperm antibodies bound to the surface of live spermatozoa can be associated with aggregation of surface antigen-antibody complexes followed by metabolic activation of spermatozoa and acrosomal reaction, which impair cell resistance. New concept of antisperm immunity and its influence on reproduction can be formulated only after comprehensive studies of the mechanisms of spermatozoon response to binding of antisperm antibodies. Further improvement of quantitative assays of antisperm antibodies and evaluation of their effect on spermatozoon function should be aimed at selection of experimental conditions preventing changes in spermatozoa coated with antisperm antibodies during in vitro manipulations.

Antisperm antibodies detection by flow cytometry is affected by aggregation of antigen-antibody complexes on the surface of spermatozoa.

Flow cytometry (FCM) analysis of live antibody-coated spermatozoa subjected to immunofluorescence staining (FCM test) is considered an objective method for the quantitative detection of antisperm antibodies (ASA). But the cross-linking of cell surface antigen (Ag) with bivalent antibodies and/or antigen-antibody (Ag-Ab) complexes with second antibodies may induce the reorganization of surface components (patching and capping) and result in their shedding from the sperm surface. The present study estimates the relationship between aggregation of Ag-Ab complexes on the sperm surface and the results of indirect FCM test. Swim-up spermatozoa of normozoospermic men were incubated with ASA-positive sera from infertile patients and with second antibodies fluorescein isothiocyanate (FITC)-labelled goat anti-human IgG polyclonal antiserum under different conditions and then analysed by FCM and fluorescence microscopy. It was shown that low temperature, cytochalasin B, excess or lack of the primary and/or secondary antibodies and sperm fixation by paraformaldehyde may inhibit aggregation and shedding of Ag-Ab complexes and dramatically increase ASA quantity determined on the sperm surface. However, inhibition of aggregation on the live sperm surface was observed only in a minority of ASA-positive samples and was poorly reproducible using semen of different donors. A high probability of Ag-Ab complex shedding from the sperm surface during experimental manipulation limits the use of indirect FCM test for quantitative ASA determination.

[Immunology of reproduction]. / Immunologiia reproduktsii.

The paper presents the results of studies of the role of immune factors in the pathogenesis of infertility, impaired gestation, and perinatal abnormalities, which have been performed at the Research Center of Obstetrics, Gynecology, and Perinatology, Russian Academy of Medical Sciences, in the past decade. It gives an evaluation of the contribution of antispermatic antibodies to infertility of unclear genesis, the systemic and local factors of immunity in females with endometriosis, the immune and interferon status in those with sexually transmitted infections, the role of immune factors and intrauterine infection in gestational abnormalities, the involvement of autoimmune mechanisms in reproductive disturbance. The trends of further studies are outlined.

Evaluation of stimulus-induced acrosome reaction by two-colour flow cytometric analysis.

Acrosome status in human spermatozoa from 20 normozoospermic men was evaluated by flow cytometry following the induction of the acrosome reaction with the ionophore A23187. Dual fluorescence staining of methanol fixed spermatozoa incubated with and without (control) the ionophore A23187 was performed with probes which targeted the outer acrosomal membrane (OAM) (rhodamine-labelled Arachis hypogaea agglutinin) or constituents of the acrosomal vesicle (fluorescein-labelled Pisum sativum agglutinin). Flow cytometry analysis revealed two major subpopulations of cells: acrosome-intact and acrosome-reacted spermatozoa after induction of the acrosome reaction. The intensity of green and red fluorescence in acrosome-reacted spermatozoa was significantly lower than that of the acrosome-intact control spermatozoa (P < 0.0001). The intensity of green fluorescence in the acrosome-intact subpopulation of spermatozoa was significantly higher than that of the control population (P < 0.002). Exposure of spermatozoa to the ionophore A23187 resulted in reliable enhancement of the number of spermatozoa with very high intensity of green and/or red fluorescence compared with the control (P < 0.03). An inverse correlation between the number of acrosome-reacted spermatozoa and spermatozoa with a very high intensity of green and/or red fluorescence was demonstrated (r = -0.631, P < 0.01). This method provides an objective and efficient procedure for quantitative estimation of the acrosomal status of human spermatozoa.

Flow cytometry study on the effect of serum and peritoneal fluid of women on sperm-binding activity of immunoglobulin G antisperm antibodies.

OBJECTIVE: To investigate the influence of sera and peritoneal fluids (PFs) from fertile and infertile women on the binding of antisperm antibodies to the surface of spermatozoa. DESIGN: The immunoglobulin (Ig) G antisperm antibodies binding to the surface of liver spermatozoa was evaluated after their incubation in antisperm antibodies-positive serum from an infertile male in the presence and absence of female sera or PFs. SETTING: Russian Scientific Center for Obstetrics, Gynaecology, and Perinatology. PATIENT(S): Serum and PF samples from fertile and infertile women; antisperm antibodies-positive serum from infertile men; high-quality fresh semen from healthy donors. INTERVENTION(S): Serum samples were obtained from fertile and infertile women and from infertile men. Peritoneal fluids were collected during routine laparoscopy. MAIN OUTCOME MEASURE(S): The proportion of spermatozoa positive for IgG antibodies and the quantity of antisperm antibodies on the sperm surface measured by flow cytometry (FCM). RESULT(S): The addition of sera from fertile or infertile women with endometriosis or pelvic adhesion disease to an IgG antisperm antibodies-positive male serum resulted in significant inhibition of the antisperm antibodies binding to the sperm surface. CONCLUSION(S): Sera of fertile as well as infertile woman contain factors that block IgG antisperm antibodies binding to the surface of live spermatozoa.

Lymphocyte subsets in the endometrium of patients with endometriosis throughout the menstrual cycle.

PROBLEM: Comparison and characterisation of different lymphocyte subsets in the endometrium of endometriosis patients and in healthy women on every day of the menstrual cycle with special emphasis on the CD4:CD8 ratio in the endometrium. METHOD: Immunohistochemical staining of 253 endometrial biopsies of infertile women with and without endometriosis with Anti-Leu4 (CD3), Anti-Leu3a (CD4), Anti-Leu2a (CD8), Anti-Leu7 and Anti-Human-B-cell (CD22) using the immune peroxidase reaction. Identification and counting of positive lymphocyte were performed on cryostat sections. RESULTS: Endometrial lymphocyte subsets show equal quantity and distribution in endometriosis patients and in the control group. After a peak in the early proliferative phase the absolute number of T lymphocytes decreases while a predominance of T-suppressor/cytotoxic T lymphocytes (CD8) compared to T-helper/inducer lymphocytes (CD4) occurs towards the end of the menstrual cycle. CONCLUSION: Endometrium as the potential parent epithelia of endometriosis lesions seems not to be altered in its lymphatic cell content compared to healthy women. Furthermore, endometrium is clearly characterised as part of the mucosa associated lymphatic tissue (MALT). T lymphocytes show specific quantitative changes due to different phases of the menstrual cycle.

[Obligate anaerobic microbes in obstetric and gynecologic diseases]. / Obligatno-anaérobnye mikroorganizmy pri akushersko-ginekologicheskoi patologii.

The paper reviews recent-years' papers and the data of their own investigations on a role of obligate anaerobic microbes in obstetric and gynecological abnormality. The fact that secondary pelvic inflammatory processes caused chiefly by non spore-forming anaerobes is ascertained. There is evidence that obligate anaerobic bacteria are involved in the abnormality directly unassociated with the development of an inflammatory process: preterm labor, premature discharge of amniotic fluid, intranatal fetal hypoxia, respiratory distress syndrome and hyaline membrane disease of the premature newborn. Among vaginal infections the key role is played by bacterial vaginosis which is, from the pathophysiological point of view, now a severe derangement of the vaginal environment system with greatly prevalent obligate anaerobic bacteria and without lactoflora. Complications associated with this abnormality are noted.