Endometriosis is currently considered as one of the most common diseases associated with infertility. A controversial issue is whether endometriosis per se exerts a detrimental effect on IVF outcomes. Failure of implantation due to endometriosis-associated infertility is a contradictory and widely discussed burden nowadays. The purpose of the study is to assess the quality of embryos and implantation rate in women with infertility associated with endometriosis. The study included infertile reproductive aged women, between 26 and 40 years who underwent IVF and ICSI procedures. The patients were divided into two groups: group I (n ¼ 70) involved 70 patients with recurrent unilateral endometriomas, II control group (n ¼ 50) with tubal factor infertility. The quality of the retrieved embryos was assessed according to the generally accepted classification of Gardner, indicating the rate of implantation in each group. Embryo transfer was performed in case of high quality embryos. Assessing the ovarian reserve indicators, in the group I patients with recurrent unilateral endometriomas the serum level of AMH was significantly lower (2.1 ± 1.75 vs. 3.2 ± 1.4, p < .005), as well as the number of retrieved oocytes (8.1 ± 3.9 and 10.1 ± 6.8, p < .005). The analysis of the results demonstrated that the duration of stimulation in the group patients with recurrent unilateral endometriomas was significantly higher in comparison with the group II (12.2 ± 1.8 and 10.2 ± 1.6 days, p < .001). Nevertheless, the number of good quality embryos retrieved was comparable in both groups (2.2 ± 1.5 and 2.8 ± 1.8). In the group I patients with recurrent unilateral endometriomas, there was a statistically significant decrease of implantation rate (17.1% vs. 24% p < .005). The results of the study revealed no statistical difference in embryo quality in the study cohort. However, it is important to note that a statistically significant difference in implantation rate in the group of endometriosis-associated infertility compared was obtained 1.5 times lower than in the control group (15.8% vs. 24.0% p < .005). The achieved results demonstrated an adverse IVF outcome in infertile women with recurrent endometrioma compared to the control group.

To evaluate the prognostic value of a comprehensive endometrial study after early reproductive losses (RL). A group of 306 women with early RL (missed abortion (n = 120), spontaneous miscarriage (n = 120), and ineffective in vitro fertilization attempts (n =66) were prospectively examined up to 6 months after the discharge of the uterus at the hospital bases of the Department of Obstetrics and Gynecology with the Сourse of perinatology at the PFUR Medical Faculty. Hysteroscopic macrotypes differentiation - hyperplastic (n = 89), hypoplastic (n = 94) and mixed (n = 87) - was carried out on the basis of features grouping characterizing the thickness, color and structure of the mucosa, the intensity of a vascular pattern in the presence of a chronic endometritis (CE). Evaluation of sonographic accuracy after hysteroscopic CE macrotypes differentiation showed the presence of false-negative conclusions: about unchanged mucosa (6.9%); endometrium polyps (3.5%); intrauterine synechiae (4.2%). Immunohistochemical staining with CD138 isolation showed higher diagnostic accuracy in CE detecting in comparison with the morphological method: in a hyperplastic macrotype (90.5% and 84.1%, respectively), hypo- (93.7% and 89.8%) and mixed (81.6% and 79.4%). Great diagnostic value is shown in identifying histopathic CE features in the context of hysteroscopic macrotypes differentiation in groups of women with RL.

The purpose of this study was to identify the relationship between the microbiological status of women and newborns, and the development of premature labor. Materials and Methods: The study included 227 pregnant women at gestational age between 28 and 36 weeks and 6 days. All women underwent an assessment of vaginal microcenosis and the quantitative and qualitative composition of the biotope of the cervical discharge; the newborns underwent bacteriological examination of the auricle, pharynx and anus. Results: Disturbances in the vaginal biotope were diagnosed in every second woman. We found that the shorter the gestation period, the higher the frequency of disturbances in the vaginal biotope, and the risk of premature birth at an earlier time correlates with the presence of infection in the mother. The risk of giving birth to an infected child is 4.2 times higher at birth from a mother who has disturbances in the biotope, compared to a woman with a normal biotope.

Механизмы, лежащие в основе развития аденомиоз-ассоциированной тазовой боли, на сегодняшний день до конца не раскрыты. Необходим комплексный подход к решению этой проблемы для разработки наиболее эффективных методов диагностики и персонифицированной терапии. Цель исследования - изучить роль рецепторов к окситоцину и вазопрессину в патогенезе тазовой боли при аденомиозе. Методика. Изучено 30 образцов ткани после после гистерэктомий у женщин с диффузным аденомиозом ІІ-ІІІ степени, сопровождающимся болевым синдромом выраженной степени тяжести, и не получавших ранее гормональную терапию. Группа морфологического контроля - 30 биоптатов женщин с аденомиозом, без болевого синдрома, прооперированных по поводу аномальных маточных кровотечений. Эти пациентки также не получали гормональную терапию. Образцы, включавшие эндометрий и миометрий, подвергали стандартным гистологическим процедурам, готовили парафиновые срезы (5 мкм). Общую морфологическую оценку проводили при окраске срезов гематоксилином и эозином. Визуализацию клеток осуществляли после иммуногистохимического окрашивания с использованием моноклональных антител к рецепторам окситоцина и поликлональные антитела к рецепторам вазопрессина. Результаты. По данным морфометрического анализа эпителиальной выстилки эндометриоидных гетеротопий статистически значимых различий в высоте клеток железистого эпителия, диаметре желез и их плотности на единицу площади между исследуемыми группами не установлено. Суммарная плотность иммунологически маркированных рецепторов к окситоцину в очагах аденомиотического поражения составила 73.7±1.8%, в группе морфологического контроля - 35.2±1.4%. В цитоплазме гладкомышечных клеток всех слоев миометрия и сосудов обнаруживали умеренную (2 балла), местами выраженную (3 балла) иммуногистохимическую реакцию к рецепторам вазопрессина - 88,4±2.3%. В группе морфологического контроля в цитоплазме гладкомышечных клеток всех слоев миометрия и сосудов также отмечалась умеренная иммуногистохимическая реакция к рецепторам вазопрессина - 43,2±1.8%. Изменение плотности рецепторов к окситоцину и вазопресину статистически значимы (p <0.05). Зключение. Патогенетически обоснованным механизмом тазовой боли у женщин с диффузным аденомиозом является изменение рецепторной чувствительности тканей миометрия к действию окситоцина и вазопрессина, что может проявляться спонтанными дисперистальтическими сокращениями миометрия спазматического характера. Pathogenetic mechanisms underlying the development of adenomyosis-associated pelvic pain are currently not fully understood and require a comprehensive approach in their analysis to determine the most effective diagnosis and individualized therapy. Objective. To expand the understanding of the pathogenesis of pelvic pain associated with adenomyosis. Methods. The study evaluated 30 (n = 30) biopsy samples obtained after hysterectomy from women with grade II-III diffuse adenomyosis accompanied by severe painful syndrome who received no hormonal therapy. The morphological comparison group consisted of 30 (n = 30) biopsy samples obtained from women with painless adenomyosis operated for abnormal uterine bleeding who did not receive any hormone therapy either. After hysterectomy, fragments of the uterine wall including the endometrium and myometrium were subjected to standard histological procedures with preparation of 5-μm paraffin sections. For general morphological assessment the sections were stained with hematoxylin and eosin. Nerve fibers were visualized using immunohistochemical (IHC) staining with monoclonal antibodies (Abcam, UK) to oxytocin receptors (OTR) (Anti-Oxytocin Receptor antibody, Clone ab217212, 1: 300) and polyclonal antibodies to vasopressin receptors (V1aR) (Anti-AVPR1A / V1aR antibody, Clone ab140492, 1: 200). Statistical analysis was performed using the SPSS 7.5 for Windows statistical software package (IBM Analytics, USA). In the absence of normal distribution, the non-parametric Wilcoxon test (Statistical Methods for Research Workers) was used with a significance level at p <0.05. Results. The morphometric analysis of the epithelial lining of endometrioid heterotopies did not show any significant differences in the height of glandular epithelium cells, gland diameter, and their density per unit area in groups 1 and 2 (p>0.05). The total density of OTR immunological labeling in foci of the adenomyotic lesion was 73.7 ± 1.8% vs. 35.2 ± 1.4% in the morphological control group (p <0.05), which indicated a significant effect of oxytocin as a ureterotonic (uterotonic?) peptide enhancing nonperistaltic contractions of the myometrium and local vasoconstriction in adenomyosis. In the cytoplasm of smooth muscle cells (SMC) of all myometrium layers and blood vessels, a moderate (score 2), sometimes pronounced (score 3) IHC response to V1aR (88.4 ± 2.3%) was found. In contrast, in the morphological control group, a moderate (score 2) IHC response to V1aR (43.2 ± 1.8%, p <0.05) was observed in SMC cytoplasm in all layers of the myometrium and blood vessels. Conclusions: As distinct from painless diffuse adenomyosis, the pathogenesis of adenomyosis-associated pelvic pain is based on increased activities of the ureterotonic (uterotonic?) factors, oxytocin (OTR, 2.5 times - 92.2 ± 2.1% vs. 36.3 ± 2.4%, p <0.05) and vasopressin (V1aR, 2.05 times - 88.4 ± 2.3% vs. 43.2 ± 1.8%, p <0.05) in the myometrium, which induces spontaneous, nonperistaltic contractions of spastic myometrium associated with increased expression of their receptors in the pattern under study.

This report is based on the analysis of the most common mistakes of antenatal care and childbirth. Materials were collected in many cities of Russia (medical faculties of universities): 3000 case histories; materials of legal medical findings; information of internet; data of correspondence questionnaire of parturients.