No 4 (2014)

The paper outlines present-day views on the ovarian reserve. It considers different exogenous and endogenous factors giving rise to premature ovarian reserve exhaustion. The role of surgical interventions into reproductive organs is covered in the light of further reproductive function. An understanding of the pathological mechanisms that act on ovarian tissue will be able to improve diagnostic methods and to predict fertility techniques.

Objective. To reveal gene polymorphisms in women prone to recurrent miscarriage. Subject and methods. Serum gene polymorphisms were investigated in 100 women. Group 1 consisted of 70 patients with recurrent miscarriage who were divided into subgroups according to the time and genesis of pregnancy losses: 1a) 30 patients with recurrent early losses (at less than 22 weeks of gestation); 1b) 30 patients with very early and early preterm labor (at 22 to 32 weeks of gestation); 1c) 10 patients with a history of antenatal fetal deaths (at more than 22 weeks of gestation). Group 2 (a control group) included 30 patients with uncomplicated pregnancy and a history of at least timely births. Results. There were significant differences in the distribution of the genotypes and alleles of the COL1A1 genes: -1997 C>A (rs1107946), IL15 RA: 364 (361) A>C (rs2296135) in the group of pregnant women with early miscarriage versus the control group; those of the genotypes and alleles of the IL8 genes: -251 A>T (rs4073), FN1: 5349+203 T>C (rs2304573) in the women with a history of early preterm labors; and those of the polymorphic IL1b genes: -31 T>C (rs1143627), IL1b: -511 G>A (rs16944), FN1: 5349+203 T>C (rs2304573), FN1:1819+7 A>T (rs3796123) in the group of women with a history of antenatal fetal deaths versus the control group. Conclusion. Determination of gene polymorphisms when planning pregnancy makes it possible to predict the course of a future pregnancy and to form groups at risk for miscarriage for more careful pregestational preparation and for identification of pregnancy management tactics.

Objective. To estimate the possibility of using echography to predict postnatal outcome in fetal congenital diaphragmatic hernia (CDH). Subject and methods. Seventy-three fetal CDH cases were analyzed. Sixty-six fetuses had left-sided hernia, 5 had right-sided hernia, and 2 had bilateral hernia. Results. The major echographic signs of CDH were cardiac compression and displacement contralateral to the diaphragmatic defect, as well as the appearance of abdominal viscera in the chest. In bilateral diaphragmatic hernia, the liver was detectable on the right side next to the heart and the intestinal loops and stomach were placed on the left. Antenatal fetal death occurred in 2 cases; termination of pregnancy did in 8. Out of 63 born neonates, 44 (70%) were operated on; 19 (30%) died preoperatively. Postoperative survival was 86%; mortality was 14%. For the prediction of postnatal outcome in fetal CDH, we proposed a new prognostic criterion, such as cardiac compression index (CCI) based on the fact that in CDH, by penetrating into the chest, the abdominal organs compress the heart, by increasing its length and decreasing its thickness. With a CCI of less than 1.5, the postnatal neonatal status was mild and moderate in 79%; with that of 1.5 or more, it was severe and extremely severe in 91%. Conclusion. Prenatal echography is a valuable technique, the use of which enables us to predict the neonatal status in fetal CDH with a high degree of accuracy.

Background. Different disorders of spermatogenesis in men are associated with elevated levels of sperm chromosome aneuploidy and, as a consequence, with increased risk of embryonic aneuploidy. Objective. To compare the clinical and economic efficiency of in vitro fertilization (IVF) followed by prenatal genetic diagnosis and that of IVF with preimplantation genetic screening (IVF/PGS) by the fluorescence in situ hybridization (FISH) method to avoid the birth of babies with aneuploidies in the couples with different types of pathozoospermia in men. Design. Comparison of IVF and IVF/PGS by the FISH method to search for the least cost-based and maximally effective (birth of a healthy = euploid child) procedure was done by a decision-making analysis. Subject. Childless couples with pathozoospermia: teratozoospermia, asthenozoospermia, and/or oligozoospermia in men. Methods. IVF or IVF/PGS by the FISH method. Primary endpoint: the cost of the birth of a healthy (euploid) neonatal infant. Results. The use of a model for rating costs and probabilities in the childless couples with pathozoospermia in men showed that the likelihood of the birth of a euploid baby was 28.5 and 31.4% when infertility was treated with IVF and IVF/PGS (FISH), respectively. The average treatment costs were 129,742.86 and 186,990.26 rbl, respectively. The incremental cost-effectiveness ratio of IVF and IVF/PGS was 20,123.62 rbl. Unlike the general population of the childless couples, in whom the cost of treatment with IVF and IVF/PGS, as calculated with reference to the birth of a healthy child, differed by 63%, that in the couples with pathozoospermia in men was only 23%. Conclusion. IVF is a more clinically and economically reasonable treatment for infertility in the general population of childless couples than IVF/PGS. In the couples with pathozoospermia in men, the latter using the FISH method may be clinically and economically reasonable if the cost of PGS is lowered.

Objective. To compare the efficacy of drugs to restore the vaginal microflora, such as gynoflor e, oral lactobacilli, and ascorbic acid, in the treatment of chronic recurrent vaginal inflammatory and noninflammatory diseases at treatment stage 2. Subject and methods. One hundred and sixty-six patients (mean age 31±7 years) with recurrent bacterial infections were examined. After the first stage of fluomisin treatment for bacterial vaginosis or vaginitis, Group 1 was randomly assigned gynoflor e, Group 2 was given other Lactobacillus preparations; Group 3 was untreated. The efficiency of restorative therapy and the rate of recurrences were estimated during visits 3 and 4 (at a 60-day interval). Results. The efficiency of using gynoflor e and other restorative drugs at treatment stage 2 showed that the clinical and laboratory effects were achieved at visit 3 in 53 and 55% of the patients with recurrent vaginitis/bacterial vaginosis, respectively. However, at visit 4, the patients treated with other eubiotics were noted to have a lower proportion of lactobacilli than those who used gynoflor e, which may be a prerequisite for an early recurrence of bacterial vaginosis. Conclusion. As compared with other treatment regimens, this therapy using fluomisin at treatment stage 1 and gynoflor e at stage 2 for recurrent vaginal infections proved to be effective in 85% of the patients, simultaneously demonstrating a better trend occurred in the recovery of the natural vaginal flora and halving the number of recurrences.

The review provides the results of investigations dealing with the most preferred birth control methods for women after termination of unwanted pregnancy, as well as a rationale for recommendations in terms of their evidence basis. Analysis of publications has shown that long-acting reversible contraception (intrauterine devices (IUD), implants, injections, and vaginal rings) is the method of first choice after abortion. Having regard to the clinical and economic effectiveness and acceptability of the methods, the IUD T- Cu 380А or implant are is most preferred. IUD insertion is recommended immediately (as compared with delayed insertion) after pregnancy termination, including that with the use of medications, which promotes an increase in the number of users and a decrease in the number of further unwanted pregnancies in the absence of increased risk for complications.

Objective. To study the efficacy of β-alanine in the therapy of climacteric manifestations in women during surgical menopause. Subject and methods. The randomized parallel-group trial enrolled 59 patients aged over 45 years with surgical menopause. Results. The international menopausal index (IMI) decreased from 19.3±2.4 to 9.1±1.5 during 3-month therapy with β-alanine (p < 0.001). The latter affected only the magnitude of neuroautonomic and, to a lesser degree, psychoemotional symptoms. Therapeutic effectiveness increased with the longer use of the drug (pairwise comparisons during 3 treatment intervals; p = 0.003; p = 0.001; p = 0.006). As compared with the control group, IMI reduced by 26, 45, and 55% after 1, 2, and 3 months of therapy, respectively (p = 0.045; p = 0.004; p = 0.001). Conclusion. β-alanine treatment reduced the number and magnitude of neuroautonomic symptoms during surgical menopause. The effectiveness of the therapy increased with its longer duration.

Retrorectal cystic hamartoma is a rare congenital tumoroid mass, the cause of which is abnormal embryo development. Its diagnostic techniques are transrectal ultrasound, magnetic resonance imaging (MRI), and computed tomography. Resection of cystic hamartomas is a conventional surgical intervention through different accesses: anterior (abdominal), posterior (sacrococcygeal, perineal, or perianal, transanal), and combined. The paper describes 2 clinical cases. One of them is retroperitoneal pararectal teratoma of the small pelvis, which was removed via pararectal approach. Surgery was performed via laparoscopic access in two other cases: neurofibroma of the retroperitoneal space with plexiform structures and cystic degeneration, as well as retrorectal cystic hаmartoma. The diagnosis was verified by MRI and histology in all cases. Conclusion. The given data agree with the data available in the literature on the advisability of surgical treatment through different approaches.