scholarly journals Evaluation of the effectiveness of a proposed approach to treat infertility against the background of uterine leiomyoma, which includes treatment with a releasing hormone agonist, hysteroresectoscopy or conservative myomectomy, and pre-pregnancy treatment

Author(s):  
S. V. Khmil ◽  
Yu. B. Drozdovska

There is much discussion about the effect of uterine leiomyomas on the outcomes of assisted reproductive technologies (ART). This study aimed to analyze the effectiveness of in vitro fertilization following the use of a therapy scheme we propose to treat infertility with the background of uterine leiomyoma. The therapy scheme includes the use of a releasing hormone agonist, hysteroresectoscopy or conservative myomectomy and pre-pregnancy pre-treatment. The clinical study involved 175 women of reproductive age who had been diagnosed with uterine leiomyoma, and were divided into the groups as follows. The treatment group A included 137 women with uterine leiomyoma, and was further divided into subgroups. Subgroup A1 included 55 women with uterine leiomyoma after conservative myomectomy who underwent the proposed treatment scheme (TS); A2 included 45 women with uterine leiomyoma after hysteroresectoscopy who underwent the TS; A3 included 37 women with uterine leiomyoma who underwent the TS but not the surgical removal of uterine leiomyoma. Control group B included 38 women with uterine leiomyoma after conservative myomectomy. All patients with intramural and submucosal myoma nodules underwent a hormonal preparatory treatment with a gonadotropin-releasing hormone (GnRH) agonist (Diphereline 3.75 mg intramuscularly once every 28 days for 3 months) prior to the myomectomy. After the surgery, patients were prescribed a combination therapy with a vitamin complex FT 500 plus, vitamin D3 and Pelvidol for three months before and during controlled ovarian stimulation (COS) protocol up to the follicle puncture. We determined that the incidence of pregnancy was the lowest (37.8 %) in women with infertility against the background of uterine leiomyoma, who surgically treated for the myomas, but underwent pre-pregnancy pre-treatment. The frequency of pregnancy did not differ between the A1 and A2 treatment groups, and was on average 7.0 % higher than in the control group, and 11.0 % higher than in the A3 group. The relative incidence of clinical pregnancies was the highest in A1 (45.5 %) and A2 (44.4 %) treatment groups. The frequency of live births in the A1 group was significantly higher than in A3 group (by 14.0 %), while the relative number of term live births in the A1 group exceeded that of A3 group by 26.0 %. Thus, both proposed therapy schemes to treat infertility against the background of uterine leiomyoma, which include the use of a releasing hormone agonist, either a conservative myomectomy or hysteroresectoscopy and pre-pregnancy pre-treatment in addition to the ART protocol with a multi-vitamin complex with inositol, vitamin D3, alpha-lipoic acid and magnesium, had the equivalent effects on the incidence of clinical pregnancy, however the frequency of live births was highest after conservative myomectomy (84.0 %).

2020 ◽  
Vol 73 (5) ◽  
pp. 868-872
Author(s):  
Iryna M. Nikitina ◽  
Volodymyr I. Boiko ◽  
Svitlana A. Smiian ◽  
Tetiana V. Babar ◽  
Natalia V. Kalashnyk ◽  
...  

The aim: The aim of the study was to improve the results of treatment of patients with endometriosis by using a combination method of therapy. Materials and methods: For two years, 136 women of reproductive age who underwent laparoscopic surgeries for ovarian endometriosis were monitored: Group I (n = 24) did not receive any hormonal treatment in the perioperative period; Group II (n = 32) – received gonadotropin-releasing hormone agonists within 3 months after surgery; Group III (n = 80) prior to laparoscopic removal of the ovarian cyst used gonadotropin-releasing hormone agonists – Triptorelin 3.75 mg intramuscularly for 2 months, as well as three months after surgery. The control group consisted of 30 healthy women of reproductive age with regular menstrual periods. All patients underwent transvaginal ultrasound, counting the number of antral follicles before and after treatment. Serum hormone levels (FSH, prolactin, thyrotropic hormone, anti-Mullerian hormone, inhibin B) were determined by enzyme-linked immunosorbent assay on Cobas e-411 analyzer (Roche Diagnostics, Switzerland) on day 2-3 of the menstrual cycle and on day 2–3 of the first menstrual period after the end of treatment. Laparoscopic removal of the cyst was performed with exfoliation of the cyst, hemostasis on the wound surface of the bed of the cyst was performed with a bipolar electrocoagulator. Bipolar coagulation and resection of the ovarian tissue with no potential was used during surgical treatment of the ovaries, which made it possible to preserve the intact portion of the ovary as much as possible. Results: Analysis of ovarian reserve indices, namely number of antral foliculs, number of antral follicles, AMG, and inhibin B levels in all examined patients with ovarian endometriomas were significantly lower than those of the control group before the start of treatment: in the ovarian endometrial group group 1.26 times (p <0.01), inhibin B – 1.5 times (p <0.01), the number of antral follicles – 1.2 times (p <0.01), due to the development dystrophic changes of the follicular apparatus due to prolonged compression, hypoxia, fibrosis in the ovaries. Patients who planned pregnancy were advised to have an active sexual life before menstruation was restored. In 23 (46.9%) of 49 patients who had reproductive plans, pregnancy occurred without first menstruation after a course of gonadotropin-releasing hormone agonists, 12 (24.5%) women became pregnant during the first three menstrual cycles. Extracorporeal fertilization was recommended for women who did not have pregnancy within 6 months of surgery. For two years in women who did not plan pregnancy, recurrence of endometriosis was not observed. Conclusions: The combination of laparoscopic treatment with gonadotropin-releasing hormone agonists in patients with endometriosis with infertility allowed to restore reproductive function in 71.4% of women, which indicates the effectiveness of the treatment method used. In addition, it helps to achieve lasting remission and addresses the socio-social problems of women’s health and maternity.


2016 ◽  
Vol 23 (3) ◽  
Author(s):  
O. M. Makarchuk ◽  
Abdulrakhman Abdulbaset Moslem

Introduction. Analysis of uterine leiomyoma incidence indicates not only its growth but also the increase in the number of women of early reproductive age. However, the problem of trigger mechanisms for its development is still uncertain and actual.The objective of the research was to assess the characteristic features of hyperplastic processes in uterus on the background of dishormonal and metabolic disorders.Materials and methods. 60 women of reproductive age with uterine leiomyoma participated in the clinical trial. They gave their informed written consent. The control group consisted of 20 healthy women of reproductive age. Statistical analysis was conducted using material package “STATISTICA for Windows®-6.0” and methods of odds ratio (OR) calculating and its 95% Confidential Interval (95% CI).Results and their discussion. According to the results of the research the main factors contributing to uterine fibroid development in women with obesity were determined. They included: the age of 30-45 years, instrumental intervention in the womb (abortion, diagnostic curettage, etc. (OR = 8.2; 95% CI: 5.1-13.5)); chronic inflammatory diseases of genitalia (OR = 7.9; 2.9-21.9); hormonal imbalances (fibro-cystic breast disease, thyroid disorders (OR = 8.61; 3.1-23.8), liver and gastrointestinal tract disorders (OR = 5.8; 2.1-15.9) sexual disorders and stress inductive factors (OR = 2.6; 1.4-7.1) (usually fibroids occur in 1-2 years after severe stress). There is a significant percentage of adenomyosis and endometrial hyperplastic processes. Growth of tumors in women with obesity increases to 35-40 years of age, and is associated not only with a progressive decrease in the functional activity of the ovaries, their sensitivity to gonadotrophic stimulation, but also with chronic functional exertion of regulation systems on the background of metabolic disorders of hemostasis and homeostasis in this category of women.Conclusions. One of the most significant risk factors for hyperplastic processes of the reproductive organs is obesity and associated metabolic disorders. In case of metabolic disorders activity and hepatocytes on the background of obesity the number of combined forms of hyperplastic processes in the uterus increases by 1.9 times. The main risk factor for fibroids in obese women is hepatocytes dysfunction on the background of a high percentage of hepatobiliary pathology, endocrine pathology – 68.3% (thyroid dysfunction, fibro-cystic breast changes). Morphological and histological structure of endometrium in obese women leads to the growth of endometrial polyps (36.66%).


2020 ◽  
pp. 48-50
Author(s):  
O.M. Perkhulyn ◽  

The formation of the puberty period is an important background for the female reproductive system in the future and the realization of the childbirth. The objective: to assess medical aspects in women with cervical insufficiency (CI) and infertility associated with anovulation in history. Materials and methods. 60 pregnant women with CI and anovulatory infertility in anamnesis formed the basic group. In these persons the pregnancy occurred after the use of additional reproductive technologies. The control group formed 30 pregnant women without CI and infertility and with physiological pregnancy. Results. In 33.33% individuals in the basic group menarche started in 16 years old and more. While in the control group in all women menarche started in 11–15 years old (χ2=11.00; p<0.001). In the reproductive age all controls (100.00%) had regular menstrual cycle that was in 3.33 times more than the women in the basic group (30.00%; χ2=36.61; p<0.001), 70.00% persons in the basic group had irregular menstruations. The menstruations were always irregular from menarche in 16.64% persons with CI vs none cases among healthy women (χ2=4.06; p=0.04). Endometriosis was diagnosed in 48.33% individuals with CI and infertility, polycystic ovary syndrome – 38.33%, diminished ovarian reserve – 26.67%, hyperandrogenism – 41.67%, ovary cyst – 20.00%. The rate of the infections of the low genital tract before pregnancy was higher in women in the basic group, also 45.00% of these women had gynecological operations (χ2=19.43; p<0.001); thyroid diseases – 25.00% (χ2=5.03; p=0.02), overweight and obesity – 26.67%. Conclusion. Thus, the results of our study indicate that in the persons with cervical infertility and anovulatory infertility in anamnesis disorders in the reproductive system mostly start from the puberty period; the high rate of gynecological diseases, operations on the pelvic organs, pregnancy loss are typical for them. Key words: infertility, cervical insufficiency, factors.


2020 ◽  
Vol 98 (Supplement_3) ◽  
pp. 35-36
Author(s):  
Victor L Ishengoma ◽  
Raghavendra G Amachawadi ◽  
Kellen A Habib ◽  
Xiaorong Shi ◽  
Taghreed Mahmood ◽  
...  

Abstract Campylobacter and Salmonella are common food borne pathogens in the gut of pigs and are shed in the feces. The control of these bacteria in pigs is of importance in reducing the potential for transmission to humans. In swine, oral route, either in-feed or in-water, is by far the most common route of administration of antibiotics. Because the distribution of the antibiotic in the gut and the dosage are different, the impact of in-feed vs. in-water administration of antibiotics on the fecal shedding of food borne pathogens, Campylobacter and Salmonella, and on the development of antimicrobial resistance (AMR) in gut bacteria is a largely unexplored area. Therefore, a study was conducted to compare the effects of in-feed and in-water antibiotic administration on fecal prevalence of Campylobacter and Salmonella and AMR development in nursery piglets. A total of 1,296 weaned piglets were allocated into pens (48 pens; 27 pigs per pen) distributed in a single room. Pens were assigned randomly to six treatment groups; Control (No antibiotic), In-feed chlortetracycline (CTC), In-water CTC, In-feed tiamulin, In-water tiamulin, and a combination of CTC and tiamulin (In-feed). Fresh fecal samples were collected randomly from 5 of 27 piglets from each pen on pre-treatment (days -7, 0), treatment (days 7, 14) and post-treatment (days 21, 28) phases. Bacterial isolations and identifications were done by culture method and PCR, respectively. Overall prevalence of Campylobacter and Salmonella were 18.2% (262/1,440) and 3.9% (56/1,440) respectively. Speciation of Campylobacter isolates indicated C. hyointestinalis (17.9%; 258/1,440) and C. coli (0.3%; 4/1,440). Pigs from control group had a higher prevalence (P&lt; 0.05) of both Campylobacter and Salmonella when compared to other treatment groups. Both treatment and post-treatment phases had a significant effect on the prevalence of Campylobacter and Salmonella (P&lt; 0.05).


Author(s):  
Kh. M. Omarova ◽  
E. S.-А. Ibragimova ◽  
T. Kh.-M. Khashaeva ◽  
I. Kh. Magomedova ◽  
R. G. Omarova ◽  
...  

Objective. To assess the condition of newborns from women of the late reproductive period (LRP), depending on the parity of births.Material and methods. The authors examined 130 pregnant women and their 130 newborns. Group I consisted of 60 primiparous women of late reproductive period and their 60 newborns, Group II included 40 multiparous women of the late reproductive period and their 40 newborns, Group III (control group) consisted of 30 healthy pregnant women aged from 18 to 25 years and their 30 newborns. The authors performed a retrospective analysis of the gestation course and perinatal outcomes. Ultrasound and neurosonography were used among the instrumental research methods.Results. Women of the late reproductive period gave birth to children in a state of asphyxia twice more often, who develop neurological disorders 1,5 times more often and complex postnatal adaptation and disorders of the perinatal period are twice more likely. Among women of the late reproductive period, primiparous women gave birth to children with the most severe disorders.Conclusion. The high incidence of neurological diseases in children born from women of the late reproductive period is associated with age-related changes in their germ cells, the implementation of assisted reproductive technologies, and the intake of hormonal drugs in early pregnancy. The data obtained should be taken into account by obstetricians in the course of pregnancy in women of late reproductive age; they should be included in the group of high risk of developing neurological disorders in children.


2021 ◽  
Vol 4 ◽  
pp. 99-105
Author(s):  
A.H. Kornatska ◽  
O.V. Trokhymovych ◽  
G.V. Chubei ◽  
M.A. Flaksemberh ◽  
L.V. Stamboli

The objective: To determine the features of the microbiocenosis of the genital tract and immunological homeostasis and in women of reproductive age with uterine leiomyoma.Materials and methods. The microbiocenosis of the genital tract and immunological homeostasis of 308 women with uterine leiomyoma aged 23–49 years were studied. The control group included 30 healthy women aged 24–37 years. Results. In women of reproductive age, the development of uterine leiomyoma is associated with a significant violation of the microecology of the genitals, the presence of nonspecific vaginitis and bacterial vaginosis, increased frequency and concentration of pathogenic flora (staphylococci and streptococci with hemolytic properties, enterobacteria), STIs or reducing the concentration of protective microflora.The study of the peculiarities of the functioning of the immune system at the local level in the presence of uterine leiomyoma indicates unidirectional disorders in the state of local immunity and changes in the protective function of cervical mucus in the examined women. Thus, under conditions of uterine leiomyoma, there is a significant activation of local immunological factors, as evidenced by a significant increase in the concentration of IgG, IgA and the appearance of IgM in cervical mucus in 27,5–32,5 % of women with uterine leiomyoma. In addition, there was suppression of phagocytic activity of neutrophils, which was manifested by a significant decrease in activity and intensity of phagocytosis, with a decrease in their functional reserve by NRT test, which creates conditions for intracellular persistence of infection, activation and persistence of inflammatory progression.Conclusions. The obtained data indicate a violation of the microecology of the genitals and the intensity of immunogenesis in women with uterine leiomyoma, which indicates that the inflammatory process of the genitals is one of the significant factors that lead to the emergence and progression of uterine leiomyoma.


2018 ◽  
Vol 73 (1) ◽  
pp. 5-15
Author(s):  
A. I. Ishenko ◽  
A. L. Unanyan ◽  
E. A. Kogan ◽  
T. A. Demura ◽  
J. M. Kossovich

Background: The widespread prevalence of infertility, the low effectiveness of assisted reproductive technologies (ART), and the high incidence of chronic endometritis (CE) in infertile women determine the relevance of the considered problem. The aim of the study was to determine the clinical and anamnestic, laboratory, and instrumental features of CE associated with infertility and unsuccessful IVF cycles in women of reproductive age. Materials and methods: The study enrollred 150 women of reproductive age with morphologically established CE (main group, n=120) and without CE (control group, n=30). A subgroup I of the main group included 64 patients with infertility and IVF failures, a subgroup II – 56 fertile women. In addition to anamnesis collection and identification of CE clinical features, all patients underwent infectious screening, immunological and immunohistochemical analysis, ultrasound examination of pelvic organs with dopplerometry, and office hysteroscopy. A comparative analysis of the data obtained from subgroups of the main group was conducted. Results: Histological study of endometrial pipelle-biopsy specimens on the 7−10th day of the cycle revealed CE in all patients of the main group. We found prevalence of mean duration of CE in the subgroup I relative to subgroup II ― 5.5±0.06 years and 2.4±0.07 years, respectively (p0.001). Infectious screening showed that 58 (90.6%) patients of the I subgroup had sterile endometrial seeding which was 16.9 times higher than in subgroup II (p0.0001). Immunological analysis determined the presence of AEAT in all patients of the subgroup I, 43 of which (67.2%) were above 265 U/ml, while 51 (91.1%) of subgroup II had no AEAT (p0.001). Immunohistochemical analysis of the endometrium on the 18th−24th day of the cycle established high expression of CD16 , CD20 , CD56 , and HLA-DRII in 58 (90.6%) patients of the subgroup I, whereas in 54 patients (96.4%) of II subgroup high expression of CD16 and CD20 with low amount of CD56- and HLA-DRII-positive cells was registered (p0.001). We determined prognostically significant clinical and anamnestic risk factors predisposing to the development of infertility in patients with CE (p0,05). We revealed certain echographic, dopplerometric, and hysteroscopic criteria of CE demonstrating the critical disruption of endometrial receptivity in infertile women. Conclusion: Most patients (90.6%) with infertility had autoimmune component of CE characterized by prolonged (more than 5 years) course, high serum level of AEAT, sterile endometrial crops, and high expression of inflammation markers CD16 , CD20 , CD56 and HLA-DRII .


SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A317-A317
Author(s):  
Paul Gunter ◽  
Philip Gehrman ◽  
James Findley ◽  
Matthew Kayser ◽  
Samuel Kuna ◽  
...  

Abstract Introduction CBT-I is the gold standard treatment for insomnia, but access to in-person care is limited, which has worsened due to the recent COVID-19 pandemic. While providers across spheres of care have rapidly pivoted to telehealth there have been few systematic comparisons of in-person treatments to telemedicine approaches. The current study, launched pre-COVID, aimed to examine the perspectives of patients who were randomly assigned to receive CBT-I in-person or via telemedicine. Additionally, provider reflections were collected. Methods Individuals with DSM5 Insomnia Disorder (n=60) were randomized to in-person CBT-I, telemedicine CBT-I or a wait-list control group. CBT-I was delivered over 6–8 weekly sessions by video telemedicine or in-person. This nested qualitative study addressed patient and provider perspectives on treatment approaches. A sample of participants from each group (n=36) were interviewed 3 months post-treatment. Phone interviews were audio recorded, transcribed and analyzed using a directed content analysis approach. Results were organized into thematic categories including 1) participant experience with CBT-I, 2) access issues and 3) accountability issues related to delivery approach. Additionally, participating providers (n=7) were interviewed and shared their reflections on delivering CBT-I in-person vs. telemedicine. Results Patients reflected positively on CBT-I, and this did not vary across treatment groups. Patients and providers noted telemedicine benefits related to access that included, but were not limited to, reducing transportation barriers to treatment and improved continuity of care (e.g. not having to cancel an appointment if a patient was traveling). Patients and providers shared concerns they had anticipated pre-treatment about possible telemedicine related technological hurdles and barriers to establishing meaningful rapport on-line. However, they reported that these concerns did not prove to be barriers to effective telemedicine visits. Conclusion This qualitative study allowed patients and their providers to reflect on their experience delivering in-person vs telemedicine CBT-I. CBT-I was accepted well regardless of delivery approach. Telemedicine is currently being deployed widely and this study provides a systematic comparison between approaches. Support (if any) This study was supported by the American Sleep Medicine Foundation.


1990 ◽  
Vol 70 (1) ◽  
pp. 107-119 ◽  
Author(s):  
A. L. SCHAEFER ◽  
S. D. M. JONES ◽  
A. K. W. TONG ◽  
B. A. YOUNG

Two experiments were completed to: (1) identify predictive acid-base and electrolyte parameters that might be correlated with meat quality in marketed bulls; and (2) to determine whether bulls could be treated with either glucose or electrolyte drinks while in lairage to improve electrolyte balance and meat quality. In the first experiment, 29 crossbred yearling bulls averaging 499 ± 13.4 kg were exposed to either a minimal stress of no mixing and 3 km transport (N = 13) or a moderate stress of mixing, 6 h transport 24 h off feed in lairage, plus an additional 3 km transport immediately prior to slaughter (N = 16). Animals exposed to moderate stress displayed higher serum chloride values (137 mmol L−1) compared to pre treatment control (121 mmol L−1) or minimal stress values (118 mmol L−1) (P ≤ 0.01). The moderate stress group also displayed lower blood hydrogen ion concentrations (P < 0.05) and produced a high frequency of dark, firm and dry meat (9 out of 16 animals compared to 0 out of 13 in the control group). In the second experiment, 79 crossbred yearling bulls averaging 595 ± 6.5 kg were divided into treatment groups of either 19 or 20 animals each and subjected to mixing, handling and a 6-h transport period after which they were left in lairage for 18–20 h before slaughter. Treatment groups were: (1) no water during lairage; (2) water only; (3) electrolyte drink; or (4) a 5% glucose drink. Animals in exp. 2 given either water or no water displayed significantly higher serum sodium (P ≤ 0.01) and chloride ion (P ≤ 0.02) levels compared to animals offered an electrolyte or glucose drink. It was also found that the urine cation levels of animals offered no water or water only were significantly higher (P ≤ 0.05). In all animals, improved electrolyte balance coincided with improved meat quality traits and carcass yield. Key words: Electrolyte balance, transport stress, bulls, carcass quality


2017 ◽  
Vol 37 (4) ◽  
pp. 395-400 ◽  
Author(s):  
Melissa Meneghel ◽  
Priscila Chediek Dall’Acqua ◽  
Marcela Ambrogi ◽  
Beatriz C.S. Leão ◽  
Nathália A.S. Rocha-Frigoni ◽  
...  

ABSTRACT: The aim of the present study was to evaluate the intracytoplasmic lipid content, development and cryotolerance of in vitro-produced bovine embryos treated with different concentrations of forskolin before vitrification. Embryos were produced from abattoir-derived ovaries and allocated into four groups. In the treatment groups, forskolin was added to the in vitro culture medium on Day 6 and incubated for 24 hours in one of the following concentrations: 2.5μM (Forsk 2.5 group), 5.0μM (Forsk 5.0 group) or 10.0μM (Forsk 10.0 group). Embryos from the control group were cultured without forskolin. On Day 7 of culture, the expanded blastocysts were stained with the lipophilic dye Sudan Black B for determination of the intracytoplasmic lipid content or were cryopreserved via the Vitri-Ingá® procedure. Although there were no significant differences (P>0.05) in the blastocyst rates between the Control group (44.9%) and the other treatments, the embryo production was lower (P<0.05) in Forsk 10.0 group (38.8%) compared to Forsk 2.5 (50.5%) and Forsk 5.0 (54.7%) groups. The intracytoplasmic lipid content (expressed in arbitrary units of pixels) in blastocysts from the Control group (1.00±0.03) was similar (P>0.05) to that found in Forsk 2.5 (0.92±0.03) and Forsk 10.0 groups (1.06±0.03) groups; however the lipid accumulation in blastocysts from Forsk 5.0 group (0.82±0.04) was lower than in the Control group (P<0.05). Based on these results, Forsk 5.0 treatment was tested for cryotolerance and it was observed that the blastocoel re-expansion rate evaluated 24 hours after warming was greater (P<0.05) in Forsk 5.0 group (72.2%) compared to the Control group (46.2%). In conclusion, pre-treatment with forskolin at a concentration of 5.0 μM for 24 hours before vitrification is effective in reducing the intracytoplasmic lipid content and, consequently, improves cryotolerance of IVP bovine embryos.


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