The concomitant estrogen-dependent diseases and the ovarian reserve condition for patients with severe peritoneal endometriosis, included in the vitro fertilization programmes [Сопутствующие эстрогензависимые заболевания и состояние овариального резерва у включаемых в программы экстракорпорального оплодотворения пациенток с тяжелым перитонеальным эндометриозом]

Aim. Is specification of the nature and frequency of concomitant forms of genital endometriosis and other estrogen-dependent diseases (EDD) for the infertile women with severe peritoneal endometriosis (PE), as well as the assessment of the ovarian reserve condition for the patients of different ages. Materials and methods. The total 142 infertile women with severe peritoneal endometriosis (III-IV stage of the external genital endometriosis according to the American Fertility Society classification) were examined at the age of 32.3±3.2 years (min-max = 23-40 years). The clinical status assessment was conducted, using a standard set of diagnostic procedures, prescribed for the inclusion of patients in the IVF program. The ovarian reserve was estimated by the level of the anti-Mullerian Hormone level determined by the immunoenzyme method. Results. The concomitant 2-sided endometriotic ovarian cysts (96%), myoma (19.7%) and the adenomyosis (16.9%) were most common for the patients with severe peritoneal endometriosis. The severely reduced the anti-Mullerian Hormone rates (35 years old (24.6% compared to 10.6% for younger patients; p=0.028). Conclusion. The infertility for severe peritoneal endometriosis is supported by concomitant estrogen-dependent diseases, of which 2-sided endometriomas, adenomyosis and uterine myoma are of the most pathological. The low efficiency of IVF in the treatment of patients with severe peritoneal endometriosis and concomitant estrogen-dependent diseases is explained by the aggravation of the embryonic and endometrial factors for the infertility. The other reason that worsens the results of IVF for such patients is late reproductive age (>35 years) that increases the observed reduction of the ovarian reserve. © 2021 Consilium Medikum. All right reserved

Intrauterine synechiae and chronic endometritis - is there a causal relationship? [Внутриматочные синехии и хронический эндометрит - есть ли причинно-следственная связь?]

Both in our country and around the world, childless marriages currently remain an important medical and social problem, the frequency of which remains high and has no tendency to decrease. One of the main roles in the structure of this condition is the uterine factor of infertility. In the structure of the uterine factor, a separate place belongs to intrauterine synechiae associated with chronic endometritis. The high prevalence, unclear mechanisms of pathogenesis and the lack of a unified approach to therapy determines not only the relevance of the chosen topic, but also the need for an integrated approach to the management of patients suffering from uterine infertility. The article presents modern ideas about the tactics of treatment of patients with infertility of uterine genesis associated with chronic endometritis and intrauterine synechiae, according to domestic and foreign literature. © 2022 The authors

The efficacy of alternative treatment tactics for uterine infertility [Эффективность альтернативных методов лечения бесплодия маточного генеза]

Chronic endometritis is associated with adverse reproductive outcomes such as implantation failure and miscarriage. A high percentage of ineffective use of assisted reproductive technologies in chronic endometritis determines the need to study morphogenesis, timely diagnosis and pathogenetic therapy of this disease. The article presents a modern view of etiopathogenesis, diagnosis, treatment tactics, as well as a clinical case of managing a patient with uterine infertility associated with repeated implantation failures, according to domestic and foreign literature. © Gynecology 2021

The contribution of chronic endometritis to reproductive system disorders in patients with repeated implantation failures [Вклад хронического эндометрита в нарушения репродуктивной системы у пациенток с повторными неудачами имплантации]

Chronic endometritis (CE) is a disease of continuous and invisible inflammation characterized by infiltration of plasma cells in the stromal region of the endometrium. Numerous studies have proven that CE leads to repeated implantation failures. While it is believed that the etiology of CE is mainly associated with microorganisms, the key links in pathogenesis are yet not fully understood, although there is a modern evidence that CE causes local immune disorders and impaired endometrial decidualization. Considering the insufficient effectiveness of antibiotic therapy for CE, especially in cases of resistant pathogens, or in the case of viral chronic endometritis, regimens with additional treatment that affect other etiopathogenetic pathways of CE development and maintenance are necessary. One of the methods that affects etiopathogenesis of CE is a cytokine therapy. In this review, the authors tried to consider CE with special emphasis on the etiology, epidemiology, clinical features, pathophysiology, and treatment of CE and reproductive disorders in women in association with repeated implantation failures. The review ends with a description of the clinical case. © Gynecology 2021

Mastalgia in infertility: Search for additional possibilities of therapy [Масталгия при бесплодии: поиск дополнительных возможностей терапии]

Aim. To assess the efficacy and safety of using the homeopathic drug Mastopol for the relief of mastalgia in women with infertility, including those associated with endometriosis, as well as to study the drug tolerability and adherence to the treatment, as well as to determine its antiproliferative and analgesic effects in patients of the study cohort. Study design: open-label, randomized, non-comparative, observational study. Material and methods. 79 infertile women with mastalgia (67 with cyclic mastalgia and 12 with acyclic mastalgia) were examined and treated with Mastopol. Mastopol was prescribed 1 tablet 3 times a day sublingually. The course of treatment was 8 weeks. The efficacy of mastalgia relief was assessed using a Visual Analogue Scale (VAS). Treatment outcomes were considered good if pain severity by the VAS decreased by 4 or more points from the baseline levels at the end of Mastopol treatment course. Results. One Mastopol treatment course provided good treatment outcomes in 76,2% of patients with cyclic mastalgia and in 33,3% of patients with acyclic mastalgia. There were no adverse reactions or complications in patients treated with Mastopol. Conclusions. Mastopol has established itself as a quite effective and safe drug in patients of the study cohort; if there is an insufficient effect, Mastopol can supplement traditional pharmacological agents recorded in the current clinical guidelines. © 2021 Federal Informational-Analytical Center of the Defense Industry. All rights reserved

The scattered puzzle effect: Implantation disorders in chronic endometritis [Эффект «разбросанных пазлов»: имплантационные нарушения при хроническом эндометрите]

Chronic endometritis (CE) is defined as a state of inflammation localized in the endometrium, accompanied by edema, dissociated maturation of epithelial cells and fibroblasts, increased stromal density and the presence of plasma cell infiltrate in it. The connection between chronic inflammation in the endometrium and infertility deserves special attention. Inadequate response of immunocompetent endometrial cells, including impaired synthesis of proinflammatory cytokines, dysreceptiveness, disorders of proliferation and differentiation processes are the main links in the formation of infertility in patients with CE. Despite the fact that the presence of a normocenosis of the uterine cavity today is not in doubt – this is a physiological norm, persistent bacterial infection of the endometrium is still called the main etiopathogenetic factor of CE and, therefore, the main point of application of therapeutic agents. Nevertheless, a number of works have emphasized the special role of not bacterial, but viral etiology of endometritis, especially in the context of infertility developing against this background. It seems that the role of viral endometrial infection in adverse pregnancy outcomes and in vitro fertilization programs is underestimated. Further research is needed to clarify the relationship of viral infection as a trigger of implantation failure in infertile women with CE. © Consilium Medikum. All rights reserved