Безопасностьометрия при непрерывной заместительной гормональной терапии 17b-эстрадиоло-эндопротезной заместительной гормональной терапии 17b-эстрадиолиин иниситисинисисиной

The aim of the study was to determine the endometrial safety of oral 17/3- oestradiol combined continuously with dydrogesterone in preventing endometrial proliferation. The low dose group comprised three 52-week (13 cycles of 28 days) studies (two of which were double blind) using a 17ft- о estradiol dose of 1 mg daily combined with dydrogesterone 2,5; 5; 10 or 20 mg daily. The high dose group comprised two 24-week double-blind studies using a 17ft-oestradiol dose of 2 mg daily combined with dydrogesterone 2,5; 5; 10 or 15 mg daily. Endometrial safety was verified by aspiration endometrial biopsies. Inadequate progestational response was defined as proliferative endometrium, endometrial polyp, hyperplasia and carcinoma. Endometrial protection was achieved with dydrogesterone at doses of 5 mg or higher combined with 1 or 2 mg 17^-oestradiol. So, 5 mg daily dydrogesterone appears to be the lowest effective dose to ensure endometrial safety in a continuous combined regimen with 1 or 2 mg 17p-oestradiol.

Does 2’-hydroxygenistein inhibit the endometrial proliferation? A preliminary study

Isoflavones, due to their claimed or demonstrated beneficial biological activities, have attracted great interest and gained popularity among the public. On the risk of endometrial hyperplasia, conflicting findings for such compounds have been reported and genistein has been intensively studied. Studies also indicated that 2’-hydroxylation of isoflavones can lead to beneficial components with superior bioactivity compared to isoflavones lacking this substituent. Till now there is no study evaluating the effect of 2’-hydroxygenistein on endometrial hyperplasia in vivo. In line with this, a 3-day uterotrophic assay was carried out to evaluate the effect of 2’-hydroxygenistein on the uterus as its endometrial hyperplasia is of significant clinical concern. Daily subcutaneous administration of 2’-hydroxygenistein significantly (p ≤ 0.05) increased uterine wet weight at 2 and 8 mg/kg/day, while it reduced (p ≤ 0.05) uterine epithelial height at all tested doses. In contrast, no significant variation was observed on vaginal epithelial height. As global result, it appears that 2’-hydroxygenistein might exhibit anti-proliferative effects in the uterus, while having no effect on the vagina. However, this aspect needs to be further investigated

Ultrasound parameters and the state of uterine hemodynamics in women with menstrual dysfunction in puberty

Studying the hemodynamic features of the pelvic organs in women is of great clinical importance, since it makes it possible to assess the degree of restoration of endometrial regeneration after menstruation, the possibility of implanting a fertilized egg and developing the placenta. In women with menstrual dysfunction in the puberty, determining the qualitative and quantitative parameters of uterine hemodynamics may be useful in choosing treatment tactics, evaluating its effectiveness, and will also help significantly in predicting the prospects for the restoration of their reproductive health. The objective: using ultrasound and dopplerometry to study the uterine hemodynamics and assess the ability of the endometrium to implant in women with menstrual dysfunction in the pubertal period. Materials and methods. To achieve this goal, 120 women of reproductive age from 19 to 32 years old were studied. According to the nature of the violations, the main group of women (n=90) with pathology of menstrual function in the puberty was divided into 3 subgroups (n=30): the first – women with primary oligomenorrhea in the anamnesis, the second – with late age menarche, the third – with puberty bleeding. The control group included women (n=30) with the correct rhythm of menstruation in puberty. Results. Based on a comparative analysis of the echographic parameters of the size of the uterus in women with menstrual irregularities in the puberty (main group) and women with the correct rhythm of menstruation (control group), it was found that in the middle stage of endometrial secretion, the uterus is 1,2 times smaller in women the main group (p<0.05) due to the width of the uterus (p<0.001). The ratio between the length of the body and cervix in the examined groups did not significantly differ. The thickness of the front wall of the uterus is less than the control values in women with late menarche (p<0.05) and puberty bleeding (p<0.01), which served as a predictor of the absence of combined uterine pathology. An echographic study of the thickness of the endometrium in the late stage of the proliferation phase in the group of women examined did not establish any significant differences with the control group. In the middle stage of the secretion phase, the endometrial thickness was less in women with menstrual dysfunction in puberty – 9.50±0.27 mm compared to 11.38±0.48 mm in the group with the correct rhythm of menstruation (p<0.001), but remained within the limits of reference values. To assess the functional activity and the possibility of secretory transformation of the endometrium, dopplerometry of the uterine arteries was performed, which did not reveal significant differences in women of the main and control groups. Conclusion. An analysis of the relationship between body and cervical lengths proves the absence of signs of genital infantilism in patients with menstrual dysfunction in the pubertal period. Dopplerometric studies of hemodynamics in the arteries of the uterus in this group of women in different phases of the menstrual cycle indicate an adequate blood supply to the uterus. And although as a result of the inferior phase of endometrial proliferation, its thickness in the middle stage of secretion remained insufficient (9.52±0.42 mm; p<0.01), normal blood flow in the radial and basal arteries of the uterus contributed to the successful implantation of a blastocyst. Keywords: menarche, oligomenorrhea, pubertal bleeding, uterine hemodynamics, endometrial proliferation, dopplerometry.

Effect of gonadotropins and endometrial thickness on pregnancy outcome in patients with unexplained infertility or polycystic ovarian syndrome undergoing intrauterine insemination

Objective The purpose of this study was to investigate the effect of gonadotropin dose and endometrial thickness (EMT) on pregnancy outcome in patients undergoing intrauterine insemination (IUI). Methods We retrospectively analyzed data from 361 patients with unexplained infertility or polycystic ovarian syndrome (PCOS) who underwent 930 IUI cycles treated with gonadotropins. Then, we measured the effects of gonadotropins and EMT on the clinical pregnancy rate. Finally, we assessed the association of various doses of gonadotropins on EMT. Results The dose of gonadotropins given and thickness of the endometrium were higher in the pregnancy group than in the nonpregnancy group (636.0 vs. 600.0 IU for gonadotropin dose; 9.15 vs. 8.70 mm for EMT). Clinical pregnancy rates were significantly improved by increasing the dose of gonadotropins (9.1%, <450 IU; 16.2%, 450–599 IU; 18.6%, 600–749 IU, and 17.3%, ≥750 IU), or by increased EMT (0%, <5.0 mm; 12.2%, 5.0–6.9 mm; 15.5%, 7.0–14.0 mm; and 33.3%, >14.0 mm). Conclusion Increasing the dose of gonadotropins to stimulate one follicle to develop may benefit endometrial proliferation and improve IUI outcomes.

Treatment of unexplained thin endometrium with autologous platelet-rich plasma in a frozen embryo transfer cycle

Inadequate endometrial proliferation is a known cause of implantation failure in assisted reproductive technology cycles. It is generally agreed that >9 mm endometrial thickness is associated with higher implantation. Several strategies have been explored to enhance endometrial proliferation. However, the results are either poor, inconsistent or subject to safety concerns. A 34-year old woman presented with unexplained thin endometrium in successive frozen embryo transfer (FET) cycles. Autologous platelet-rich plasma (PRP) was infused in the uterine cavity on day 10 of second FET cycle enhancing endometrial thickness, which post-PRP infusion measured 10.9 mm. Blastocyst-stage embryos were transferred resulting in a successful pregnancy. Autologous intrauterine infusion of PRP positively impacts endometrial proliferation and implantation which is safe, low resource and minimally invasive.