Research objective: to study the clinical efficacy of the proposed treatment complex in pregnant women with coronavirus disease (COVID-19).Materials and methods. 60 pregnant women with a moderate COVID-19 who were treated at the Kyiv City Center for Reproductive and Perinatal Medicine were examined and selected to assess the effectiveness of the proposed treatment. Pregnant women were divided into 2 clinical groups: the main group (n = 30) were prescribed treatment complex with progestin, the comparison group consisted of 30 pregnant women with COVID-19, who did not differ in age, sex, body mass index and received only standard drug therapy. Given the immunomodulatory effect, micronized progesterone was administered orally 200 mg three times a day immediately after hospitalization for 2 weeks, regardless of gestational age. Clinical manifestations, laboratory and instrumental indicators, duration of oxygen therapy and respiratory support, duration of hospital stay and intensive care were analyzed to assess the treatment complex.Results. Therapeutic complex with progesterone helps to reduce the severity of respiratory disorders in pregnant women with COVID-19, the general condition of pregnant women improves faster and inflammatory changes in the lungs regress. The positive dynamics of pulse oximetry indicators was noted. The frequency of the additional methods of respiratory support and transfer to the intensive care unit were lower, and a more rapid normalization of laboratory parameters was noted. Incidence of gestational complications (threats of pregnancy termination, placental insufficiency, fetal growth retardation and distress, oligohydramnios, premature birth and premature rupture of membranes) was lower against the background of treatment with progesterone, children status was better at birth. The need for oxygen therapy, the length of stay in the intensive care unit and the total length of hospitalization are significantly reduced when progesterone was prescribed for pregnant women with COVID-19.Conclusions. The use of progesterone in pregnant women with coronavirus disease has a stabilizing effect, has no negative side effects which is significantly expands the scope of the proposed therapy in pregnant women at different stages of gestation.

Objective: optimization of pregravid (pre-pregnancy) preparation in patients with tubal-peritoneal infertility factor and marked delay in endometrial development after unsuccessful assisted reproductive technology (ART) treatment by the use of endometrium injection scratching technology with autoplasma.Material and methods. Study included 40 cases of unsuccessful treatment attempts for tubal-peritoneal factor infertility with severe delay of endometrial development and 10 patients with tubal-peritoneal factor infertility with normal endometrium with one or more unsuccessful ART attempts on history and the existence of cryopreserved embryos of satisfactory quality from previous cycles of assisted reproductive technology. The average age was 39.5 ± 3.1 years. Patients were divided into groups: I – 21 patients who underwent endometrial injection scratching and hormonе replacement therapy (HRT) with a standard (4/6 mg) dose of estradiol; II – 19 patients who were prescribed HRT with a standard (4/6 mg) dose of estradiol; control – 10 patients with normal endometrium who underwent cryo-ET with standard (4/6 mg) dose of estradiol.Clinical results were evaluated and compared in terms of pregnancy rate per embryo transfer and pregnancy loss rate in the first trimester. The correspondence of the morphofunctional structure of the endometrium was evaluated by ultrasound, cytologically, Doppler measurements, histologically, immunohistochemically and via selective electron microscopy. Endometrium was 8.9 ± 1.1 mm during the period of progesterone prescription in the cryoembryo transfer cycle. All participants were transferred day 5 embryos. Results. In the cryo-ET program autoplasma injection scratching in patients with marked delay of endometrial development after the first seven days of monotherapy with a starting dose of estradiol was accompanied by a significant improvement in clinical outcomes in terms of pregnancy rate (25%) and definite decrease of early reproductive losses (25%).Conclusions. After pre-pregnancy preparation according to our method, it is quite sufficient to perform HRT with a standard dose of estradiol (4/6 mg/day) before starting progesterone irrespective of the endometrial development degree. Meanwhile, injection scratching is advisable to be prescribed in cases of marked delay in the endometrium development and it should be combined with physiotherapy methods.

The document was approved at an expanded meeting of the Ukrainian Society of Gynecological Endocrinology with the involvement of all board members and representatives of the Association of Obstetricians-Gynecologists of Ukraine, the Association of Pharmacologists of Ukraine, the Association of Anesthesiologists of Ukraine, as well during the Third Ukrainian School of Gynecological and Reproductive Endocrinology with international participation ISGE 19–20.03.21.The COVID-19 pandemic has significantly impacted medical practice, in terms of organizational and clinical practices, posing a number of complex and contradictory challenges for professionals.This document is the result of the systematization of scientific data available by March 2021 and recommendations of international medical and specialized professional societies on controversial clinical issues in gynecological practice caused by the COVID-19 pandemic, as well as certain issues of safety and ratio of using hormonal drugs. The involvement of experts from professional associations of the obstetric and gynecological field, pharmacology, anesthesiology and vascular surgery and phlebology in the working group made it possible to formulate clinically justified provisions of the position.The position includes three thematic sections: “On the use of estrogen-containing combined hormonal contraceptives (CHC) during the COVID-19 pandemic”; “On the use of menopausal hormone therapy (MHT) during the COVID-19 pandemic”; “On the issue of unregistered compounded bioidentical hormones”. At the beginning of each thematic section, the main conclusions of the consensus position of professional medical associations are presented. According to the data available by March 2021, there is no reason to limit the use of CHC or MHT in healthy women (currently not having COVID-19). The question of CHC or MHT discontinuing or switching to other forms by women with COVID-19 should be decided depending on the severity of the disease, the total set of risk factors for thromboembolic complications and other individual characteristics of the clinical situation. Further research will provide elaboration of more detailed algorithms. Physicians need to be vigilant about the safety of compounded Bioidentical Hormonal Therapy (cBHT) in any dosage form (including pellets), especially during the COVID-19 pandemic, given the unexplored systemic effects and therefore the potential risks. Preference should be given to officially licensed medicinal products with a well-studied safety profile and clinical effects, the use of which is authorized by doctor's prescription and supported by clinical protocols and guidelines.

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