Journal of obstetrics and women's diseases

BACKGROUND: In reproductive-age patients with ovarian tumors and low ovarian reserve (anti-Müllerian hormone levels < 1.0 ng/ml), standard controlled ovarian stimulation is often inapplicable due to hormonal risks and the need to delay surgery. Alternative methods enabling non-stimulation oocyte retrieval are required.

AIM: The aim of this study was to assess the feasibility of performing intraoperative sampling of oocytes in the natural cycle and efficiency of obtaining and fertilization of oocytes in patients of reproductive age with benign or borderline ovarian tumors and low ovarian reserve who underwent organ-preserving surgery using argon plasma coagulation, and to analyze early reproductive outcomes after a frozen embryo transfer in patients who have reached the cryotransfer stage.

METHODS: This single-center prospective non-randomized study included 38 patients (O-RADS 2–3, tubal infertility, anti-Müllerian hormone level < 1.0 ng/ml). Ultrasound follicular monitoring and intraoperative oocyte aspiration were performed. Mature oocytes (MII) were vitrified; and immature oocytes (GV, MI) underwent in vitro maturation (IVM). Cystectomy was completed with argon plasma coagulation of the tumor bed. At 3 months post-surgery, with favorable histology, we carried out oocyte warming, intracytoplasmic sperm injection, blastocyst culture, cryopreservation, and frozen embryo transfer in a treatment cycle.

RESULTS: Intraoperative oocyte retrieval was performed in 36 of 38 patients (94.7%), with at least one oocyte obtained in 34 patients (94.4%). 61 oocytes (average 1.6 ± 0.7 per patient) were aspirated, of which 28 oocytes (45.9%) were mature (MII). After IVM, 18 of 33 immature oocytes (54.5%) reached the MII stage, the total number of mature oocytes being 46. Fertilization by intracytoplasmic sperm injection was performed on all mature oocytes, with normal fertilization recorded in 35 cases (76.1%). 27 blastocysts (77.1% of those fertilized) were obtained and cryopreserved followed by creating an embryos bank for 25 patients. Of the 25 cryopreserved embryo transfers, clinical pregnancy occurred in 11 cases (44.0% per transfer). The cumulative live birth rate for all included patients (n = 38) was 21.1% (8/38), and taking into account three progressive pregnancies (>22 weeks), it was 28.9% (11/38). We recorded no intraoperative and postoperative complications. The use of argon plasma coagulation ensured a reliable hemostasis with a coagulation necrosis depth of no more than 1.5 mm; the decrease in anti-Müllerian hormone levels after 3 months amounting to 9.4%.

CONCLUSION: The proposed method of intraoperative oocyte retrieval in natural cycles combined with argon plasma coagulation is a safe and effective approach for preserving reproductive potential in patients with ovarian tumors and low ovarian reserve. It enables oocyte/embryo collection and cryopreservation without delaying surgery or exposing patients to stimulation risks, while coagulation minimizes postoperative ovarian tissue damage. The cumulative live birth rate of 28.9% demonstrates the real feasibility of achieving reproductive outcomes in this challenging patient group.

BACKGROUND: In the Republic of Tajikistan, the prevalence of preterm birth has shown no downward trend in recent years. Early prediction and timely prevention therefore remain relevant strategies for reducing the incidence of preterm birth. Existing nomograms for short-term prediction of preterm birth rely on costly laboratory and instrumental methods and offer limited practical value in low-resource settings. Taking into account the regional characteristics of Tajikistan, the search for tools enabling the long-term prediction of preterm birth based on data collected at a pregnant woman’s first antenatal care appointment to primary health care facilities represents a relevant line of research.

AIM: The aim of this study was to identify independent clinical, social, and anamnestic predictors of preterm birth in a population of pregnant women residing in Tajikistan and, based on these, to develop a prognostic model with a clinical risk calculator.

METHODS: This retrospective case–control study included delivery records and prenatal care charts of 180 women with singleton pregnancies registered in the first trimester: 120 with preterm birth (< 37+0 weeks) and 60 with term birth (≥37+0 weeks). We studied clinical, social, and anamnestic factors recorded at the initial visit to a primary health care facility. Independent predictors were identified using multivariable logistic regression, with model performance assessed by ROC analysis and internal validation performed using the bootstrap resampling method (1,000 iterations).

RESULTS: Multivariable logistic regression identified the following independent predictors of preterm birth: history of induced abortion [odds ratio (OR) 4.65; 95% confidence interval (CI) 1.47–14.74; p = 0.009], history of preterm birth (OR 3.73; 95% CI 1.53–9.08; p = 0.004), physical labor (OR 3.22; 95% CI 1.53–6.76; p = 0.002), anemia (OR 2.90; 95% CI 1.28–6.57; p = 0.011), and obesity (OR 2.65; 95% CI 1.15–6.11; p = 0.022); all these factors were incorporated into the model. Bacteriuria was included in the model due its clinical relevance (OR 2.90; 95% CI 0.95–8.84; p = 0.062). The resulting prognostic model demonstrated the following discriminatory performance: area under the ROC curve was 0.776 (95% CI 0.708–0.845), and overall accuracy was 74.4%. The optimal probability threshold, determined by the Youden index, was p = 0.615 (sensitivity 72.5%, specificity 73.3%). Internal validation using the bootstrap resampling method (1,000 iterations) confirmed the model robustness (95% CI for the area under the ROC curve 0.708–0.845). An online calculator derived from the model is designed to stratify the risk of preterm birth at the stage of the woman’s first prenatal appointment.

CONCLUSION: Adaptation of the model to the regional conditions of Tajikistan makes it applicable to primary obstetric care settings in Central Asian countries with comparable socioeconomic profiles.

BACKGROUND: Ovarian dermoid cysts are the most common benign germ cell tumors. Current pediatric screening protocols mandate pelvic ultrasound only at ages 6 and 15, creating a diagnostic gap during the period of hormonal changes (ages 7–14). A comparative analysis of the clinical and morphological characteristics of mature ovarian teratomas between pediatric and adult groups was conducted, including a statistical assessment of the data obtained.

AIM: The aim of this study was to conduct a comparative clinical and morphological analysis of mature ovarian teratomas in patients of different age groups.

METHODS: A cross-sectional, two-center study was conducted. Group 1 consisted of patients aged ≥18 years, and Group 2 comprised patients aged < 18 years. Inclusion criteria for the study groups were a verified diagnosis of mature ovarian teratoma and the availability of clinical and morphological data. Exclusion criteria included immature teratoma, malignant transformation, absence of morphological examination, and incomplete data. The primary outcome measure was the intergroup comparison of median cyst volumes. Secondary outcome measures included emergency hospitalization rates, surgical access type, extent of surgical intervention, and histological composition. Statistical analysis utilized the Mann–Whitney U test, Fisher’s exact test, and Spearman’s rank correlation coefficient; the significance level was set at p < 0.05.

RESULTS: The median cyst volume in Group 2 was more than 3.3 times higher than in Group 1 (p = 0.038). The emergency hospitalization rate was higher in Group 2 (p = 0.008). Adnexectomy was performed more than twice as often in Group 2 (p = 0.003). Cyst volume was the key predictor of organ-removing surgery in the both study groups. Histologically, hair follicles (p = 0.021), bone tissue (p = 0.035), and formed dental tissues — the latter being absent in all adult cases (p = 0.0004) — were more frequent in Group 2. Smooth muscle tissue (p = 0.0001) and respiratory epithelium (p = 0.007) predominated in Group 1.

CONCLUSION: Ovarian dermoid cysts in children and adolescents are detected at larger volumes than in adults, resulting in higher rates of complicated disease courses, open surgical approaches, and adnexectomies. The histological composition of the cysts demonstrates age-related differences. The main limitation of this study is its retrospective, cross-sectional design, which highlights the need for prospective studies.

BACKGROUND: Endometriosis plays a leading role in the impairment of fertility. An imbalance of angiogenic factors underlies the pathogenesis of infertility, however, the prognostic value of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) markers for assessing the risk of impaired fertility in patients with endometriosis remains poorly studied.

AIM: The aim of this study was to evaluate serum sFlt-1 and PlGF levels, as well as the sFlt-1/PlGF ratio, in patients with endometriosis, and to assess the predictive value of these parameters in the diagnosis of endometriosis-associated infertility.

METHODS: This pilot prospective study was conducted on 20 reproductive-aged patients with confirmed endometriosis. All patients were divided into two groups: Group 1 (the main group) included patients with endometriosis and infertility (n = 10), and Group 2 included patients with endometriosis without fertility disorders (n = 10). Serum sFlt-1 and PlGF levels were assessed using electrochemiluminescence immunoassay (Cobas E 411, Roche). Statistical analysis was performed using the Mann–Whitney U test.

RESULTS: In patients with infertility, PlGF level was lower than in patients without infertility: 11.28 (10.60–13.28) vs. 16.38 (12.14–19.29) pg/ml (p = 0.028). However, sFlt-1 values did not differ between the two groups (p = 0.32). The sFlt-1/PlGF ratio in the infertile group was higher: 8.65 (7.09–10.80) vs. 6.06 (5.10–7.13) (p = 0.046). We found a negative correlation between the sFlt-1/PlGF ratio and the age at menarche (p = 0.036) and a positive correlation with the severity of pain according to the visual analog scale (p = 0.041).

CONCLUSION: In patients with infertility and endometriosis, an imbalance of angiogenesis factors is manifested by a decrease in PlGF level and an increase in the sFlt-1/PlGF ratio. The data obtained suggest that the sFlt-1/PlGF ratio can be used as a potential prognostic marker for the risk of infertility in patients with endometriosis.

Pelvic organ prolapse (POP) is a condition that significantly impairs women’s quality of life due to a combination of vaginal, urological, colorectal, and sexual symptoms. Despite its high prevalence, early diagnosis of POP remains challenging owing to the discrepancy between subjective symptoms and the anatomical severity of the disease, as well as the lack of a unified diagnostic algorithm. The aim of this review was to systematize current diagnostic methods for POP in women and evaluate their clinical significance. This analytical review of the literature published between 2020 and 2025 was conducted using the PubMed/MEDLINE and eLibrary (RSCI) databases. The analysis included clinical guidelines, systematic reviews, and original studies focusing on clinical, instrumental, and digital diagnostic modalities for POP. It was demonstrated that contemporary diagnosis of POP should rely on a comprehensive approach that integrates a structured symptom assessment, validated questionnaires, standardized clinical staging via the POP-Q system, and pelvic floor imaging. Of particular importance are transperineal ultrasound in various modes and magnetic resonance imaging, which allow for the evaluation of both anatomical and functional changes during stress maneuvers. While magnetic resonance imaging is highly informative in complex multicompartment cases and for preoperative anatomical definition, ultrasound remains a more accessible, cost-effective, non-invasive, and real-time tool. Thus, the integrated use of clinical and instrumental methods enhances the accuracy of POP detection, improves grading assessment for early and more objective diagnosis, and optimizes management strategies.