No 2 (2025)

This article represents a unique modern concept of neuroimmune mechanisms in the genesis of preeclampsia that are mediated by neuron-specific proteins (NSP). This concept is confirmed by relevant data in world literature both on the nature and essence of preeclampsia, and new diagnostic and therapeutic strategies. For the first time, the domestic literature reveals the concept of neuroplacentation and fetal programming influenced by the placenta, and the hypothesis is put forward about their role in the pathogenesis of preeclampsia. The data on the role of NSP as biomarkers of neurocorticogenesis, fetal and maternal brain damage, as well as the functional status of the blood-brain barrier (BBB) and mechanisms of endothelial dysfunction, including the impact of damage-associated molecules and hyperactivation of the complement system in the development of PE is systematized. The latest information on the identified therapeutic targets in PE and possibilities of their modification and application in clinical practice is represented. Comparative analysis of a large number of clinical observations, the data on general and special research methods, as well as more than 20 years of our own research made it possible to develop, provide scientific explanation and advance a new concept of understanding preeclampsia, that is based on the key role of NSP, BBB and hyperactivation of the complement immune defense.

The aim of this paper is to identify the temporal and causal relationship between impairments of neuroplacentation, fetal neurocorticogenesis, NSP, increased permeability of the BBB in the development of preeclampsia, as well as search for new pathogenetic strategies for its prevention and treatment.

Conclusion: This article will help specialists to understand the nature of preeclampsia as a multisystem neuroinflammatory gestational endotheliosis, leading not only to impairment of cerebral vascular function and integrity of the BBB, both in the mother and the fetus, but also to pathological programming of further child neurodevelopment and long-term neurodegenerative processes in mother. The proposed concept will help to revise therapeutic approaches to management of patients with preeclampsia, opens possibilities for application of innovative approaches to treatment and search for new therapeutic targets.

Background: Despite the numerous proposed models and diagnostic algorithms, early diagnosis of ovarian cancer remains a significant challenge in modern gynecologic oncology. Solutions to this problem include the improvement of diagnostic equipment, the introduction of novel prognostic models and the use of advanced ultrasound imaging techniques.

Objective: To analyze the results of ultrasound models used in the detection of ovarian cancer in different age groups and in the implementation of screening in various risk groups, in order to create an optimal comprehensive algorithm for the early diagnosis of ovarian cancer at the primary diagnostic stage.

Materials and methods: A total of 50 publications were selected from 186 publications, including meta-analyses, reviews, and articles using PubMed.

Results: The present study investigated and compared the use of modern ultrasound models and ultrasound imaging techniques in the diagnosis of ovarian masses in different age cohorts and risk groups for the development of ovarian cancer.

Conclusion: Despite the use of new modern ultrasound models, the challenge of early diagnosis of ovarian cancer persists and makes it necessary to create a new complex algorithm with the use of additional clinical and ultrasound diagnostic methods.

Objective: To enhance the differential diagnosis of fetal growth restriction (FGR) and small-for-gestational-age (SGA) fetuses using functional diagnostic methods.

Materials and methods: This case-control study included 13,232 patients who were divided into three groups. Group 1 comprised pregnant women with FGR (n=242), group 2 included pregnant women with SGA (n=395), and group 3 consisted of pregnant women without FGR and SGA (n=12,595). Postnatally, neonatal length and height indicators were assessed according to the INTERGROWTH-21 centile curve. The sample for model development and training consisted of 13,232 patients, while a test sample of 1,843 patients was used to evaluate the model's performance.

Results: The developed formula (1), which includes fetal abdominal circumference (mm) (AC), right uterine artery pulsatility index (RUtA-PI) (percentile), and cerebro-placental ratio (CPR) (percentile), enabled the diagnosis of FGR with a sensitivity of 84% and a specificity of 82%. To differentiate between SGA and FGR, a second formula (2) was created, incorporating AC (mm), uterine artery pulsatility index (UA PI) (percentile), and middle cerebral artery pulsatility index (MCA PI) (percentile). This formula allows for the diagnosis of SGA as distinct from FGR, with a sensitivity of 67% and specificity of 88%.

Conclusion: The developed formulas facilitate the diagnosis of FGR and SGA, enabling timely decision-making regarding pregnancy management strategies. This approach aims to reduce the incidence of iatrogenic interventions, neonatal morbidity, and mortality while improving the quality of medical care.

Objective: To assess the volumes of fetal anatomical structures using magnetic resonance imaging (MRI) in pregnant women with late-onset fetal growth restriction (FGR) and small-for-gestational-age (SGA) fetuses.

Materials and methods: This prospective cohort study included 15 pregnant women with late-onset FGR and 15 pregnant women with SGA who underwent MRI. The control group consisted of nine pregnant women with appropriate-for-gestational-age fetuses. Using manual selection of the regions of interest, the volumes of the supratentorial brain and cerebellum were measured, and their ratios were calculated. Quantitative measurements of all the brain structures were converted to percentile values.

Results: The percentile values of supratentorial brain and cerebellum volumes were significantly smaller in the late-onset FGR group (p=0.004 and p<0.001, respectively). There were no statistically significant differences in the volume of the brain structures in the SGA group.

Conclusion: Fetuses with late-onset fetal growth restriction have reduced supratentorial brain and cerebellar volumes, as assessed by MRI, compared with controls. Placental insufficiency in late-onset FGR has a greater effect on brain volume than on birth weight. Further studies are needed to clarify the areas of interest in the brain and to determine their association with the severity and likelihood of reversibility of neurological deficits in newborns and infants with late-onset fetal growth restriction.

Endometriosis is a chronic inflammatory condition characterized by the presence of endometrial-like tissue outside the uterus. This condition can be accompanied by psychosomatic and social discomfort, that requires further research to understand the relationship between different factors influencing its development.

Objective: To explore the spectrum of psychopathological symptoms and syndromes in patients with endometriosis and assess their impact on the development of endometriosis for further determination of possible approaches to treatment in the framework of complex patient-oriented therapy.

Materials and methods: The study included 65 female patients with the diagnosis of endometriosis. Online survey was conducted using Google Forms, which included a set of psychometric tools to assess the levels of anxiety and depression, quality of life, pain catastrophizing in women with chronic pelvic pain (CPP) and its intensity. Statistical analysis was performed using Microsoft Excel and jamovi module for general linear models (GLM).

Results: As a result of the study, 8 general linear models with significance level of p<0.001 with a spectrum of reproductive and mental health indicators were created, and a hypothetical model of relationship between psychoemotional status and CPP in endometriosis was suggested.

Conclusion: The study of the psycho-emotional status of patients with endometriosis found a complex of psychosomatic factors affecting women with this condition. There is a strong relationship between the level of pain, quality of life and women’s mental health, that emphasizes the need for a complex approach to treatment aimed to eliminate psycho-emotional factors and improve the quality of life of patients with endometriosis.

Relevance: Determining the lipid profile of embryo culture medium is a modern and promising noninvasive method for predicting the effectiveness of assisted reproductive technology (ART) programs. The use of machine learning for the identification of the most significant lipid groups in the culture medium allows the processing of non-linear relationships within the data and the extraction of the most informative data from the input parameters.

Objective: To develop a method for predicting ART outcomes based on analyzing the lipid profile of embryo culture medium on day 5 post-fertilization using gradient boosting (GB), and to identify the lipids that contribute most to this prediction.

Materials and methods: Sixty couples seeking ART for infertility treatment were included in the study. Patients with tubal-peritoneal factor infertility underwent ovarian stimulation, following a protocol that included a gonadotropin-releasing hormone antagonist. On the day of embryo transfer, culture medium was collected, followed by cryopreservation of the medium samples. The lipid profile of the samples was determined using liquid chromatography-mass spectrometry (LC-MS). The data obtained were analyzed using GB.

Results: A GB model was developed to predict ART outcomes based on lipid profiles of the culture medium. The model achieved 79% accuracy (f1 score: 0.81) in identifying the lipid profiles associated with embryos that resulted in pregnancy. Among the lipids identified, triacylglycerols were found to contribute the most to determining embryo implantation potential.

Conclusion: Analyzing LC-MS data using GB allows for the identification of different classes of lipids in the embryo culture medium, which can serve as a noninvasive approach to assess embryo quality and implantation potential. This can also facilitate the development of a predictive testing system to determine the effectiveness of ART programs. Additionally, this information enables a more detailed investigation of the mechanisms of gamete damage in patients with various extragenital diseases, and can assist in developing methods for the selective transfer of the most promising embryos.

Objective: To study the effect of the combination of myoinositol (MI) and α-lactalbumin (α-LA) on the quality of oocytes and embryos and to evaluate the effectiveness of in vitro fertilization (IVF) treatment in patients with polycystic ovary syndrome (PCOS) taking into account the presence of insulin resistance and polymorphic variants of the follicle-stimulating hormone (FSH) receptor gene.

Materials and methods: An observational comparative single-center INO-1 study enrolled 224 patients with infertility and PCOS (phenotypes A and D) who were screened for insulin resistance and FSH receptor gene polymorphisms (Asn680Ser). The patients were randomly divided into four groups depending on the presence or absence of insulin resistance and polymorphic variants of the FSH receptor gene: group 1 (n=52) had FSH receptor gene polymorphism (+), insulin resistance (-), group 2 (n=55) had FSH receptor gene polymorphism (-), insulin resistance (+), group 3 (n=59) had FSH receptor gene polymorphism (+), insulin resistance (+), group 4 (n=58) had FSH receptor gene polymorphism (-), insulin resistance (-). Depending on the type of therapy, the patients in each group were divided into two subgroups. The patients of the 1st subgroup received a combination of MI 600 mg+α-LA+folic acid 200 mcg (Inofert Forte, ITALFARMACO, Italy) one capsule twice a day, orally, for a course duration of 3 months before starting the IVF program. The patients of the 2nd subgroup received folic acid 400 mcg per day routinely, orally, for a course duration of 3 months before starting the IVF program. The quality of oocytes and embryos and the pregnancy rate per embryo transfer in the IVF programs after preconception supplementation with MI+α-LA combination were evaluated.

Results: The rate of mature oocyte retrieval was significantly higher in patients of subgroup 1 with insulin resistance (groups 2 and 3) who received MI+α-LA supplementation compared to patients of subgroup 2 who received folic acid supplementation routinely. This rate was 80.8% versus 51.7% (p=0.045) in group 2 and 64.5% versus 35.7% (p=0.027) in group 3. The rate of obtaining good quality embryos was significantly higher in patients of subgroup 1 in groups 2 and 3, namely 65.4 % versus 37.9 % (p=0.042) in group 2 and 54.8 % versus 28.6 % (p=0.041) in group 3. Comparable results were obtained when the pregnancy rate per embryo transfer in IVF programs was assessed in those insulin-resistant patients who were administered the MI+α-LA combination. The outcome of IVF programs in group 2 was 53.8% versus 27.6% (p=0.047) and the outcome in group 3 was 41.9% versus 17.9% (p=0.045).

Conclusion: The administration of the MI+α-LA combination (Inofert Forte, ITALFARMACO, Italy) to patients diagnosed with PCOS and insulin resistance before the IVF treatment is advisable, as it helps to correct insulin resistance and increase ovarian sensitivity to gonadotropins. This results in obtaining mature oocytes and embryos of good quality and increases the pregnancy rate.

The relevance of the topic is due to declining birth rate in Russia, that is associated with social and demographic, medical and environmental factors.

The article considers the issues of the influence of micronutrients on the reproductive potential of a couple in the preconception period. Pregravid preparation including diagnosis, preventive and therapeutic measures, plays a key role in increasing fertility and reducing the risks of pregnancy complications. One of the most important issues is micronutrient deficiency, which is widespread among women and men of reproductive age. It is remarkable to note that 70–80% of women are deficient in three or more vitamins, including vitamin B, vitamin C, vitamin E, and micronutrients such as iodine, selenium and magnesium. Deficiency in these compounds negatively influences sperm quality, the process of implantation and fetal development. Taking vitamin and mineral supplements (VMS) improves fertility, has positive effect on the course of pregnancy and increases the chances of getting pregnant. Antioxidants that help to reduce oxidative stress and improve spermatogenesis are essential for men. Preparations containing L-arginine, folic acid, vitamins E and C show positive effects on sperm quality and conception probability. It should be noted that there is a need for multidisciplinary approach to pregnancy planning and importance in further research on the effects of vitamin and mineral supplements on reproductive health. These measures are aimed at increasing birth rate and improving the demographic situation in Russia.

Conclusion: Further research is needed on the effect of microelements and vitamins on improvement of reproductive function in married couples.

Relevance: Mixed types of infertility in combination with genetic disorders are particularly difficult to diagnose and treat. The Shereshevsky–Turner syndrome (STS) is the most common chromosomal pathology with total or partial monosomy of chromosome.

Case report: A clinical case of a 38-year-old patient with mosaic variant of STS syndrome with karyotype 45,X[4]/46,X[16] in combination with hyperandrogenism represented. The patient underwent treatment using assisted reproductive technologies: three stimulation protocols, preimplantation genetic testing for aneuploidy, two cryotransfers of embryos with normal karyotype. Clinical pregnancy was not achieved. Current data on the diagnosis and treatment of patients with STS syndrome, possibilities of realization of reproductive function are represented. Based on the international experience, the risks of developing cardiovascular diseases and metabolic disorders in this category of patients were assessed.

Conclusion: The mosaic variant of STS often have no specific clinical symptoms specific for this syndrome, and therefore is diagnosed quite late. The peculiarity of this clinical case is the presence of combined chromosomal and endocrine pathology, pronounced ovarian hyperandrogenism with virilization of the genitals, as well as the presence of a male factor infertility in the married couple. In this regard, treatment of infertility in this case is very difficult.