Vol 28, No 6 (2021)

More than a third of a modern woman's life is spent in conditions of sex hormones deficiency. Hormonal changes that occur in menopause are accompanied by pronounced clinical manifestations: neuropsychic, vegetative-vascular, and metabolic disorders. Vasomotor symptoms, depression, urogenital disorders significantly worsen the quality of life of patients. However, the greatest danger to life is posed by late climacteric disorders: dyslipidemia and obesity, atherosclerosis, arterial hypertension, coronary artery disease (CAD), and osteoporosis. Gynecologists, therapists, general practitioners should contribute to the early detection of signs of climacteric disorders in patients, as well as prevent the consequences of estrogen deficiency in the future. Menopausal hormone therapy (MHT) during the menopausal transition and early menopause («window of therapeutic opportunities») allows women to maintain health during this difficult period of her life. The timely use of MHT effectively reduces not only the vasomotor and urogenital manifestations of climacteric syndrome, but also the risk of atherosclerosis, CAD, osteoporosis and significantly increases the quality of life of a woman as a whole.

Background. Iron deficiency anemia (IDA) is a common disease among pregnant women in the Russian Federation, averaging 36%; in severe cases, it complicates the course and outcomes of pregnancy and childbirth for the mother and newborn, which determines the need for early diagnosis of iron deficiency (ID) and its correction. Results. It was noted that the most common cause of ID in pregnant women is an insufficient intake of iron from food or an already existing latent iron deficiency before pregnancy. The clinical and laboratory characteristics of IDA and latent iron deficiency (LID) are presented. The importance of the determination of serum ferritin (FS) level in the screening of LID is emphasized. Modern methods of diagnostics and treatment of LID and IDA during pregnancy are presented in the form of algorithms developed on the basis of the provisions of the Council of Experts (June, 2020). Conclusion. Currently, the screening of ID with the determination of SF level should become the standard of medical care for pregnant women. It is necessary to inform women of reproductive age planning a pregnancy about the adverse consequences of ID and its correction before pregnancy.

Cryotransfer allows to choose the most favorable time for implantation, as well as to determine the most viable embryo. Two-thirds of implantation failures are due to a violation of the interaction of the embryo and the endometrium. Currently, a range of methods has been developed that increase the endometrium receptivity and increase the chance of pregnancy after cryotransfer. Thee include immunotherapy, endometrial scratching, ERA test, uterine artery vasodilation, instillation of human chorionic gonadotropin. The use of somatotropin, platelet-rich plasma, metformin, acupuncture and determination of the microflora of the endometrium is also discussed. Modern research is aimed at understanding the mechanisms affecting the endometrium to prevent defective embryo implantation, as well as to increase receptivity by artificial methods and to determine the ideal moment and microenvironment of the endometrium for cryotransfer.

Background. Researchers note an increase in the frequency of relapses of vaginal dysbiosis to 69-80% of observations within 12 months. Currently, information on the participation of cytokines in the implementation of the innate immune response of the mucous membranes of the female reproductive tract has been obtained. The use of immunodiagnostics and immunomodulatory therapy with exogenous cytokines can significantly improve treatment outcomes and relapse prevention.Objective. Evaluation of the effectiveness of therapy and the frequency of relapses in patients with recurrent infectious and inflammatory diseases of the lower genital tract of combined viral and bacterial etiology using various regimens of local immunomodulatory therapy. Methods. A prospective, randomized, comparative, parallel-group clinical study was conducted. 58 women with recurrent vaginal dys-biosis were examined. In group I (n=30), the drug Superlimph 25 U was used vaginally daily for 10 days, in group II (n=28) - 10 U for 20 days; both groups reseived etiotropic therapy with a combined broad-spectrum drug with antibacterial, antifungal and anti-inflammatory effects (1 vaginal tablet daily for 10 days). Microscopy of vaginal smears, real-time PCR, determination of blood serum cytokine levels (IL-1β, -2, -4, -6, -8, -10, tumor necrosis factor α, interferon γ - IFN-γ) were used.Results. Clinical recovery occurred in 90% (27/30; p<0.001) and 89% (25/28; p<0.001), respectively. Microbiological recovery according to microscopic examination was observed in 100% of patients in both groups (30/30 and 28/28; p<0.001). The frequency of HSV-2 virus shedding in group I decreased from 83% before treatment to 37% after it (p<0.001), as in group II - from 82 to 43%, respectively (p=0.002), p=0.63 - between groups after treatment. Before treatment, the level of all cytokines, except IFN-γ, was higher than the reference values; after treatment, their values decreased in both groups (p<0.001). During 12 months after treatment, in group I, high cytokine levels persisted in 13.3% and a relapse of vaginal dysbiosis was detected in 6.7% (2/30) of patients, in group II it was not observed (p=0.44). No side effects were observed during treatment. Adherence and acceptability were 100% in both groups.Conclusion. Recurrent combined viral-bacterial vaginal infections are accompanied by an imbalance of pro- and anti-inflammatory cytokines. Treatment using the drug Superlimph (25 IU for 10 and 10 IU 20 days) in combination with etiotropic therapy has comparable clinical and microbiological efficacy, prevents recurrence of infections, with a preferable course of 20 days with a dose of 10 IU

Background. Male infertility has a multifactorial genesis, due to both congenital genetic disorders and acquired pathologies, such as urogenital infections, immune and endocrine diseases, hyperproduction of reactive oxygen species, etc. More than 30% of cases of male infertility are attributed to idiopathic disorders with an unexplained etiology. At the same time, men have an age-related decline in reproductive function, change of the architectonics of the testicles and the levels of reproductive hormones. Women got pregnant from older men have high risk of miscarriage and children of such couples have the likelihood of developing some disorders, including schizophrenia, autism, bipolar disorder, suicide attempts, and substance use. All of the above indicates the relevance of studies of risk factors for male infertility in the age aspect, which is necessary for the development of algorithms for timely prevention, as well as for the treatment of infertility. Objective. Analysis of the role of infectious and inflammatory processes associated with risk factors for infertility in men from infertile couples in terms of age. Methods. An observational retrospective, cross-sectional study was carried out. Outpatient medical records of 1380 male patients with the problem of the absence of pregnancy after marriage were analyzed. All patients were followed-up in Novosibirsk Center for Reproductive Medicine, GC “Mother and Child". Men from the formed sample (n=1380) were divided into 5 groups: group 1 (n=322) included patients aged 20.0-24.9 years (n=20) and patients aged 25.0-29.9 years (n=302); group 2 (n=488) - 30.0-34.9 years; group 3 (n=315) - 35.0-39.9 years; group 4 (n=163) - 40.0-44.9 years; group 5 (n=92) included patients aged 45.0-49.9 years (n=62), 50.0-54.9 years (n=22), and 55.0-59.9 years (n=8). Combining in groups 1 and 5 was carried out due to the small number of participants in individual age groups and the need to analyze the entire sample of patients. Results. In the general sample of men (n=1380), a high prevalence of persons (52.7%) with sexually transmitted infections (STIs), prostatitis (31.7%), and hepatitis B/C (5.9%) was detected. Analysis of infectious and inflammatory risk factors depending on age in the surveyed men has revealed a significant increase in the incidence of STIs in men under 45, an increase in the prevalence of prostatitis with age and a significant increase in the incidence of hepatitis B/C in men aged 35-45 years. Conclusion. Analysis of the risk factors for the development of infertility associated with infectious etiology has revealed STIs with the maximum frequency in men from infertile couples; prostatitis took the leading place among inflammatory diseases of the urogenital system, and hepatitis B/C - among socially significant infections. Given the significant increase in the incidence of STIs with age, it is necessary to carry out health education aimed at increasing the frequency of the use of barrier methods of contraception and regular assessment of the presence of STIs in men at any age. Taking into account the increase in the incidence of prostatitis with age and the complex underlying pathophysiological mechanisms, an integrated approach to this problem is required. Due to the high prevalence of hepatitis B and C in the 35-45 year-old age group and its pronounced negative impact on both fertility and the somatic status of patients, it is necessary to conduct screening tests for infection in this age group, and if it is detected, conduct antiviral therapy, aimed at both reducing viral load and complete cure.

Background. Sexual function, along with the basic needs of the body, such as sleep or food, occupies one of the main positions in the normal life of a person. Sexual function is one of the basic human impulses that manifests itself during any period of sexual life and is considered an important factor in determining the quality of life of adults, and which can dramatically reduce the quality of life. Objective. Evaluation of the effect of the novel coronavirus pandemic on the development of female sexual dysfunction. Methods. The study involved 364 women aged 18 to 59 years. The Female Sexual Function Index (FSFI) questionnaire was used for the differential assessment of clinical manifestations of sexual dysfunction. Such parameters as desire, pain during intercourse, orgasm, arousal, lubrication, satisfaction before and during the COVID-19 pandemic were assessed. Results. Comparison of the average values of the studied indicators in women during a pandemic of a new coronavirus infection has revealed that problems associated with orgasm, arousal and the presence of pain during intercourse were detected statistically significantly more often. The study found a better overall FSFI score in women before a pandemic compared to FSFI scores during a pandemic. Also, when comparing two groups (women with and without sexual dysfunctions before and during the pandemic), it was found that the change in sexual function was not only negative. In women with sexual dysfunction before the pandemic, there was an improvement in the quality of sexual health and lack of sexual dysfunction during the pandemic. Conclusion. The results of the study showed that the pandemic of the new coronavirus infection had a significant effect on the development of sexual dysfunctions in women.

Background. Non-developing pregnancy (NDP) is one of the pressing problems of obstetrics and gynecology. Up to 20% of pregnancies end in spontaneous termination in the form of the NDP, and up to 80% of them result in reproductive losses in the first trimester of pregnancy. It remains relevant to study the qualitative and quantitative indicators of the cytogenetic status of abortions to identify not only the cause of NDP in a specific clinical case, but also the patterns of chromosomal mutagenesis in the population and assess its contribution to the development of reproductive losses in the population. Objective. Analysis of the results of a cytogenetic study of the abortive material of residents of Moscow and the Moscow region with non-develping pregnancies (NB) for the period from 2017 to 2021. Methods. The data of cytogenetic analysis of the abortive material of 1487 women carried out in the GEN-LAB laboratory by the assignment from clinics in Moscow and the Moscow region were retrospectively analyzed. The mean age varied widely: from 14 to 49 years, amounting to 33.4±5.5 years. Cytogenetic analysis was performed after preliminary tissue cultivation according to the standard method. Statistical analysis of the results was carried out using the Statistica 10.0 software package (Statsoft, USA). Results. The number of chromosomal abnormalities (CAs) was found to be age-dependent and associated with the early term of NDP. The largest number of CAs was accounted for by on women aged 35 to 40 years, while in the age group over 40 years, the proportion of abortuses with and without anomalies did not differ significantly. A significantly larger number of CAs was found in the abortive material of women with NDP at the gestational age up to 12 weeks. The frequency of CAs did not significantly differ depending on the type of pregnancy: natural or as a result of in vitro fertilization. The largest difference depending on the patient age were related to the proportion of trisomies and triploidies: if the former were more often detected in women of late reproductive age (35 years and older), then the latter were more typical for abortions in women under 35 years of age. In women aged 45 years, a case of NDP with a probability of 50% is associated with the presence of at least one trisomy. At the age of 30, this probability is 30%. Conclusion. CAs in abortive material of women with NDP are detected in 51.2% of cases, numerical abnormalities prevail over structural ones. It is advisable to use cytogenetic analysis at the early stages of pregnancy planning to identify factors that can provoke its abortion.

Background. Globally, the number of cases of tuberculosis with pathogen resistance, sometimes to all available anti-tuberculosis drugs (anti-TB drugs), is increasing. This fact prompts the development of new anti-TB drugs that are effective against multidrug-resistant tuberculosis. Objective. Evaluation of the toxic effect on the fetus and embryo of a new anti-tuberculosis drug of the diarylquinoline group with the working name thiosonide in an experiment on rats. Methods. To study the effect of thiosonide on embryonic development, experiments were carried out in 30 pregnant white outbred rats with an initial weight of 220-250 g. Antenatal effect of thiosonide on postnatal development was studied in experiments on 20 outbred white rats, 10 animals per group. Impact assessment criteria: weight dynamics and physical development of infant rats, development of physical activity (horizontal rope test); formation of sensory-motor reflexes (righting reflex and cliff avoidance reflex), behavior in an open field (registration of horizontal and vertical motor activity, exploratory and emotional reactions, grooming). Results. The absence of embryotoxic and fetotoxic effects of thiosonide administered to pregnant rats orally at doses of 10 and 100 mg/ kg was shown. The rates of embryonic death, body weight and fetal size were close to the control group values. In experiments studying the effect of thiosonide intake by pregnant rats on the postnatal development of rats no developmental deviations were revealed. The physical development of infant rats in the experimental group did not differ from that in the control group. It was found that the righting reflex, cliff avoidance reflex and behavior in the open field on the 5th day of life were formed in all infant rats in both experimental and control groups and corresponded to the physiological ranges. Conclusion. Thiosonide has no embryotoxic and fetotoxic effects, which makes it possible to consider it as a promising drug for the treatment of tuberculosis.