No 8 (2013)

The review discusses current views on the impact of induced cycle programming on the outcomes of assisted reproductive technology programs. Ovarian stimulation protocols with gonadotropin-releasing hormone antagonists are commonly used in routine clinical practice, simple and easy-to-use for both the patient and the physician. It is precisely this makes us look for ways to enhance their efficiency.

The review gives an update on the epidemiology and pathogenesis of bacterial vaginosis. It considers the merits and demerits of available laboratory methods for the diagnosis of vaginal microcenosis. New approaches to treating vaginal dysbiosis are outlined.

The paper presents data on the association of polymorphisms in the genes encoding the development of autoimmune states with hypothyroidism in pregnant women Objective To study the associations of polymorphisms in the human leukocyte antigen (HLA) class II DDB1 gene with hypothyroidism in Russian pregnant women. Subject and methods. Gene polymorphisms were determined in 178 women with singleton pregnancy, by using a set of reagents to type human histocompatibility class II(HLA-DRB1) genes by amplification. A study group included 65 women with hypothyroidism. A control group consisted of 113 healthy pregnant women. Results. Markers for inherited predisposition to hypothyroidism were described in pregnant women. A significant difference between the examined groups was found in only two alleles: DRB1*04 and DRB1*11. The DRB1*04 allele group was associated with an increased risk of hypothyroidism. Its frequency in the study and control groups was 20.8 and 10.6%, respectively (p = 0.009; OR 2.21, 95 CI 1.21-4.04). The DRB1*11 allele group was associated with disease resistance; its frequency was 7.7% in the patients and 17.7% in the healthy individuals (p=0.009; OR 0.39, 95% CI 0.18-0.79). Conclusion. The authors revealed a significant relationship of polymorphisms in the DRB1*04 allele group to the development of hypothyroidism in pregnant women, as well as the protective role for the DRB1*11 allele group, suggesting the important role of genetic polymorphism in the genesis of thyroid diseases.

Objective. To study the effectiveness of an in vitro fertilization (IVF) program in women with uterine myoma and in those who underwent myomectomy in relation to the current endometrial receptivity markers pinopodia, leukemia inhibitory factor (LIF), vascular endothelial growth factor-A (VEGF-A), claudin-5 (CLDN-5). Subject and methods. The morphological and immunohistochemical features of the endometrium and the outcomes of the IVF program were studied in 52 patients with intramural uterine myoma (or concurrent with subserous myoma) up to 4 cm in diameter with no deformity of the uterine cavity (Group 1), 53 patients after laparoscopic myomectomy (for intramural uterine myoma) without opening the uterine cavity, which had been done at least 6 months before inclusion into the IVF program (Group 2), and 53 women with tuboperitoneal factor infertility with no myometrial pathology (a control group). Results. Conception rates were 23.1% in Group 1, 30.2% in Group 2, and 41.5% in the control group, the decrease in the conception rate being statistically significant in the uterine myoma group as compared with the control. Implantation rates were 11.9, 16.2, and 23.9%, respectively, those being significantly higher in the control group than in the uterine myoma and postmyomectomy groups. The implantation rates were 11.9, 16.2, and 23.9%, respectively; those being significantly higher than in the group of patients with uterine myoma and post-myomectomy. The endometrium of patients with a successful attempt of IVF and embryo transfer showed a higher level of mature pinopodia-containing cells, higher expression of LIF and VEGF-A in the stroma and epithelial layer. The vascular endometrial epithelium was characterized by a higher level of VEGF-A and a lower concentration of CLDN-5. Conclusion. In the patients who have undergone laparoscopic myomectomy prior to the IVF program, the conception rate is comparable with that in the patients without uterine myoma, which supports the need for myomectomy if intramural nodules are 4 cm or more in diameter. It is necessary to conduct an in-depth investigation involving the determination of a wider range of markers to study the mechanisms of action of uterine myoma on endometrial receptivity.

Objective. To study the molecular biological features of endometrial hyperplastic processes. Subject and methods. A prospective study was conducted in 1490 patients, including 620 women with a histologically verified endometrial hyperplastic process (a study group) and 870 patients without endometrial pathology (a comparison group). After a comprehensive immunomorphological study, the investigators formed 5 study groups: 1) 248 women with simple endometrial hyperplasia without atypia; 2) 94 with complex endometrial hyperplasia without atypia; 3) 42 patients with simple and complex endometrial hyperplasia with atypia; 4) 142 with endometrial hyperplastic processes concurrent with chronic endometritis; 5) 94 with chronic endometritis and reactive endometrial hyperplasia. Results. The early stages of development of abnormal endometrial processes (simple and complex hyperplasia without atypia) were marked by a trend toward decreased apoptosis and enhanced sclerosing activity (elevated transforming growth factor-ß1 (TGFß1) levels), as in the gland epithelium. With the progression of the process (chronic endometritis concurrent with simple endometrial hyperplasia and reactive hyperplasia), there was inhibition of apoptosis and the extracellular matrix exhibited the actively ongoing processes of stromal formation and neoangiogenesis (the high production and accumulation of LOX), fibronectin, vascular endometrial growth factor, and TGFß1). Conclusion. The found features of the molecular biological profile of endometrial hyperplasia concurrent with chronic endometritis are suggestive of enhanced cellular proliferative activity, intensive growth factor expression, activated sclerosis and angiogenesis, proving the role of an inflammatory factor in the creation of optimal conditions for tumor transformation of endometrial tissue.

Objective. To estimate the pattern of newly detected cervical intraepithelial neoplasia (CIN) cases in relation to the age of Omsk women. Subject and methods. A descriptive observational epidemiological study of found CIN cases was conducted in the women regionally attached to this health clinic for service, by using the primary records of Omsk Women’s Health Clinic One over 2002 to 2012. Results. There was a substantial change in the age structure of CIN towards a predominance of the disease in patients aged 18-35 years (increase rate = + 11.3; p < 0.001) as compared to those at an older age; a correlation between the grade of CIN and the women’s age (p < 0.001); a direct relationship between the grade of CIN and the patients’ age (p < 0.001). Grade I CIN was prevalent in women of reproductive age and Grade II CIN was in those over 50 years, (p < 0.001). Despite the trend towards a decrease in CIN II(decrease rate = -7.0;p < 0.001) and CIN III (decrease rate = -3.0; p < 0.05) in the past decade (from visit rates), there was a considerable proportion of CIN III in patients aged 18-35 (10.5%), 36-49 (22.9%), and over 50 (26.6%) years. Conclusion. The findings suggest that the epidemiological situation of CIN substantially changed in the study period.

Objective. To assess the role of three-dimensional (3D) power Doppler angiography in obstructive uropathies, the relationship of vascular indices to fetal renal artery blood flow values and the magnitude of dilation of the renal collecting system in the antenatal period and to determine whether the findings can be used to predict the neonatal status. Subject and methods. A prospective case-control analysis was made in 45 fetuses with obstructive defects of the urinary tract and in 45 fetuses without any malformations at 20 to 40 weeks of gestation, in whom renal volume, dilatation of the calycopelvic system (CPS), renal artery blood flow values, and 3D power Doppler angiographic parameters were analyzed. The set of neonatal studies included physical examination, echography, and contrast-enhanced magnetic resonance imaging of the urinary tract. Results. In the study group, the renal volumes measured by 3D echography were found to differ from those calculated using three linear dimensions. Pulsed wave Doppler imaging of the renal artery demonstrated statistically significant differences in blood flow values in the study groups, starting at 25 weeks of pregnancy. Analysis of 3D power Doppler angiographic findings showed that the vascular indices (VI, FI, and VFI) in the unaltered kidneys were directly proportional to pregnancy duration, organ volume, and parenchymal thickness. These indices were substantially decreased in obstructive uropathies as compared to the control group regardless of gestational age. Correlation analysis indicated that renal volume, CPS dilation and volume, and parenchymal thickness preservation affected VI and VFI values in obstructive uropathies.

Objective. To analyze the authors’ data on the surgical correction of fetofetal transfusion syndrome (FFTS). Subject and methods. Over 2 years, the authors performed a total of 42 operations to correct FFTS: 16 (38%) septotomies, 10 (24%) laser coagulations of umbilical cord vessels, and 16 (38%) laser coagulations of placental anastomoses in Quintero Stages III-IV FFTS. Results. In 2011, sixteen fetoscopic septotomies were carried out at 22-26 weeks’ gestation in Quintero Stages III-IV FFTS. Pregnancy could be prolonged by an average of 5.5 weeks (from 3 to 11 weeks). All births were premature; the pregnancy length averaged 31 weeks (27-34 weeks). Manipulation complications were 40%. The efficiency was 60%. In 2012, intrauterine correction of Quintero Stages III-IV FFTS in 16 patients by total coagulation of placental anastomoses resulted in the birth and survival of 14 babies, including 4 (40%) twins. After coagulation there was one (60%) fetus in 6 cases and a donor in all cases. Complications were 37%. All the births were premature at 27-39 weeks (33 weeks). In 2011-2012, ten sessions of laser umbilical cord vessel coagulation were made in Quintero Stages III-IV FFTS. Survival of one of the twins was noted in 8 (80%) cases. Conclusion. According to our data, laser coagulation of placental anastomoses is the best decision to choose a FFTS treatment option.

During pregnancy, folate deficiency leads to a substantial increase in the rate of malformations due to impaired DNA methylation. Folate deficiency is not always successfully compensated for by synthetic folic acid only since the latter in the body must be converted into active folate forms (tetrahydrofolates) through special enzyme systems. In many women, the functioning of these systems is impaired due to genetic defects, medications that block these enzymes, and other causes. This makes the use of active folates required to enhance the efficacy and safety of a compensating procedure for folic deficiency particularly in respective risk groups. This paper gives the results of a systematic analysis of the data of basic and clinical medicine, which point to the promise of using active folate forms for the nutritional support of pregnancy and other applications in obstetrics and gynecology. Unlike inactive folic acid, the excess of which blocks the metabolism of folates; excessive active folates do not inhibit folate metabolism. Therefore, active folates produce no side effects typical of the excess intake of folic acid and exert a positive effect in any genotype of the enzyme systems of folate biotransformations.

Background. Along with drug treatments, laparoscopic myomectomy, a reconstructive and plastic operation, has been increasingly used to treat uterine myoma in patients who are planning pregnancy. In this period, the major goals of rehabilitation in patients undergoing laparoscopic myomectomy are to ensure reliable contraception and to reduce the risk of recurrence. These requirements are met with a group of combined contraceptives. Objective. To evaluate the efficiency and safety of using different combined contraceptives (CC) after laparoscopic myomectomy in infertile patients planning pregnancy. Subject and methods. The paper analyzes the experience with CC used within 6 months after laparoscopic myomectomy in patients planning pregnancy. According to body mass index and the presence of hypertension, the patients enrolled in the trial were divided into 3 groups: 1) 47 patients receiving a CC containing 15 μg ethinylestradiol and ethonogestrel; 2) 79 patients taking a CC containing 20 μg ethinylestradiol and desogestrel; 3) 37 women having 30 μg ethinylestradiol and drospirenone. The authors analyzed the incidence of recurrent uterine myoma 6 months after the use of a CC containing different amounts of an estrogen component and the tolerance and reliability of the contraceptive effect of the test agents. Results. In the patients receiving the combined contraceptive containing 15 μg ethinylestradiol and 0.12 mg ethonogestrel (the vaginal ring Novaring), recurrent uterine myoma was diagnosed in 1 (2.1%) case. In those taking a combined oral contraceptive (COC) containing 20 μg of ethinylestradiol and 15 μg desogestrel (novinet), it was noted in 3 (3.8%) cases, and in the women having 30 μg ethinylestradiol and 3 μg drospirenone (midiana), it was seen in 5 (13.5%) cases. No significant side effects were observed, neither were pregnancy cases with the use of the test agents. Conclusion. The test CCs may be recommended for the rehabilitation of patients undergoing laparoscopic myomectomy. However, the approach to choosing hormone therapy must be differentiated in relation to the presence of metabolic comorbidities and the family history of uterine myoma.