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Среди супружеских пар детородного возраста частота бесплодия в разных регионах России колеблется от 8 до 19%. Восстановление репродуктивной функции в услови-ях сложной демографической ситуации в стране -задача, выходящая за рамки только медицинской науки. В связи с этим к вспомогательным репродуктивным технологиям (ВРТ) проявляют повышенный интерес не только в Рос-сии, но и за рубежом. Во многих странах эффективность результатов экстракорпорального оплодотворения (ЭКО) и переноса эмбрионов (ПЭ) определяется двумя фактора-ми -функциональной полноценностью эмбриона на ста-дии бластоцисты и отсутствием внутриматочной патоло-гии. Одной из главных причин неполноценной или не-удачной имплантации являются нарушенная функция и e-mail: miss.yakovchuk@mail.ru Представлен анализ опубликованных работ последних лет, касающийся вопросов этиологии и патогенеза хронического эндометрита. Хронический эндометрит -клинико-морфологический синдром, при котором в результате персистиру-ющего повреждения эндометрия инфекционным фактором возникают множественные вторичные морфофункциональ-ные изменения, нарушающие циклическую биотрансформацию и рецептивность слизистой оболочки тела матки. Среди женщин с верифицированным хроническим эндометритом у 60% диагностируется бесплодие. Особенностями хрониче-ского эндометрита в настоящее время являются увеличение значимости условно-патогенной микрофлоры, рост устой-чивости условно-патогенных микроорганизмов к фармакотерапии, увеличение числа стертых форм и атипичного тече-ния. При реализации хронического воспалительного процесса в эндометрии на клеточном уровне происходят следующие нарушения: расстройства метаболизма, нарушение цепи иммунокомпетентной системы и развитие аутоиммунных про-цессов, нарушение эспрессии рецепторов стероидных гормонов, формирование провоспалительного Th-1-типа имунного ответа вместо необходимого для успешного развития беременности Th-2-типа такого ответа, ухудшение микроциркуля-ции, нарастание гипоксии, дисбаланса про-и антиоксидантной систем.Авторы информируют об отсутствии конфликта интересов. The paper analyzes published recent papers on the etiology and pathogenesis of chronic endometritis. The latter is a clinical and morphological syndrome, in which persistent endometrial injury caused by infection results in multiple secondary morphofunctional changes impairing cyclic biotransformation and mucosal receptivity of the corpus uteri. Infertility was diagnosed in 60% of women with verified chronic endometritis. The specific features of chronic endometritis are now the increased significance of the opportunistic microflora, the higher resistance of opportunistic microorganisms to pharmacotherapy, a larger number of subtle forms, and an atypical course. When a chronic inflammatory process occurs in the endometrium, there are the following disorders at the cellular level: metabolic disturbances; immunocompetent system chain breakdown and development of autoimmune processes; impaired steroid hormone receptors expression; formation of a proinflammatory Th1-immune response in...

Pelvic inflammatory diseases (PID) are on the second place in the structure of gynecological incidence. It has been proven, that PID develops in case of disturbed immune balance and often complicated by pelvic adhesions. Aim - to study in a comparative aspect the features of expression and distribution of proinflammatory cytokines (IL-1, IL-2, IL-6 and TNF-a) in the tissue of intact pelvic peritoneum and adhesions in women of reproductive age with PID, and evaluate the effectiveness of the proposed method of prevention of pelvic adhesions at women of reproductive age. Materials and methods. One hundred patients of reproductive age suffering from tubal and peritoneal form of infertility, who had a history of chronic PID and pelvic adhesions and thirty healthy women in the control group, were included at this study. Results. The presence of macrophages and proinflammatory cytokines IL-1, IL-2, IL-6 and TNF-a in adhesions of the abdominal cavity in patients with PID is the evidence of their internal inflammatory activity. According to the received data, the number of patients without pelvic adhesions was 4.3 times higher in the main group compared to the control group. Сonclusion. The proposed scheme of pelvic adhesions prevention, taking into account the pathogenic role of inflammatory disorders in the adhesiogenesis, allows to reduce the adhesion after the surgical treatment in 4.3 times and the density of the reformed adhesions in 8 times.

Purpose: This article describes the experience of using the Enhanced Recovery After Surgery (ERAS) program in the treatment of female patients with pelvioperitonitis in a gynecological in-patient department. Materials and Methods: We examined 60 female patients who were divided into the main and comparison groups. The groups were comparable in terms of age, marital status, education, and place of residence. In addition to the standard approaches in the treatment of pelvioperitonitis, 30 patients of the main group were treated using some elements of the concept of enhanced recovery, such as detailed preoperative counseling about future treatment, non-use of premedication, control of hypothermia during and after surgery, prevention of dyspeptic disorders in postoperative period, avoiding narcotic analgesics, early enteral nutrition and mobilization. In the comparison group, which also included 30 patients, the treatment of pelvioperitonitis was carried out in strict accordance with the standard scheme - surgery, balanced infusion therapy, symptomatic treatment. Results: At the same time, the pain level by the visual analogue scale (VAS) averaged 6.11 ± 0.34 after 2, 4 and 8 hours in women from the comparison group. Vomiting was registered in 3 (10.0%) patients from the main group on the day 1 of the postoperative period. Whereas 7 (23.3%) patients from the comparison group had vomiting on the day 1 of the postoperative period. The absence of active motility and passage of flatus, an increase in hypoproteinemia, hypoalbuminemia, and an increase in the level of leukocytosis in both groups showed the severity of the systemic inflammatory response. However, by the end of the day 2 of the postoperative period, the improvement in biochemical parameters was registered as a sign of a positive change in the patients’ general condition. LII decreased by 1.5 times by the day 5 in the comparison group; but in the main group it decreased by 2.3 times. First active peristaltic noises were auscultated and first passage of flatus were noted on average after 20.33 ± 1.02 hours in the main group, but in the comparison group - after 40.28 ± 0.81 hours. In addition to that, the need for pharmacological intestinal stimulation was 2.5 times higher in patients from the comparison group than in patients from the main group. Postoperative purulent inflammation of the wound was registered in 9 (30.0%) women from the control group. However, only 2 (6.7%) women from the main group had one of the above mentioned disorders. The absolute risk reduction is 15% and NNT = 7. The average hospital stay for patients from the main group was 6.15 ± 0.25 days, and 8.64 ± 0.38 days for women from the comparison group. Conclusion: The results obtained during the study prove the effectiveness of the concept of enhanced recovery in the treatment of pelvioperitonitis.

The article presents a systematic review of the main pathogenetic mechanisms of the onset and development of insufficiency of the luteal phase (NLF) and its association with hypothelamoid-pituitary-ovarian dysfunction. The characteristics of clinical variants of the course of this pathology and its consequences for the reproductive health of women are given. The list of modern methods of NLF diagnosis and brief characteristics of diagnostic studies necessary for correct diagnosis according to current standards and protocols are presented. The review of modern methods of treatment of NLF aimed at correcting the deficit of progesterone, the elimination of hyperprolactinemia and leveling the effects of chronic stress on the body is presented. Key words: insufficiency of the luteal phase, progesterone, Vitex sacred, Mastodynon®.