Репродуктивное здоровье мужчин в парах, страдающих невынашиванием беременности

In the context of current demographic situation the problem of miscarriage has become especially acute. Traditionally various aspects of miscarriage and the preterm labor have been viewed through the prism of the woman's health. At the same time, according to the present reproductive medicine, a proper approach to this problem includes taking into account the state of health of both future parents. In contrast to infertility, male reproductive health in couples, suffering from miscarriage, and its contribution to the outcome of pregnancy, ending without childbirth, hasn't been determined yet. The article includes the results of studying reproductive health in 62 men – husbands of women, suffering from miscarriage at different terms. The role of chronic viral infection as a cause of spermatogenesis disturbances has been shown.В разрезе современной демографической ситуации проблема невынашивания беременности приобрела особую остроту. Традиционно различные аспекты невынашивания и недонашивания беременности принято рассматривать сквозь призму здоровья женщины-матери. Вместе с тем современный репродуктологический подход предусматривает необходимость учета здоровья обоих будущих родителей. В противовес бесплодию, репродуктивное здоровье мужчин в парах, страдающих невынашиванием, практически не изучено, и вклад его нарушений в исход беременности, не закончившейся деторождением, не определен. Представлены результаты изучения репродуктивного здоровья 62 мужчин, супругов женщин, страдающих невынашиванием беременности в различном сроке. Показана роль хронической вирусной инфекции как причины развития нарушений сперматогенеза

Obesity in women: current aspects of reproductive health disorders

Obesity and overweight tend to increase in prevalence in the whole world. Obese people have a higher incidence of cardiovascular diseases, stroke, osteoarthritis, diabetes mellitus and reproductive system diseases. This is especially evident in women. Hormonal imbalances is developed among obese women in the hypothalamic-pituitary-ovarian axis, typically there are menstruation disorders, anovulation and female infertility. Adipose tissue is an endocrine organ, with an intricate role in bioactive molecules secrete, in particularly adipokines, which interact differently with a variety of molecular pathways, contribute to the development of insulin resistance, inflammation, hypertension, increased risk of cardiovascular events, disorders of blood clotting, differentiation and maturation of oocytes. In addition, women with obesity and metabolic syndrome have problems with conception at the endometrial level often, a significantly higher risk of having a miscarriage, and worse assisted reproductive technology outcomes. Obesity has negative effects on the endometrium in non-pregnant women, it is increasing the risk of abnormal uterine bleeding. Hormones derived from adipose tissue could be affected on the  function of  the uterus/endometrium and, consequently, affect the amount of menstrual blood loss. Contradictory results are observed in patients with endometriosis. The correlation of body mass index to the risk of endometriosis has not been proven in clinical studies, but there was a direct relationship between the severity of endometriosis and a high body mass index. The review presents possible relationships of diseases of the reproductive system with obesity and overweight, determining their development and pathogenesis of disorders of the formation of the functions of reproductive organs

ПОЛИМОРФИЗМ ГЕНА NAT2 КАК ПРЕДИКТОР РЕЦИДИВОВ ПОСЛЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПРОЛАПСА ТАЗОВЫХ ОРГАНОВ

Background: Pelvic organ prolapse (POP) is the most frequent disease component in the structure of gynecological pathology (from 28 to 38.9%) and its incidence is increasing. Most of the research studies were initiated to develop various kinds of operative treatment for common prolapse cases (POP-Q III−IV); however, a large number of surgical interventions associated with a high percentage of complications and a high rate of relapses confirm the difficulty for problem-solving. In this regard, there is a need to expand ideas about the pathogenesis of the disease and develop approaches to the prediction of recurrence surgical treatment, choosing the correct and timely treatment strategy. Currently, great importance is given to the study of genetic control of connective tissue metabolism. The evidence demonstrated that polymorphism of NAT2 gene results in genetically determined disorders of connective tissue catabolism which increases the possibility of disease development approximately in 2 times. Point mutations in NAT2 lead to the so-called slow-acetylation which determines the predominance of the decay rate of collagen over its synthesis.Aim: Analyze the significance of NAT2 polymorphism as a predictor for failure of surgical treatment of pelvic organ prolapse.Materials and methods: The prospective cohort clinical trial enrolled 140 women of the reproductive age (from 28 to 42 y.o.) with symptomatic prolapse (POP-Q Stage II−III) who were examined and received treatment in the period from 2008 to 2014. All patients underwent surgical treatment of POP. The treatment included colpoperineorrhaphy with levatorplasty. In 12.9% of patients who had stress urinary incontinence — in combination with a loop urethropexies transobturatory access (Transobturator Vaginal Tape, TVT-O). Long-term results of treatment effectiveness were assessed in 3−5 years. Results: The findings revealed that the incidence rate of point mutations of NAT2 gene was 2-fold higher in patients with POP included in the ineffective treatment group (61.8%) if compared to the rate registered in the effective treatment group (30.6%).Conclusions: The obtained data indicate that the presence of point mutations in NAT2 gene is a poor prognostic factor for general types of genital prolapse and a predictor for failure of surgical treatment.Обоснование. Пролапс тазовых органов (ПТО) — наиболее частое заболевание: число случаев в структуре гинекологической патологии составляет от 28 до 38,9% и продолжает увеличиваться. Большинство исследований посвящено разработке различных видов оперативного лечения распространенных форм пролапса (POP-Q III−IV), однако наличие большого количества вариантов хирургических вмешательств (около 400) в сочетании с высоким процентом их осложнений, а также высокой частотой рецидивов свидетельствуют о действительной сложности решения данной проблемы. Увеличение распространения ПТО среди пациенток репродуктивного возраста связывают с высокой частотой дисплазии соединительной ткани в популяции. В настоящее время большое значение уделяется изучению генов, контролирующих метаболизм соединительной ткани. Имеются данные о наличии генетически детерминированного нарушения катаболизма соединительной ткани вследствие полиморфизма гена NAT2, увеличивающего вероятность развития ПТО примерно в 2 раза. Наличие так называемого медленного ацетилирования гена NAT2, обусловленного точечными мутациями, определяет преобладание скорости распада коллагена над его синтезом. В связи с этим возникает необходимость расширения представления о патогенезе заболевания и разработки подходов к прогнозированию возникновения рецидивов хирургического лечения, выбора правильной и своевременной тактики лечения.Цель исследования ― изучить значение генетического полиморфизма NAT2 как одного из возможных предикторов рецидивов после хирургического лечения пролапса тазовых органов. Методы. В проспективное когортное клиническое исследование было включено 140 женщин репродуктивного периода с ПТО II−III стадии по классификации РОР-Q в возрасте от 28 до 42 лет, которым проводилось обследование и лечение в период с 2008 по 2014 г. Всем 140 (100%) пациенткам было выполнено хирургическое лечение ПТО, включавшее кольпоперинеорафию с леваторопластикой, у больных со стрессовым недержанием мочи (12,9%) — в сочетании с петлевой уретропексией трансобтураторным доступом (Transobturator Vaginal Tape, TVT-O). Отдаленные результаты эффективности лечения оценивали через 3−5 лет. Вычислен относительный риск связи наличия точечных мутаций гена NAT2 c отдаленными результатами хирургического лечения.Результаты. Полученные данные свидетельствуют о том, что частота встречаемости точечных мутаций гена NAT2 у пациенток с ПТО в группе неэффективного лечения была более чем в 2 раза выше и составила 61,8% против 30,6% в группе эффективного лечения.Заключение. Полученные в ходе настоящего исследования данные свидетельствуют о том, что носительство точечных мутаций в гене NAT2, определяющих преобладание катаболизма коллагена над его синтезом, является прогностически неблагоприятным фактором как наличия распространенных форм пролапса гениталий, так и предиктором рецидивов после хирургического лечения

Гинекологическая заболеваемость и репродуктивные потери в России в первой декаде XXI в.

In the recent years the state of reproductive health of women in Russia has attracted a careful attention of scientists, clinicians and health professionals. The article includes the analysis of the Federal State Statistics Service data. Tendencies in gynecologic incidence for the recent 13 years have been revealed. The analysis of the structure of reproductive losses in the Russian Federation in 2009 has been carried out.Состояние репродуктивного здоровья женщин России в последние годы привлекает пристальное внимание ученых, клиницистов и организаторов здравоохранения. В статье представлен анализ данных Росстата, выявлены тенденции гинекологической заболеваемости за последние 13 лет. Проведен анализ структуры репродуктивных потерь в РФ за 2009 г

Овариальный резерв в динамике у девушек-подростков и молодых женщин после хирургического лечения по поводу доброкачественных болезней яичников

It was done estimation the condition of ovarian reserve of 51 women 15—25 years old in dynamic after surgery and conservative treatment for benign non-inflammatory ovarian diseases, by identification of AMG level, ovarian volume and count of antral follicles in each ovarian immediately and after 6 month after treatment. Complemented the existing ideas about the negative effects on the state of ovarian reserve intervention and specific nosology.Проведена оценка состояния овариального резерва у 51 женщин 15—25 лет после оперативного и консервативного лечения по поводу доброкачественных невоспалительных болезней яичника при помощи определения уровня АМГ, обьема яичников и количества антральных фолликулов в каждом из них в динамике сразу и через 6 месяцев после операции. Дополнены имеющиеся представления о негативном влиянии на состояние овариального резерва оперативного вмешательства и определенных нозологий

Metabesity: pathogenetic bases and predictive capabilities. A review

One of the most pressing problems of our time is obesity, recognized by the WHO as a pandemic of the XXI century. It is important to remember that obesity is a full-fledged nosological entity, but many women think that obesity is just a problem of beauty and aesthetics. It is important to note that this nosology has a number of serious consequences, starting with the development of cardiovascular disease and ending with cancer. However, the “problem in the problem” is the so-called “metabesity” – a new term that reflects a number of diseases, the pathogenesis of which is based on the metabolic syndrome. Obesity, metabolic syndrome and metabesity seem to be different concepts, but the absolute identity of the pathogenetic basis characterizes them as successive stages of one global process. In this regard, it is necessary to highlight the key mechanisms of the development of the described disorders and to consider the concept of clinical management of patients in this cohort

Immune response and cytokine status at varicose vein disease of pelvis minor in women

The article describes participation of immune system in pathogenesis of varicose vein of pelvis minor. The study revealed elevation of proinflammatory cytokines, discovered disturbances in cellular and humoral units of immunity. Indicated changes are evidence for inflammatory character of changes in venous vascular wall, causing its destruction and varicose dilatation

The Immune Profile of the Endometrium in the "Uterine Factor" of Infertility

Background: This study aimed to investigate the endometrial characteristics (pathomorphological and immunological) of women with infertility. Methods and Results: Data from an immunohistochemical study of endometrial biopsies (TNF-α, IL-10, GM-CSF, CXCL16, BCA1, TGF-β1) collected during the “implantation window” and microbiota studied by real-time polymerase chain reaction in 171 patients (21 women with unexplained infertility, 36 - chronic endometritis, 74 - tubal-peritoneal infertility, 22 - external genital endometriosis, 8 - "thin" endometrium, and 10 healthy fertile women from the comparison group) were analyzed to identify molecular signatures. Chronic endometritis was verified morphologically and immunohistochemically. Each group revealed different immune endometrial phenotypes. The basis of the "normal" phenotype was a controlled immune inflammation and a Lactobacillus-dominant microbiota (LDM) type. In contrast to the comparison group, in the group with the phenotype of chronic inflammation, an excessive immune response (overexpression of TNF-α, GM-CSF, CXCL16, BCA1, and a decrease in IL-10 and TGF-β1 in glandular epithelium and stroma) was determined on the background of non-Lactobacillus-dominated microbiota (NLDM) type (63.3%) (P<0.001). The peculiar feature of a dysplastic phenotype was a "poor" immune response, with maximal TGF-β1 overexpression (P<0.001) and a NLDM type (47.1%). We determined an excessive immune response in the proliferative endometrial phenotype (GM-CSF overexpression by 1.2 times in the glandular epithelium and stroma [P<0.001 in both cases] and a decrease in IL-10 by 1.6 times in the glandular epithelium and 1.2 times in the stroma [P<0.001 in both cases]). Uterine microbiome disorders were detected less frequently than in patients with the inflammation phenotype (31.6%) (P=0.01). In the phenotype with impaired immune status, there was a decrease in GM-CSF, BCA1, CXCL16, TNF-α, and IL-10 markers in both endometrial compartments (P<0.001) with a LDM type (81.2%). Conclusion. The molecular signatures of the endometrium are due to the heterogeneity of immune factors and microbiota. Aberrant expression of immune factors may contribute to the formation of a microenvironment unfavorable for blastocyst implantation

Efficacy of immune correcting therapy at varicose vein disease of pelvis minor in women

In the article the complex therapy of varicose vein disease of pelvis minor in women is suggested; it includes phlebotropic, metabolic and immunotropic drugs. Indicated scheme of treatment lead to improvement of hemodynamic parameters of venous system of pelvis minor. Positive changes of parameters of cytokine, cellular and humoral units of immune system are evidence for decrease of inflammatory response of venous vascular wall

Risk factors for in vitro fertilization failures in women with adenomyosis-associated infertility

Aim. To identify risk factors for in vitro fertilization (IVF) failures in women with adenomyosis-associated infertility. Materials and methods. The study included 83 patients of reproductive age with adenomyosis. Women were divided into two groups: the main group (n=53) included patients with adenomyosis and a history of 1 or more unsuccessful attempts at embryo transfer, and the comparison group (n=30) included women with adenomyosis without impaired fertile function. The mean age of the patients was 364.0 years. Results. Gynecological conditions such as cervical dysplasia, noninflammatory vaginal diseases, and a history of sexually transmitted infections (STIs) were significantly (5-fold) more common in patients with a history of IVF failures (p0.05). A high prevalence of endocrine and digestive system disorders (27.7 and 7.7 times, respectively) was found in infertile women with adenomyosis (p0.05). Coagulation disorders were identified 4.8 times more often in women with adenomyosis-associated infertility and IVF failures. Inflammatory and proliferative endometrial diseases (hyperplasia, intrauterine synechia, and chronic endometritis) were significantly more common in patients in the main group than in patients with adenomyosis without impaired fertility (p0.05). Conclusion. Risk factors for IVF failure in women with adenomyosis-associated infertility are other specified coagulation defects [D68.8] (antiphospholipid syndrome), odds ratio (OR) 4.8, 95% confidence interval (CI) 1.120.9; dysplasia of cervix uteri, unspecified [N87.9] (OR 10.2, 95% CI 1.292.4), other noninflammatory disorders of vagina [N89.7] (OR 10.2, 95% CI 1.292.4), STIs (OR 12.7, 95% CI 1.4112.5), endocrine system disorders (OR 27.7, 95% CI 1.5516.5), and digestive system disorders (OR 7.8, 95% CI 2.227.8)