Journal of obstetrics and women's diseases

BACKGROUND: Endometriosis is most often characterized by two main clinical symptoms, namely, pelvic pain and infertility. Hormonal therapy may be prescribed to reduce the recurrence of the disease after surgical treatment and to relieve pain. It in most cases is incompatible with pregnancy planning and infertility treatment in in vitro fertilization programs. Currently, a protocol with various gestagens has been described for ovarian stimulation applicable in programs with cryopreservation of all embryos. However, there is scarce data on the use of such a protocol with dienogest that is widely used in the treatment of endometriosis.

AIM: The aim of this study was to assess the effectiveness and safety of using a protocol of assisted reproductive technology with dienogest in patients with endometriosis and infertility.

METHODS: This retrospective single-center cohort study included patients aged 18 to 45 years with infertility and endometriosis confirmed by surgical treatment or imaging methods (magnetic resonance imaging and ultrasound). The included couples underwent cycles of assisted reproductive technology with ovarian stimulation: with dienogest 2 mg/day continuously, with gonadotropin-releasing hormone agonists, and with gonadotropin-releasing hormone antagonists. All obtained blastocysts were cryopreserved by vitrification. Transfer of thawed embryos was performed in a modified natural cycle or with hormone replacement therapy. We assessed the frequency of obtaining embryos suitable for cryopreservation and euploid (according to the results of preimplantation genetic testing), as well as the frequency of pregnancy and its outcome. When assessing safety, side effects of the drugs used and the frequency of complications were monitored.

RESULTS: 49 couples underwent 80 cycles of assisted reproductive technology with ovarian stimulation: dienogest was used in group 1 (n = 29); protocol with gonadotropin-releasing hormone agonists in group 2 (n = 9); and protocol with gonadotropin-releasing hormone antagonists in group 3 (n = 42). All obtained blastocysts were cryopreserved by vitrification (162 embryos in total). The average age of the patients was 37.99 ± 4.50 years. In group 3, women more often reported local adverse reactions after the introduction of gonadotropin-releasing hormone antagonists (p = 0.021). The study groups did not differ in the frequency of other adverse reactions such as abdominal pain, gastrointestinal symptoms, and headache (p = 0.823). The results of ovarian stimulation were comparable between all the study groups. In total, 31 embryo transfers were performed. The clinical pregnancy rate was 35.5% (95% confidence interval 19.2–54.6): 75.0% in group 1, 33.3% in group 2, and 20.0% in group 3 (p = 0.023). No differences were found in the analysis of pregnancy outcomes between the study groups (p = 0.118). The groups did not differ in the frequency of preimplantation genetic testing (p = 0.153) and embryo quality (p = 0.82).

CONCLUSION: The ovarian stimulation protocol with dienogest allows for effective treatment of infertility in patients with endometriosis without discontinuing drug therapy for a long time.

BACKGROUND: Infectious complications associated with the use of medical implants pose a significant challenge, particularly for materials prone to bacterial colonization and biofilm formation. Staphylococcus aureus is one of the most critical pathogens responsible for implant-associated infections. The physicochemical properties of implant surfaces, such as roughness, hydrophobicity, and chemical composition, influence bacterial adhesion. Currently, there is insufficient comparative data on Staphylococcus aureus adhesion to different materials used in gynecological practice, including polypropylene and titanium. Studying this process is essential for reducing the risk of infectious complications and optimizing implant properties.

AIM: The aim of this study was to conduct a comparative analysis of Staphylococcus aureus adhesion to titanium and polypropylene implants, assessing the impact of their physicochemical characteristics on bacterial attachment.

METHODS: This experimental comparative in vitro study examined two types of medical mesh implants made of polypropylene (Gynemesh PS, Johnson & Johnson, USA) and titanium (Titanium Silk, Elastic Titanium Implants Ltd., Russia). To assess the adhesive properties, a daily culture of Staphylococcus aureus VT209 was incubated with implant samples at 37 ℃ for 1 hour. After washing, bacterial adhesion was quantitatively assessed using culture-based methods. Scanning electron microscopy and energy-dispersive X-ray spectroscopy were employed to analyze surface microstructure and chemical composition.

RESULTS: Quantitative adhesion levels of Staphylococcus aureus to titanium and polypropylene meshes were similar (p > 0.05); however, bacterial distribution patterns differed. Polypropylene implants showed uniform bacterial adhesion, whereas titanium implants exhibited localized bacterial concentration at the edges. Scanning electron microscopy analysis revealed surface roughness and microdefects at the edges of titanium implants, likely contributing to increased bacterial adhesion. Energy-dispersive X-ray spectroscopy analysis indicated differences in chemical composition between central and edge regions of titanium implants, with edge areas containing additional elements (carbon, oxygen, fluorine, iron), possibly introduced during mechanical processing and oxidation.

CONCLUSION: While the overall bacterial adhesion levels on titanium and polypropylene implants were comparable, the observed differences in bacterial distribution suggest an increased risk of infection in mechanically processed titanium areas. Further research is needed to explore surface modification strategies for titanium implants to minimize bacterial adhesion, including improved surface treatments and antimicrobial coatings. These findings may contribute to the development of safer medical implants and a reduction in implant-associated infections.

BACKGROUND: Fatty acids are important components of the oocyte microenvironment, exhibiting both pro-inflammatory and lipotoxic effects as well as anti-inflammatory effects depending on the presence and quantity of unsaturated bonds. Changes in the lipid profile of follicular fluid in obese patients may be a mechanism that leads to a decrease in oocyte competence and pregnancy rate in assisted reproductive technology programs. However, the available literature data is fragmentary and contradictory, which dictates the need for further research.

AIM: The aim of this study was to investigate the lipid profile of follicular fluid in patients undergoing assisted reproductive technology programs with ovarian stimulation depending on the body mass index using MALDI (matrix-assisted laser desorption/ionization) mass spectrometry.

METHODS: This study involved patients undergoing infertility treatment using assisted reproductive technology in a short protocol using gonadotropin-releasing hormone antagonists. The levels of essential saturated and unsaturated fatty acids were analyzed in the follicular fluid of the first aspirated follicle using MALDI mass spectrometry.

RESULTS: Two study groups were formed out of 138 patients: patients with normal body mass index (n = 38) and patients with overweight and obesity (n = 76). The latter were characterized by higher levels of myristic and stearic acids and lower levels of oleic acid in the follicular fluid. The level of myristic acid in the follicular fluid positively correlated with the body mass index, while the level of oleic acid negatively correlated with this parameter.

CONCLUSION: The data obtained indicate that overweight and obesity are associated with increased levels of saturated myristic and stearic acids in the follicular fluid, which negatively impact folliculogenesis, as well as a decrease in the level of monounsaturated oleic acid in the follicular fluid, which is able to compensate for the lipotoxic effects of saturated fatty acids.

BACKGROUND: Disorders of the immune system, which regulates adhesion, invasion, proliferation, apoptosis, and neoangiogenesis, are essential in the development of endometriosis. At the same time, a significant role is assigned to the immunogenetic aspects of the progression of endometriosis, in particular, the influence of major histocompatibility complex, or human leukocyte antigens, on the regulation of the immune system in this disease. However, characteristic features of its expression in different types of endometriosis are poorly understood.

AIM: The aim of this study was to determine the human leukocyte antigen–DR isotype (major histocompatibility complex class II) (HLA-DR) expression characteristics in endometrioid heterotopias in different types of endometriosis such as adenomyosis, endometrial ovarian cysts, and extragenital endometriosis.

METHODS: This retrospective study was performed based on morphological and immunohistochemical studies of surgical material. The latter was carried out using the standard avidin-biotin complex method using mouse monoclonal antibodies specific to HLA-DR (class II).

RESULTS: The study included 329 women aged 18 to 47 years who underwent surgical interventions for endometriosis of various organ localizations: 98 cases of internal genital endometriosis (adenomyosis), 196 cases of endometrial ovarian cysts, and 35 cases of extragenital endometriosis (21 cases of postoperative scar endometriosis and 14 cases of endometriosis of various parts of the intestine). Regardless of the organ localization of endometriosis, a clear pattern of HLA-DR (class II) expression was found. HLA-DR positive cells were found in the stroma of adenomyosis foci, in the capsules of endometrial ovarian cysts, and in extragenital heterotopias. They were more common in postoperative scar endometriosis—79 [75; 104], intestinal endometriosis—55 [50; 59], adenomyosis—56 [32; 97], and in endometrial ovarian cysts, their expression value was 14 [10; 63]. The glandular epithelium in endometrial heterotopias with signs of proliferation or secretion was HLA-DR negative in all the studied types of endometriosis—in adenomyosis, postoperative scar endometriosis, and intestinal endometriosis. Positive HLA-DR (class II) expression was found only in the epithelial lining of cystically transformed glands in adenomyosis foci and extragenital sites of endometriosis. The largest number of HLA-DR positive epithelial cells was found in the epithelial lining of endometrial ovarian cysts, the expression intensity being weak in 12.3%, intermediate in 72.3%, and strong in 15.4% of cases.

CONCLUSION: The data obtained suggest that the HLA-DR positive phenotype of endometriosis may reflect a specific morphogenesis and abnormalities in the cell genome associated with chronic inflammation, which is important in the prognosis of the clinical course of the disease. Further comprehensive clinical, morphological, and molecular genetic studies are required.

This article discusses the relevance of adhesive disease after caesarian section due to the increase in the frequency of repeated operative delivery and the increasing risk of complications during both pregnancy and surgery.

The modern understanding of the pathogenesis of the adhesive process is highlighted in the article. It has been shown that in response to a peritoneal injury, a local inflammatory process is activated and local activation of the coagulation system occurs. In this case, the first few days of the postoperative period are extremely important, as mature fibrous adhesions are subsequently formed, and adhesion formation becomes irreversible.

The effectiveness of surgical, physiotherapeutic and drug-induced methods of treatment and prevention of the adhesion process is evaluated, and their insufficient effectiveness is shown. It is noted that the creation of a barrier between the contacting surfaces in the abdominal cavity is the optimal method for preventing spike formation. The methods of creating an anti-adhesion barrier proposed to date are considered.

The possibilities of non-invasive diagnostics of adhesive disease using ultrasound are shown, with the main ultrasound signs of abdominal adhesions considered. Preoperative ultrasound allows for assessing the risks of repeated surgical intervention and correctly determining the patient’s routing for delivery.

Borderline ovarian tumors account for approximately 20% of epithelial ovarian tumors and are frequently diagnosed in women of reproductive age. Therefore, fertility preservation during treatment of these tumors is of particular importance. Organ-preserving surgeries are the preferred treatment method; however, they are associated with an increased risk of disease recurrence.

The aim of this study was to present a clinical case of managing a patient with recurrent borderline ovarian tumor and to assess the possibilities of preserving reproductive function using organ-preserving approaches.

We report the clinical case of a 36-year-old patient with recurrent serous borderline cystadenoma of the ovary. In 2018, laparoscopic resection of the left ovary was performed, followed by left-sided adnexectomy. Recurrences occurred in 2022 and 2024, requiring repeated surgical interventions. Menstrual function and the possibility of pregnancy planning using assisted reproductive technology were evaluated during follow-up.

Organ-preserving surgeries allowed preservation of the patient’s menstrual function and fertility potential despite multiple tumor recurrences. Timely surgical treatment and careful dynamic monitoring contributed to the absence of severe complications and maintenance of reproductive health.

Organ-preserving treatment methods for borderline ovarian tumors represent an effective approach to fertility preservation in women of reproductive age. Nevertheless, they require individualized treatment strategies and continuous monitoring, taking into account the patient’s reproductive plans and risk of recurrence.

Sanatorium and resort business is an integral part of state policy and an important element of the public health system in many countries. Great interest of specialists is shown in the works of the outstanding urogynecologist Professor Alexander M. Mazhbits, who published several works in the first half of the 20th century on the treatment of gynecological patients at resorts, including mud and brine baths.

Professor Alexander M. Mazhbits paid special attention to intravaginal and intrarectal mud therapy for gynecological patients. Later, this method was positively noted at Caucasian resorts (Yessentuki, Kislovodsk, Zheleznovodsk, etc.), in Crimea (Saki), and elsewhere (Moscow, Saratov, Leningrad, etc.).

During his work in Arkhangelsk in the 1950s, the professor continued to study issues of balneology and made a huge contribution to the development of balneology for urogynecological practice.

The main advantage of the professor’s works is that he substantiated the mechanism of action of mud therapy in gynecology with sufficient completeness and objectivity, and formulated reasonable indications for mud therapy in gynecological patients.

At present, modern society is focused on a healthy lifestyle, which considers sanatorium and resort complexes. Using the healing properties of mud and balneological factors, they offer a wide range of additional services such as spa procedures, fitness programs, and dietary nutrition.

In the Russian Federation, health resort business is an integral part of state policy and an important element of the public health system.