How dangerous is the IVF program

Today we will talk about the most exciting aspects of the IVF program and, based on scientific research in recent years, we will answer possible questions.

What is the danger of ovulation stimulation? Modern features

In the past years of the revival and the beginning of the use of controlled superovulation in the implementation of IVF programs, reproductologists used high doses of gonadotropins during stimulation, sought to get as many oocytes as possible, since it was believed that this increases the chances of fertilization and obtaining embryos. As they tried to get more cells, they also tried to transfer “more” embryos.

Now the approaches have changed categorically. Currently, it has been proven that the use of high doses of gonadotropins during controlled supervovulation does not increase the chances of fertilization, leads to rapid depletion of the ovaries, has a greater number of side effects. The ovarian response to stimulation after puncture is evaluated as follows: 0 oocytes – no response, 1-2 oocytes-poor response, 3-6 oocytes-a satisfactory response, more than 7 oocytes – a good response.

It is proved that the level of ovarian response does not affect the quality of embryos in the presence of mature oocytes. However, with a satisfactory and good response, it is possible to cryopreservate a larger number of embryos without forcing a woman to undergo the ovulation stimulation procedure several times.

IVF program

With a poor answer, the scheme of “accumulation” of embryos is currently used: several ovulation stimulations are performed with minimal doses of gonadotropins and 1-2 embryos are obtained from each such program, after which the “best” embryos are cryopreserved and only then the endometrium is prepared for embryo transfer. This scheme is beneficial for its gentle effect on the ovaries of a woman, it also contributes to the production of the most mature eggs and is used mainly in women with extremely low ovarian reserve (AMH level<1 ng/ml).

Ovarian hyperstimulation syndrome, what is it and how to avoid it?

Most women suffering from infertility have heard about ovarian hyperstimulation syndrome, the fear of this complication of IVF often pushes women away from the program. Ovarian hyperstimulation syndrome (OHSS) is a condition based on the reaction of the ovaries in response to the introduction of hormonal drugs (ovulation inducers), the doses of which exceed physiological values. This condition was first described in 1930 when using the serum of foaled mares.

Ovarian hyperstimulation syndrome is characterized by a fairly wide range of clinical manifestations: from minor changes in laboratory parameters to quite serious conditions requiring hospitalization.

The main reasons for its occurrence are high doses of hormonal drugs that are used to stimulate ovulation, and with a high level of activity of the hormone estradiol, which is produced in growing follicles, high levels of the hormone hCG. The main risk group for the formation of this syndrome are girls with a diagnosis of “Polycystic ovary syndrome”, since this group has a high follicular reserve and a large number of follicles “begins to grow” during induction.

Ovarian hyperstimulation syndrome is currently a well-studied syndrome, for this reason, reproductologists around the world are trying to stimulate the ovaries using minimal hormonal load, pursuing the main goal: to get the maximum number of mature and high-quality oocytes, to avoid ovarian hyperstimulation syndrome. All patients who are preparing for the IVF program undergo a thorough examination (according to order 107n of the Russian Federation), a reproductive doctor assesses all possible risks, preventive measures are taken in the presence of risk factors for OHSS.

Women with a high risk of the syndrome are recommended to carry out an IVF protocol followed by embryo cryopreservation and embryo transfer in another cycle.

IVF program” freezing ” of embryos

The cryopreservation method allows you to save embryos for a long time, so if the IVF attempt is unsuccessful, the “saved” embryos can be used in the future. In cases where the IVF program has been successful and the pregnancy has occurred, the remaining frozen embryos can be used in the future, when the couple decides to give birth to another child. An additional advantage of the method is to reduce the number of repeated ovarian stimulation and follicle puncture, which significantly reduces the drug load on the female body.

Drug therapy of diffuse mastopathy and PMS

According to the WHO definition (Geneva, 1984), mastopathy (fibrocystic disease, dyshormonal dysplasia of the mammary glands) is a dyshormonal hyperplastic process characterized by a wide range of proliferative and regressive changes in breast tissue with an abnormal ratio of epithelial and connective tissue components. Fibrocystic disease is very heterogeneous in its clinical, radiological and morphological manifestations. The etiology of the disease is also diverse. The occurrence of mastopathy is often associated with violations of the reproductive sphere of a woman, social and household problems, hormonal imbalance, various types of hepatopathies that lead to hormonal and metabolic disorders.

Clinically, fibrocystic disease is manifested primarily by mastalgia, varying in nature and degree of intensity. As a rule, pain in the mammary glands bothers the patient before menstruation or in the middle of the menstrual cycle. Often such complaints are accompanied by an increase in volume, swelling, swelling of the mammary glands. The tissues become heterogeneous, painful on palpation, seals form. When pressing on the nipples, discharge may appear.

Classifications of mastopathy

Despite the many proposed classifications of mastopathy, one of them does not fully reflect the full variety of morphological changes occurring in the mammary gland. In clinical practice, the classification proposed by N. I. Rozhkova (1993) is most often used, where the following forms of mastopathy are distinguished: diffuse mastopathy with a predominance of the glandular component (adenosis); diffuse fibrocystic mastopathy with a predominance of the fibrous component; diffuse fibrocystic mastopathy with a predominance of the cystic component; mixed diffuse fibrocystic mastopathy; sclerosing adenosis; nodular fibrocystic mastopathy.

According to the degree of severity of the detected changes, diffuse fibrocystic mastopathy (FCM) is divided into slightly, moderately and sharply expressed. According to the degree of proliferative activity of the epithelium, there are: mastopathy without proliferation (I degree); mastopathy with epithelial proliferation (II degree); mastopathy with atypical epithelial proliferation (III degree). Due to the presence of a wide range of clinical and histological manifestations, the treatment of diffuse mastopathy is very difficult and requires, first of all, the establishment of the main causes of the disease. Adequately selected therapy should be complex, long-term, taking into account the hormonal, metabolic characteristics of the patient’s body, concomitant diseases. According to modern concepts, the complex treatment program for diffuse mastopathy includes phytotherapy-collections of herbs of multidirectional action.

Treatment of mastopathy

One of the most effective means of treating mastopathy and premenstrual syndrome is the combined drug Mastodinone (manufacturer-the German company “Bionorica”). The main component of the drug is an extract of prutnyak fruit BN0 1095. In addition, it includes a basilisk-shaped stalk, an alpine violet, a bitter chestnut, a multicolored killer whale, a tiger lily. The use of ordinary prutnyak (synonym-Abraham’s tree; Lat. Vitex adpis castus) has a long history (the first description refers to the IV century BC). Vitex agnus castus is widely used in the treatment of gynecological diseases: menstrual cycle disorders, amenorrhea, luteal phase insufficiency, premenstrual syndrome. Since 1975, the extract of prutnyak fruits has been used in the form of the phytopreparation Mastodinon.

The main mechanism of action is a stimulating effect on the dopamine D2 receptors of the anterior pituitary lobe, which leads to a decrease in prolactin secretion. Hyperprolactinemia, which is not associated with pregnancy and lactation, has a direct stimulating effect on proliferative processes in peripheral target organs, which is realized by increasing the production of estrogens by the ovaries. The ability of prolactin to increase the content of estradiol receptors in the tissues of the mammary glands also plays a role. These mechanisms determine the development of the entire symptom complex characteristic of premenstrual syndrome and fibrocystic disease.

mastopathy

A decrease in the increased level of prolactin due to taking Mastodinone leads to a regression of pathological processes in the mammary glands and stops the cyclic pain syndrome in mastopathy or premenstrual syndrome. When the prolactin level is normalized, the rhythmic production and the ratio of gonadotropins are restored, the imbalance between estradiol and progesterone is eliminated, which contributes to the restoration of the menstrual cycle. The recommended regimen for taking Mastodinone is 30 drops (1 tablet) 2 times a day for 3 months without a break, regardless of the menstrual cycle. After that, you can take a break for 1-2 months, then resume taking the drug. Clinical improvement is noted after 4-6 weeks of use. Individual intolerance to the drug is extremely rare.

Unlike many dietary supplements advertised for the treatment of fibrocystic disease, the effectiveness of Mastodinone has been demonstrated in a number of scientific studies, the results of which have been published in domestic and foreign literature. The most satisfactory results were obtained in the group of patients with diffuse forms of mastopathy and premenstrual syndrome (n=1472). 1064 patients (72.3%) noted a significant improvement in well-being (a decrease in the density of breast tissue, a decrease or cessation of nipple discharge, normalization of the menstrual cycle, a decrease in headaches and abdominal pain), 397 women did not record changes in their condition and only 11 patients complained of increased symptoms.

Conclusion

Thus, the results of the conducted studies have shown the high effectiveness of Mastodinone and Cyclodynone in patients with benign diseases of the mammary glands and menstrual function disorders. It should be emphasized that the high effectiveness of the drugs in combination with a low frequency of adverse reactions makes them extremely attractive for wide use.

Female Bodybuilding and Steroids

Often, many women coming to the mirror are disappointed: sluggish, not knowing even the minimum load, muscles, accumulated fat, swollen thighs. And how do you want to look like a Greek goddess and catch admiring glances at yourself, and that men turn their necks when you pass by?! But how to do it? Female bodybuilding is the answer.

Female Bodybuilding

All is not lost! It’s time to do bodybuilding. Bodybuilding literally means building, the architecture of the body. There are few people left who would dispute the benefits of this sport. Medical science has proven that weight training is a magical panacea for the troubles that come with the years, from the destructive lifestyle that we lead. But the figures of many bodybuilders are embarrassing. It seems to people that such achievements are possible only as a result of hard, many hours of work, incompatible with the lifestyle they lead, or with taking some drugs (for example, clomid) that provide growth and relief of muscles. They are partly right. However, just one 40-minute workout a week can have a pronounced effect, even the usual morning 10-15-minute exercise brings tremendous benefits to the body and stagnant muscles. Well, if you want to look like a bodybuilder, you need to train like a bodybuilder. That is, according to a scientifically-based method of training with special sports nutrition, purposefully and stubbornly. You can make your body strong and beautiful by walking the beaten paths of champions, using the legendary techniques of famous bodybuilders.

A man who wants to be like the heroes of Hollywood action movies, who do not care about lifting a truck or dispelling clouds of enemies without straining, has to work hard for a long time in the gym. It is three times more difficult for a woman to become such an Amazon. For the fairer sex, a serious restructuring of the body is fraught with serious health problems.

According to the plan of nature, the number of cells that form muscles. It remains relatively constant throughout life. Muscle cells do not multiply, they can only increase in size. How many muscle cells a person is endowed with at birth will depend on how soon he will be able to turn a soft, loose tummy into a rubber-like press. The growth of muscle mass is impossible without the entry into the body of the main building material for the formation of contractile fibers-proteins.

The fat layer between the muscles and the skin does not give the muscles beauty, so a large amount of animal and vegetable fats, as well as carbohydrates contained in food, is not consumed by a real bodybuilder.

It is not difficult for men with a minimum amount of fat in the diet to live at all. The main thing is not to bring yourself to a complete ” degreasing”. It begins to dissolve its own fat, for example, which is located around the kidneys, supports them and is a good amortizer. The kidneys can move down, become ” wandering”, which is fraught with a lot of unpleasant sensations and, in addition, can lead a handsome man to the nephrology department. In women, adipose tissue also serves as a source for the construction of their own sex hormones – estrogens. We have two x-chromosomes and we are, of course, women, but, figuratively speaking, fat makes a woman actually a woman. The shape of the female breast, so adored by men,is due to adipose tissue.. That is why completely fat-free bodybuilders can not boast of beautiful, lush, soft breasts. However, now plastic surgery is on top with numerous mammoprostheses.

How to achieve the result?

Who among us has not dreamed of achieving the desired results as soon as possible? Still, there is no need to hurry. A well-chosen training program and a proper nutrition system allow a woman to get rid of excess fat from 2% monthly, until the goal of harmony and perfection of the body is achieved. After several months of working in the gym, a woman, going to the mirror, can find remarkable results that are already noticed by others: the stomach does not hang down, does not gather folds, the buttocks have tightened, become elastic, the treacherous breeches have significantly decreased in size, and the chest, which until recently was hanging sadly from the chest wall, suddenly begins to please the eye. At this stage, body building can be called a beautiful word fitness. Literally translated from English, this word means ” fitness”, and this term means the development of optimal physical abilities that allow “to withstand the hardships of modern life”. For some, fitness means a thin waist, for others-to squeeze out their own weight lying down, for others-just feeling good. And for a woman engaged in physical labor, the level of fitness will be different than the necessary level for a secretary-assistant, older people need a different program and level than young people.

What is important in fitness is not strength, endurance or fat content, but their combination. A prerequisite for fitness is the lack of bodybuilding massiveness. For a bodybuilder, muscle mass is everything! A fitness player with her beautiful, harmoniously developed body can not be disliked even by people who are far from sports. The main slogan of fitness is for beauty and femininity! Such results are achieved by special types of training aimed at women. At the same time, muscle strength increases, but the relief of the muscles remains smooth and soft. In addition, with the help of strength exercises, such vital qualities as endurance, speed, flexibility, dexterity are developed. Fitness has a positive effect on the cardiovascular system, normalizes the physical and mental state, which allows a person to live fully and successfully endure all the hardships of life presented in our turbulent time. Most are quite satisfied with the transformed body, which has not lost a single drop of femininity. They stop and maintain the achieved state with short, but regular workouts.

Many women think that training with weights will immediately lead to the growth of huge muscles and loss of femininity. But this is a misconception!

Imagine that all women who train with loads have large muscles. Then why do we not see such girls in athletic halls? It’s very simple. In order to develop such muscles, a woman needs: genetic data, intensive long-term training, it is desirable to have an increased level of testosterone (male hormone). Most of the pumped-up women are elite professional female bodybuilding, athletes engaged in light and weightlifting, who have been training for years to achieve such a result. Of course, there are also those who additionally take androgens for an unnatural increase in muscle volume. It is very difficult for an ordinary woman to develop really big muscles. But many people do not understand this and avoid bodybuilding. And big muscles in the mass consciousness make a woman less of a woman. All over the world, the strength, musculature and masculinization of a woman seems at best a strange phenomenon, and at worst it causes dislike and disgust. And it is quite obvious that if professional bodybuilders become more and more like guys with implanted breasts, female bodybuilding will die.

Female bodybuilding harm from testosterone

But some women do not stop at the achieved harmony and go further than female bodybuilding-fitness. What makes women increase the load and bring the body to a state of total masculinization, sacrificing their own health? Scientists have conducted research and noted that a mental illness called “muscle dysmorphia”is common among bodybuilders. This disease is inherent in both women and men. In this condition, a person is constantly worried: have his muscles disappeared somewhere? And did the torso look worse than 2-3 hours ago? Such thoughts make him / her not leave the gym at all or turn his / her entire home into a gym. The constant self-admiration of the reflection in the mirror does not suit the worried bodybuilder at all.

female bodybuilding

Strength exercises more than five times a week are a serious danger for women. Ardent bodybuilding fans often suffer from eating disorders, a distorted perception of their own body and complications caused by the excessive use of steroid hormones. Today, the truth of female bodybuilding is that female bodybuilders are sitting on the needle just like men. This is an easier way to build muscle. After all, without this, nothing shines at tournaments. But hormones in the bodies and souls of women cause more severe and irreversible symptoms of rejuvenation. Muscles by themselves do not take away a woman’s femininity. Femininity is taken away by steroids!

As steroids penetrated into female bodybuilding, public interest in it fell. Today, creatures whose gender is difficult to determine, if at all possible, are coming to the podium. Except for Linda Murray and Sue Price, who somehow managed to survive in this battle for masculinity, the ranks of participants were terrifying. The participants do not discuss the topic of “chemistry”, and go into a deaf refusal with such questions. Since this topic is quite painful for them, and no one will ever understand what happens to a woman’s brain when she gradually turns into a man.

Testosterone causes significant harm to a woman’s health. Normally, they produce this sex hormone in a small amount. In minidoses, getting into the blood, the hormone stimulates muscle growth, improves regenerative processes in tissues, reduces the phenomena of osteoporosis, accelerates metabolism, and does not have a bad effect on the body. But everything is good in moderation, however, for female athletes, the abuse of steroid hormones is typical. Horse doses of synthetic analogues of testosterone cause suppression of the production of female sex hormones, moreover, they have effects that do not improve the appearance of a woman at all. Among the numerous side effects:

  • skin defects, a huge number of red pimples appear on the face, scientifically called acne, the skin becomes drier, pimply, with laces of veins on swinging muscles;
  • hirsutism or increased hair growth on the body and on the face is an irreversible effect of steroids. Hair breaks out on the chin, on the upper lip, arms, legs, and even on the chest. And in the perineum, they grow just crazy! Depilation will have to be done, almost every day, for the rest of your life. Hair loss and deterioration of the structure of the hair on the head;
  • stretching of the abdominal wall: steroids irritate the intestines, as a result, constipation, accumulation of gas, liquids begin. The stomach sticks out forward, and to hide it, you need to constantly strain the press. Pathological weakening of the internal corset, stretching of the abdominal wall, training with a load lead to rectal prolapse and hemorrhoids;
  • a sharp increase in the smell of sweat: testosterone affects the sweat glands, the composition changes and the secretion of sweat increases, the smell becomes unpleasant, striking, like a man after a long active workout. Aggressiveness and psychological instability: testosterone makes a bodybuilder simply unmanageable. She will yell, make a row, wave her hands about and without;
  • sexual aggression and increased sexual activity: a bodybuilder wants complete animal satisfaction immediately, right where physical desire has rolled over her, and this is several or more times a day. And it will be quite burdensome for a partner to perform male duties several times a day. And it is very unusual and many people become uncomfortable if the partner expresses her emotions in a male baritone (and if the neighbors are listening ?!);
  • the coarsening of the voice, the growth of cartilage (an overgrown nose) is an irreversible process;
  • clitoral enlargement (irreversible process): to an unnatural size, and in a state of arousal, the clitoris increases even more, almost like a small penis during an erection. To see a woman like this is not a sight for faint-hearted men! Bodybuilders say that thanks to such an acquisition, they experience a deeper orgasm, and sometimes the sensitivity increases so much that climbing the stairs in tight jeans becomes a problem due to unbearable excitement. And this is forever;
  • increased vaginal secretion: vaginal discharge, which becomes abundant only at the moment of the highest sexual arousal, in “steroid patients’ The changes of bodybuilders occur continuously, creating a lot of problems. This is not a disease or an infection, but simply a physiological disorder that stops with the cessation of taking steroidoad;
  • absence of menstruation;
  • ovarian sclerocystic disease: with subsequent infertility. The ovaries, as if hiding from male hormones, are covered with a dense capsule;
  • liver damage, increased blood pressure and other disorders of the cardiovascular system.

Conclusion

We found out why masculinization occurs, why large muscles grow in a short time and saw the problem of taking steroids by a woman even deeper. If you accept it, then stop before it’s too late!

Female bodybuilding is a wonderful and very useful sport, the purpose of which is to make your body worthy of your spirit. This is one of the ways to keep yourself in good physical shape. And you can choose how strong, beautiful, fit you want to become. Come up with your own ideal and strive for it, and “healthy” bodybuilding is a great ally for you in this!

Hormone therapy during menopause

Hormone therapy: During the menopausal transition, the restructuring of hormonal homeostasis causes a number of changes in the female body, which negatively affect the quality of life and can lead to the formation of chronic diseases.

Hormonal therapy (contraception) and prevention of unwanted pregnancy

Hormonal contraception (combined and purely gestational) is widely used in gynecological practice, and the need for its appointment for the purpose of preventing pregnancy persists until the onset of menopause. Hormonal contraceptives are based on progestins-derivatives of nortestosterone, 17-hydroxyprogesterone or spironolactone. They are used as monopreparations or in combination with estrogens (ethinyl estradiol, estradiol, etc.), the main purpose of which is to level the side effects of progestogens.

Hormonal contraceptives have many positive non-contraceptive properties. Reducing the risk of ovarian cancer directly depends on the duration of combined oral contraception, and this effect persists up to 20 years after discontinuation of the method. The same is true for reducing the risk of endometrial cancer, which correlates with the duration of use of combined oral contraceptives and is observed for more than 20 years after their withdrawal. Combined oral contraceptives also reduce the risk of colorectal cancer and, without significantly affecting the risks of other malignancies, generally reduce the cancer risk. In addition, there is evidence of proven therapeutic or preventive effects of combined hormonal contraception (CGC) in relation to a number of gynecological and extragenital diseases and conditions.

But even if there are additional indications in the instructions for the use of the contraceptive drug, hormonal contraception remains primarily a method of preventing pregnancy. Ignoring this circumstance, recommending a contraceptive to a patient who does not live a sexual life, or is absolutely unable to conceive, or who wants to become pregnant, is possible only in cases where there is no alternative way to resolve a clinically significant problem. However, it is during the menopausal transition against the background of a decrease in sexual activity and the ability to conceive that complaints of menstrual cycle disorders often appear, requiring the appointment of therapy, not contraception.

Menopausal hormone therapy and correction of menopausal disorders

The late phase of the menopausal transition begins with the prolongation of menstrual delays up to 60 days and the appearance of episodes of amenorrhea, characterized by an increase in the frequency of anovulatory cycles. The duration of this stage of reproductive aging is usually one to three years before menopause. Do not forget about stimulating ovulation with clomid. There is an opinion that the secretion of estradiol at this time steadily decreases, and the level of follicle-stimulating hormone increases. However, monitoring of hormonal indicators demonstrates their significant variability and the possibility of periodic return to the premenopausal range. Given such significant fluctuations in the secretion of follicle-stimulating hormone, it is not recommended to use the determination of its concentration in the blood to clarify the status of the reproductive system. Like the early phase of the menopausal transition, the late phase is established clinically by the appearance of intermenstrual intervals, the duration of which exceeds 60 days.

Of course, the clinical criteria for entering the menopausal transition are valid only if the initial regular rhythm of menstruation and the non-use of hormonal drugs that simulate the menstrual rhythm. If it is impossible to establish the status of the reproductive system clinically, the average population characteristics should be used, according to which the majority of women enter perimenopause after 45 years. Starting from this age, complaints of hot flashes and other vasomotor and psychosomatic symptoms signal the onset of a late phase of the menopausal transition associated with estrogen deficiency, and require MGT. There may be a reasonable objection: according to the instructions for the use of MGT drugs, they are recommended to be prescribed to women during the menopausal transition with a duration of menstruation delay of more than six months. Why do the instructions and clinical recommendations of international and expert communities contradict each other?

Thus, vasomotor and psychosomatic symptoms caused by estrogen deficiency, which not only negatively affect the quality of life, but also reflect delayed health problems, become the main starting point in solving the issue of MHT. Waiting for six months of amenorrhea to initiate MGT is advisable when a woman’s complaints are insignificant, do not violate the quality of life and, accordingly, call into question the very need for treatment.

Principles of prescribing hormone therapy

After studying the characteristics of the three types of hormone therapy and the indications for their appointment, it becomes clear that the choice of one or another of them will depend on the status of the reproductive system, evaluated clinically or, if such an approach is impossible, established presumably by the age of the patient.

Contraception will be the first in the order of use of hormone therapy methods, which is built depending on the age. Recommendations on the specifics of the primary appointment of KGC come into force when consulting women over 35 years old, that is, long before the beginning of the menopausal transition.

hormone therapy

The main concern when using hormonal contraception is the risk of thrombosis due to the action of the estrogenic component. The generalized data indicate a low frequency of thrombotic complications of KGC: the frequency of acute conditions caused by thrombosis is 6-9. 9 cases per 10,000 women per year. These conditions are usually represented by venous thromboembolism. The risk of myocardial infarction increases exclusively in women who smoke, and a twofold increase in the risk of ischemic stroke does not look so threatening due to its rarity in the population of women of fertile age (1 case per 10,000 women per year) and dependence on other factors, especially migraines.

Nevertheless, the increased risk of thrombotic complications in the older age group imposes a number of restrictions on the use of KGK, including in women who smoke or patients with migraine. In the absence of contraindications to taking KGK, only those drugs that contain estradiol or a microdose of ethinyl estradiol are suitable for primary administration. Minimizing the effect of the estrogenic component allows not only to reduce thrombotic risks, but also to reduce the likelihood of estrogen-dependent weight gain associated with fluid retention, as well as to increase the level of triglycerides entering the fat depots. Overweight is an additional risk factor for thrombosis in adult women, which deserves attention in the process of individual selection of a contraceptive.

If there are appropriate indications and there are no contraindications, drugs of sex steroid hormones and their combinations can be used in the periods of late reproduction, menopausal transition and postmenopause, providing a high quality of life and prevention of diseases associated with aging. The skillful use of this resource is really able to provide women with active longevity.

Infertile marriage

Infertile marriage is the absence of pregnancy in the spouses of childbearing age during one year of regular sexual life without contraception. The frequency of infertile marriages is 8-17% and has no tendency to decrease. Every year,2-2.5 million new cases of male and female infertility are registered in the world.

Important parameters that affect the effectiveness of infertility treatment are the age of a woman and the duration of a barren marriage.

So, if in the population of women under 30 years of age during one year of regular sexual life without protection, spontaneous pregnancy occurs in 80% of cases, before 40 years-in 25%, then after 40 years-no more than 10%.

Factors that put patients at risk for possible infertility:

  • age over 35 years;
  • the duration of infertility in this and previous marriages is more than five years;
  • miscarriage in the anamnesis;
  • neuroendocrine disorders of the menstrual cycle;
  • sexually transmitted infections that were transmitted before and during marriage; genital endometriosis;
  • repeated surgical interventions on the female genital organs, especially performed by laparotomy (removal of ovarian cysts, tuboovarial inflammatory formations, plastic of the fallopian tubes, ectopic pregnancy, myomectomy).

Such patients need an in-depth examination, even if they do not raise the issue of infertility treatment (active identification of potentially infertile married couples) when applying to a medical institution.

Algorithm of examination of women with infertility

Anamnesis: information about the number of marriages, the nature of infertility (primary/secondary), the duration of infertility, the number of pregnancies in marriages, their outcomes and complications. Features of menstrual function, menstrual cycle disorders, probable causes and duration. Analysis of previous examination and treatment, the use of contraceptives and medications that affect fertility. Extragenital diseases and surgical interventions, including gynecological; inflammatory diseases of the pelvic organs (etiological factors, features of the clinical course, the number of episodes). Features of the influence of environmental factors, occupational hazards, bad habits (alcohol, drugs).

Clinical examination: determination of the body mass index; the presence of hirsutism; the degree of development of the mammary glands and discharge from them; the state of the thyroid gland, skin and mucous membranes; assessment of the general condition, gynecological status.

TORCH-complex: determination of antibodies (immunoglobulins – Ig) G and M to rubella, toxoplasmosis, herpes simplex virus types 1 and 2, cytomegalovirus. If there are no IgG antibodies to rubella, you should be vaccinated.

infertile marriage

Ultrasound examination of the pelvic organs. Ultrasound examination of the mammary glands for all women under 36 years of age and the thyroid gland (if indicated).

Endoscopic methods: laparoscopy and hysteroscopy followed by endometrial biopsy in the presence of endometrial pathology and subsequent histological examination of scrapings

If the examination program is not fully completed, the diagnosis of infertility in a woman cannot be considered reliable, and treatment will obviously be unsuccessful. Taking clomid here will not be effective.

Algorithms for diagnosing male infertility

Anamnesis: number of marriages; primary/secondary infertility; duration of infertility; previous examination and treatment for infertility; systemic diseases (diabetes mellitus, nervous and mental diseases, tuberculosis); medicinal and other therapies affecting fertility; surgical interventions on the organs of the urogenital tract; sexually transmitted infections; congenital and acquired pathology of the reproductive system; sexual and ejaculatory dysfunction; environmental factors, occupational hazards and bad habits (smoking, alcohol, drugs).

Clinical examination: measurement of height and body weight; determination of the presence of signs of hyperandrogenism, gynecomastia; andrological examination of the genitals, inguinal region and prostate.

Additional research methods: determination of prolactin levels, follicle-stimulating hormone, testosterone; thermography of the scrotum; craniogram (if pituitary adenoma is suspected); testicular biopsy.

As a rule, the frequency of female infertility is 70-75%, male-35-40%. The combination of female and male infertility occurs in 30-35% of married couples.

Stages of therapy depending on the causes of infertile marriage

Tubal-peritoneal factor. Rehabilitation and conservative treatment (antibiotic therapy, physiotherapy, balneotherapy) for 6-12 months are subject to patients after laparoscopic correction of the adhesive process of the first-second degree according to the Hulk classification and with passable fallopian tubes. In the absence of pregnancy, repeated surgical treatment is not indicated and the couple is sent to an IVF clinic. In the presence of hydrosalpinxes, the inability to restore the patency of the fallopian tubes, the third-fourth degree of the adhesive process, the IVF program is immediately shown.

After laparoscopic removal of foci of endometriosis, endometrioid ovarian cysts and salpingo-oovariolysis (with adhesive process in the small pelvis) for three to six cycles, depending on the stage of endometriosis, progestogen therapy is carried out in a continuous mode, gonadotropin – releasing hormone agonists, danazol, estrogen-progestogenic drugs.

Infertile marriage: The male factor of infertility. Depending on the parameters of the spermogram and the results of the clinical examination of the husband, it is possible to conduct intrauterine insemination with the sperm of the husband or donor for three to six cycles against the background of ovulation stimulation in the wife. If the therapy is ineffective, IVF is indicated, often with the procedure of intracytoplasmic injection of a sperm into an egg.

A infertile marriage couple should be warned about a possible additional examination after consultation with specialists of the clinic.

Complications during pregnancy

Women who may develop potentially life-threatening complications during pregnancy can be identified by checking the level of hormones in the placenta. This was shown by a new study, the results of which appeared in the pages of the journal Nature Communications Biology.

Scientists have found a way to check the level of specific proteins and hormones in the placenta to predict which women will have serious complications during pregnancy, for example, gestational diabetes.. “We know that the placenta reflects many changes in a woman’s body during pregnancy, and our study showed that hormonal biomarkers of the placenta can indicate which women will have complications during pregnancy. We found that these biomarkers are already present in the first trimester of pregnancy, although complications are more often diagnosed only in the second or third trimester, when disorders can already have serious consequences for the health of the mother and her developing child,” said Dr. Amanda N. Sferruzzi — Perry, lead author of the study.

complications during pregnancy

Specific proteins

The researchers studied specific proteins produced by the placenta of mice and compared them with blood samples of women who had a pregnancy without complications, and those who developed gestational diabetes mellitus. Experts found that about a third of the detected proteins changed in regnancy, which proceeded with complications.

After conducting a small experiment to test whether placental proteins and hormones would have any clinical significance, the experts found that abnormal hormone levels were present in the mother’s blood at 12 weeks of gestation in those women who developed gestational diabetes mellitus. According to scientists, this complication of pregnancy is usually diagnosed at 24-28 weeks. It turns out that since blood samples show the presence of these biomarkers in the early stages of pregnancy, this can lead to an earlier diagnosis of complications, which allows you to start treatment faster.

Scientists hope that the new test will detect gestational diabetes mellitus at an earlier stage of pregnancy, which will make it possible to prevent the disease or protect a woman and child from the most dangerous complications.

Are oral contraceptives a method of preventing certain types of cancer?

Scientists have found that taking oral contraceptives reduces the risk of endometrial and ovarian cancer. About the results of a study published in the journal Cancer Research.

Swedish scientists have studied the medical data of more than 250 thousand women born from 1939 to 1970. The researchers compared the incidence of breast, ovarian, and endometrial cancers among women who used oral contraception and those who never took hormonal contraceptives. About 80% of the study participants used oral contraceptives for an average of 10 years.

It turned out that in women who took oral contraceptives, the risk of endometrial cancer decreased by 32%, and the risk of ovarian cancer — by 28%.

“The results of the study that the use of contraceptives (oral) protects against endometrial and ovarian cancer are confirmed by earlier work. However, the additional information that the risk reduction is fixed for 35 years after stopping taking contraceptives is new” said Veriwell Marina Stasenko, an oncologist-gynecologist at the cancer center at New York University Langone Medical Center.

A study has shown a link between taking hormonal drugs and reducing the risk of developing certain types of cancer. However, scientists have already suggested that the basis of such protection may be the suppression of ovulation.

oral contraceptives

In addition, scientists say that taking contraceptives can lead to breast cancer. Previous studies have shown a link between birth control pills and an increased risk of breast cancer. However, the risks were small and decreased after discontinuation of the drugs. The present study of scientists also confirmed the results of earlier works. Experts found that the use of oral contraceptives led to a slight increase in the risk of breast cancer. The risk gradually began to decrease about eight years after the women stopped taking contraceptives.

Scientists emphasize that the patient should make a decision about the use of oral contraceptives only after consulting with a doctor. At the same time, it is necessary to calculate the individual risk from taking drugs, take into account the predisposition to cancer and comorbidity.

Treatment of diffuse fibrocystic mastopathy

In premenopausal women, mastopathy occurs in 20 % of women. After the onset of menopause, new cysts and nodes usually do not appear, which proves the involvement of ovarian hormones in the occurrence of the disease.

Currently, it is known that malignant diseases of the mammary glands occur 3-5 times more often against the background of benign neoplasms of the mammary glands and in 30% of cases with nodular forms of mastopathy with proliferation phenomena. Therefore, in the fight against cancer, along with the early diagnosis of malignant tumors, timely detection and treatment of precancerous diseases is no less important.

There are non-proliferative and proliferative forms of mastopathy. At the same time, the risk of malignancy in the non-proliferative form is 0.86%, with moderate proliferation – 2.34%, with pronounced proliferation – 31.4%

The main role in the occurrence of fibrocystic mastopathy is assigned to dishormonal disorders in the body of a woman. It is known that the development of the mammary glands, regular cyclic changes in them in puberty, as well as changes in their function during pregnancy and lactation are influenced by a whole complex of hormones: gonadotropin-releasing hormone of the hypothalamus, gonadotropins (luteinizing and follicle-stimulating hormones), prolactin, chorionic gonadotropin, thyroid-stimulating hormone, androgens, corticosteroids, insulin, estrogens and progesterone.

Any disorders of the hormone balance are accompanied by dysplastic changes in the breast tissue. The etiology and pathogenesis of myopathy have not yet been definitively established, although more than a hundred years have passed since the description of this symptom complex. An important role in the pathogenesis is assigned to relative or absolute hyperestrogenism and progesterone deficiency. Estrogens cause the proliferation of the ductal alveolar epithelium and stroma, and progesterone counteracts these processes, ensures the differentiation of the epithelium and the cessation of mitotic activity. Progesterone has the ability to reduce the expression of estrogen receptors and reduce the local level of active estrogens, thereby limiting the stimulation of breast tissue proliferation.

Mastopathy – Hormonal imbalance

Hormonal imbalance in the breast tissues in the direction of progesterone deficiency is accompanied by edema and hypertrophy of the intra-lobular connective tissue, and the proliferation of the ductal epithelium leads to the formation of cysts.

In the development of mastopathy, an important role is played by the level of blood prolactin, which has a diverse effect on the breast tissue, stimulating metabolic processes in the epithelium of the mammary glands throughout a woman’s life. Hyperprolactinemia outside of pregnancy is accompanied by swelling, swelling, soreness and swelling in the mammary glands, more pronounced in the second phase of the menstrual cycle.

The most common cause of mastopathy is hypothalamic-pituitary diseases, thyroid disorders, obesity, hyperprolactinemia, diabetes mellitus, impaired lipid metabolism, etc.

The cause of dyshormonal disorders of the mammary glands can be gynecological diseases; sexual disorders, hereditary predisposition, pathological processes in the liver and bile ducts, pregnancy and childbirth, stressful situations. Often, mastopathy develops during menarche or menopause. In the adolescent period and in young women, the diffuse type of mastopathy with minor clinical manifestations, characterized by moderate soreness in the upper-outer quadrant of the breast, is most often detected.

mastopathy & clomid

At the age of 30-40, multiple small cysts with a predominance of the glandular component are most often detected; the pain syndrome is usually pronounced significantly. Single large cysts are most common in patients aged 35 years and older.

Fibrocystic mastopathy is also found in women with a regular two-phase menstrual cycle.

Conclusions:

In recent years, as a result of the conducted research, the need for active therapy, in which the leading place belongs to hormones, has become obvious. With the accumulation of clinical experience with the use of norplant, there were reports of its positive effect on diffuse hyperplastic processes in the mammary glands, since under the influence of the gestagenic component in the hyperplastic epithelium, not only the inhibition of proliferative activity, but also the development of decidual-like transformation of the epithelium, as well as atrophic changes in the epithelium of the glands and stroma, consistently occurs. In this regard, the use of progestogens is effective in 70 % of women with hyperplastic processes in the mammary glands. The study of the effect of norplant on the condition of the mammary glands in 37 women with diffuse mastopathy showed a decrease or cessation of pain and tension in the mammary glands. In a control study after 1 year on ultrasound or mammography, there was a decrease in the density of glandular and fibrous components due to a decrease in the areas of hyperplastic tissue, which was interpreted as a regression of hyperplastic processes in the mammary glands. In 12 women, the condition of the mammary glands remained the same. Despite the disappearance of their mastodinia, the structural tissue of the mammary glands did not undergo any changes. The most common side effect of norplant, as well as depo-provera, is a violation of the menstrual cycle in the form of amenorrhea and intermenstrual spotting. The use of oral progestogens for intermenstrual spotting and combined contraceptives for amenorrhea (for 1-2 cycles) leads to the restoration of the menstrual cycle in the vast majority of patients.

Currently, oral (tableted) progestogens are also used for the treatment of mastopathy.

There is no treatment algorithm for mastopathy. Conservative treatment is indicated for all patients with diffuse mastopathy.

Empirical therapy of vulvovaginitis in women

Empirical therapy of vulvovaginitis in women: At the turn of the millennium, a real revolution took place in our understanding of vaginal infections. The Koch postulate “one disease-one pathogen”, which was once accepted as an axiom, was replaced by the understanding that in the vast majority of cases these conditions have a mixed etiology, and nosological forms caused by a single pathogen are rare. When treating a patient with bacterial vaginosis or vaginitis, the obstetrician-gynecologist should be guided by new data on the causes and pathogenesis of these diseases. We won’t talk about clomid today.

“Lonely” microbes are rare, usually there is a “cocktail” of bacteria, fungi, viruses and protozoa. A wide variety of” permanent inhabitants “of the biotope ensures its normal functional state, and also prevents colonization by” external ” obligate and facultative pathogens of diseases. In one patient, mutually exclusive states of the vaginal microbiome can be observed simultaneously. For example, candidiasis or aerobic vaginitis, the” instigators ” of which need oxygen, and bacterial vaginosis caused by anaerobic microorganisms.

J. Sobel distinguishes two types of mixed infections: mixed infection and co-infection. In mixed infections, all pathogens jointly damage the mucous membrane of the genital tract, entering into complex relationships aimed at increasing virulence and drug resistance. Coinfections are detected against the background of an active inflammatory process caused by a dominant pathogen. The rest remain invisible and manifest themselves only after the elimination of the predecessor.

Antibiotic resistance is an interdisciplinary and inter-state problem, for the effective solution of which, both at the hospital and outpatient level, it is necessary to consolidate doctors of different specialties. The growing resistance of microorganisms to antibiotics poses a difficult task for the obstetrician-gynecologist. The scientific justification for the combination of most vaginal infections and vaginal dysbiosis makes doctors more scrupulous in their diagnosis and treatment. A drug for the local therapy of vulvovaginitis should “cover” the entire spectrum of possible pathogens due to its constituent substances of multidirectional action. In order to avoid reducing compliance, instead of several drugs, it is advisable to prescribe a combined drug with the widest possible spectrum of action, covering most of the potential pathogens of vaginal infection – bacteria, fungi and protozoa.

Empirical therapy of vulvovaginitis: Materials and methods

Exclusion criteria:

  • hypersensitivity to one or more components of the drug Gainomax;
  • taking antiseptics, antibiotics, and antibiotics at the time of inclusion in the study;
  • the need for systemic use of glucocorticosteroids, cytostatics and systemic antibiotics;
  • documented HIV infection, syphilis and other sexually transmitted infections (chlamydia infection, gonorrhea, trichomoniasis) detected during the screening stage;
  • acute somatic diseases;
  • the period of pregnancy or breastfeeding.

Patient follow-up included consecutive visits.

At the first visit (screening, inclusion in the study), the written informed consent of the patients was obtained, the inclusion criteria were checked, and the exclusion criteria were evaluated. After examination and taking the material for analysis (bacterioscopy and pH-metry of vaginal secretions, real-time polymerase chain reaction (PCR) analysis (Femoflor-16)), based on complaints and clinical symptoms, the patients were immediately prescribed empirical therapy with the complex antimicrobial drug Gainomax. All patients were divided into two representative groups. 36 (50%) patients of the first group took Gainomax one suppository once a day for seven days, according to the approved instructions; 36 (50%) patients of the second group – Gainomax one suppository twice a day for three days, according to the approved instructions.

Empirical therapy of vulvovaginitis

At the second visit, 10-12 days after the completion of seven – or three-day therapy with Gainomax, a control examination was performed, which included a repeated gynecological examination, an assessment of the dynamics of clinical symptoms, the pH index and the microbial landscape of the vaginal discharge. Satisfaction and compliance of therapy, adverse events associated with the use of Gainomax were evaluated, the proportion of patients with a complete cure was determined, and cases of ineffectiveness of therapy were recorded. All medical procedures performed in the study were routine, used in everyday clinical practice, which determined the non-interventional (observational) nature of the study.

Conclusion

The analysis of the effectiveness of empirical therapy of acute vulvovaginitis using the drug Gainomax showed no complaints of abnormal vaginal discharge at the second visit in 94.4% of patients of the first and 97.2% of patients of the second group. A significant decrease in the volume of vaginal discharge was noted by 83.3% and 80.6% of patients of the first and second groups, respectively. The complete disappearance of unpleasant odors, itching and burning sensations in the vagina was indicated by 91.7% of the patients of the first group and 94.4% of the patients of the second group. When objectively evaluated, normalization of the color of the vaginal walls, moderate volume and “slimy” nature of secretions were recorded in all participants of the study. In most of them, bacterioscopy of vaginal smears after empirical therapy revealed a significant decrease in the number of white blood cells in the visual field. After therapy, yeast-like fungi of the genus Candida were not detected in any patient.

Modern view on the problem of tubal-peritoneal infertility

Tubal-peritoneal factor is currently the leading cause of female infertility, accounting, according to various authors, from 20 to 72%. Despite the achievements of modern medicine, tubal-peritoneal infertility is still one of the most serious pathological conditions, taking into account the difficulty of its diagnosis and treatment, as well as the possibility of restoring reproductive function.

The main causes of tubal-peritoneal infertility are:

  • previously transmitted inflammatory diseases of the pelvic organs of a specific and non-specific nature, of which the most important are chlamydia, gonorrhea, mycoplasma and trichomonas infections;
  • various intrauterine manipulations (artificial termination of pregnancy, separate diagnostic scraping of the endometrium and endocervix, hysteroscopy with removal of endometrial polyps or submucous myomatous nodes, etc.);
  • postpartum and postabortem complications of traumatic and inflammatory genesis;
  • previous surgical interventions on the pelvic organs (ovarian resection, conservative myomectomy, tubectomy, tubal ligation) and the abdominal cavity, especially those performed according to emergency indications from traditional laparotomy access and complicated by the development of peritonitis (for example, appendectomy).

Damage to the abdominal cavity during surgery and the subsequent development of aseptic inflammation lead to the deposition of fibrin in the area of the surgical wound with local activation of fibrinolysis and proteolysis, which ultimately contributes to the resorption of primary fibrinous deposits without the formation of adhesions. With the development of postoperative infection, the inflammatory-dystrophic process is delayed, which does not allow fibrinous formations to dissolve and contributes to excessive local collagen production with the formation of powerful connective tissue junctions – adhesions.

tubal-peritoneal infertility

The severity of the adhesive process in the pelvis directly depends on the extent of the spread of adhesions in the abdominal cavity, which is mainly determined by the volume and type of surgical intervention. In this regard, in order to prevent the development of the adhesive process in the abdominal cavity, one should strive to minimize the surgical intervention, giving preference to the laparoscopic method (especially when performing planned surgical interventions on the pelvic organs in women of reproductive age).

Treatment of tubal-peritoneal infertility

Treatment of tubal-peritoneal infertility includes conservative and surgical methods used sequentially or in combination with each other. Conservative treatment of tubal-peritoneal infertility involves anti-inflammatory antibacterial, immunomodulatory, antifibrosing therapy and physiotherapy.

When sexually transmitted infections are detected and / or a morphologically verified diagnosis of chronic endometritis, therapy should be comprehensive, etiopathogenetic and aimed at the complete elimination of the identified pathogens. Immunomodulatory therapy is an indispensable part of the treatment of tubal-peritoneal infertility, since chronic inflammatory processes of the pelvic organs are always accompanied by immunological disorders, which requires mandatory correction.

One of the options for antifibrosing therapy is the general and local use of various drugs with a resorbing effect – biostimulants, enzymes and glucocorticosteroids (hydrocortisone) in the form of tampons, as well as hydrotubation. Unfortunately, the clinical experience of using hydrotubation as a method of local treatment of tubal-peritoneal infertility has demonstrated insufficient effectiveness and a high frequency of various complications. Among them, most often there is an exacerbation of chronic inflammatory diseases of the pelvic organs with a violation of the functional ability of endosalpinx cells and the development of hydrosalpinx, which significantly reduces the peristaltic activity of the fallopian tubes and disrupts the transport of gametes through them.

Thus, tubal-peritoneal infertility requires early diagnosis and gradual long-term rehabilitation after undergoing surgical treatment. Also remember that ovulation stimulation is possible with the help of the drug clomid. One of the most effective ways to preserve the reproductive function is the prevention of tubal-peritoneal infertility, which consists in the prevention and timely treatment of inflammatory diseases of the pelvic organs, the rational management of childbirth and the postpartum period, and the implementation of rehabilitation measures in the near future after gynecological operations.