The way to restore reproductive function in women with polycystic ovary syndrome

 

(57) Abstract:

The invention relates to medicine, obstetrics, and gynecology. Perform a wedge resection of the ovaries. Determine the chemiluminescence of blood. Assign estrogenicity drugs within 3-4 months. Re-define the chemiluminescence of blood. When the value of sutasoma 7,9 10-6quantum/min and below cancel extrogen-gestagennye drugs. Allows you to provide a normal pregnancy. table 1.

The invention relates to medicine and will find wide application in gynecology.

Pregnancy, occurring in the induction of ovulation in patients with polycystic ovary syndrome (PCOS) after surgical treatment, is a high-risk pregnancy (Kirushenko A. P., Savci M, Polycystic ovaries. Obstetrics and gynecology, 1994, No. 1, S. 11-14; Drucker N. A. Biochemical aspects of regulation of fetoplacental system in women with hypofunction of various origins. Abstract. Diss. Prof. Biol. Sciences. - Rostov-on-don: 1994, 39 S. ) This situation is due to the fact that pregnancy occurs on the background of significant changes in the endocrine system (Manuilova I. A. Obstetrics and gynecology, 1986, No. 2, S. 23-27), leading to the development of such on the seat complications of the fetus: malformations, malnutrition, growth retardation (Ignatova M. B. Obstetrics and gynecology, 1986, No. 12, S. 18-21; Pamfilio Y. I., Zaets centuries, Circular A. A. Seminate A. I. Obstetrics and gynecology, 1987, No. 6, S. 42-44; Afonin, A. A. Adaptation and development of children born to women with induced pregnancy and support of a system of preventive and rehabilitation measures. Abstract. Diss. Prof. the honey. Sciences.-M: 1994, 40 C.). In this regard, the problem of PCOS acquires acquires not only medical, but also a great social significance as the birth of a sick child has severe moral influence on parents and causes material damage to the state.

In clinical practice for the treatment of PCOS commonly used wedge resection of the ovaries. However, after the surgery before becoming pregnant usually do not control the metabolic status of women, in particular, the condition of metabolic processes in the endometrium, to provide conditions for normal nidali ovum, processes placentation and overall pregnancy outcomes. The absence of such a control does not allow to objectively evaluate the efficiency of recovery of women's reproductive function after treatment.

the religious ovaries. Obstetrics and gynecology, 1994, No. 1, S. 11-14). The method consists in conducting wedge resection of the ovaries and subsequent resolution to get pregnant. In the absence of the effect of the operation (not pregnancy) within 6 months is supplemental hormonal therapy (gestagens in the 2nd phase 2-3 of the cycle, then clomiphene from 5 th to 9-th day of the cycle not more than 6 months).

The disadvantages of this method include the following:

1. The treatment is carried out without an objective assessment of metabolic processes in the endometrium, without which no one is guaranteed a normal process of placentation and suitable during pregnancy.

2. Not provided a favorable outcome of pregnancy and the birth of a healthy child.

These drawbacks can be eliminated in the inventive solution.

The purpose of the invention is to develop a simple, accurate method for the recovery of reproductive function in women with PCOS.

This goal is achieved by the fact that after the surgery wedge resection of the ovaries in the venous blood of the patient determine chemiluminescence, prescribe estrogen-gestagennye drugs for 3-4 months, then re-define the chemiluminescence and the size is here.

The criterion for the usefulness of surgical and medication effects on the mechanisms of regulation of reproductive functions this group of women may be a state of metabolic processes in the body.

An important role in the chain of biochemical processes in the cell, play a reaction of lipid peroxidation (LPO), with free-radical character. Process FLOOR directly linked the rate of cell division, state of oxidative phosphorylation, the synthesis of prostaglandins and sterols, the function of enzyme systems (Abramova I. J., Oksenhendler, And. People and anti-oxidant substances. - L.: Nauka, 1985, 230 C.)

It is well known the existence of processes of lipid peroxidation in all membrane structures of cells, including cells of the endometrium. By modifying their intensity in the membrane there is a change in cellular metabolism. The latter ensures the renewal of membrane structures, and regulation of ion transport, aimed at changing the activity of membrane-bound enzymes (Lankin C. H. Enzymatic lipid peroxidation. RBM. beach. zhurn., 1984, T. 56, No. 3, S. 517-331). It is now established that the activation of the on status of hormonal receptors on the membranes (Sergeev, P. C., May A. I., Cucumbers S. I. Molecular mechanisms of titratable estrogen. The success of mo. Biol., 1974, T. 38, No. 1, S. 107-121). In this regard, changes due to PCOS endometrial - target organ steroid hormones, are to some extent a reflection of the intensity processes of the census oxidation of lipids. The integral ratio of free radical oxidation of lipids and antioxidant defenses is chemiluminescence, allowing the most objectively evaluate these processes. Known close correlative relationship between indicators of chemiluminescence in tissues and serum (plasma) blood (Sarkis J. I., Chebotarev E. E., Baraboi C. A., eagle C. E. , Chebotarev, E. Chemiluminescence of blood in experimental and clinical Oncology. - Kiev: Nauk. Dumka, 1984, 184 C.), which allows you to use the latest for evaluation of free radical processes in the cell. Held surgical treatment of PCOS with subsequent correction of the estrogen-gestagenna drugs hormonal status of women can ensure the reduction of GENDER in connection with the known antioxidant properties of steroid hormones, which in turn will eliminate damage to cell membranes and OTP is vidualistic on normalization of metabolic processes and the willingness of the woman to conceive.

The method is as follows.

Women suffering from infertility, on the background of PCOS spend wedge resection of the ovaries with the removal of 2/3 of the ovarian tissue. After operations are performed with the blood from the cubital vein and measured in the serum of spontaneous chemiluminescence.

On the fifth day after surgery, prescribe estrogen-gestagennye drugs (rigevidon, trisiston) within 3-4 months. After graduating from medical course have re-analysis of the chemiluminescence of blood serum. When the value of sutasoma chemiluminescence in blood serum 7,9106quantum/min and below estrogen-gestagennye drugs overturned and the woman is allowed to get pregnant, in the case when sutasoma chemiluminescence above 7,9106quantum/min receiving estrogen-gestagennah drugs should be continued for 3 months.

Registration CHL carry on any chemiluminometer. We used chemiluminometer "Emilite" model EL 1003 AND firm "Biorad" (Austria) with the spectral range 350-950 nm, dynamic range 105- 1012quanta per second. The measurements were carried out at a wavelength of 425 nm and standardization of the signal at 5000 mU, which corresponds to the luminous intensity 50 ml molar phosphate buffer solution pH 7,4, placed in the cuvette of chemiluminometer, which is placed in the dark chamber, and after 1 min measure of sutasoma chemiluminescence. The results are expressed in Quant/min

We conducted a comparison of the degree of chemiluminescence in the endometrial tissue and blood women before surgery and after surgery. The results showed that the endometrial tissue before the operation, the amount of chemiluminescence in Quant/min8was 1,440,5. In the blood of these women, this figure was consistent with 9,20,8106quantum/min After treatment in the endometrium, this value was equal to 0,8810+0,3108; in the blood - 5,6 + 0,24106. Conducted correlation analysis between the degree of chemiluminescence in the endometrial tissue and blood showed the presence of a direct correlative relationships (r=0.79).

Give clinical examples, confirming the importance of determining spontaneous chemiluminescence in blood serum of women with PCOS after clinopodia resection of the ovaries and of course the estrogen-gestagennah preparations for assessing recovery of reproductive function in women.

Example 1. The patient In society, 22 years old, was admitted 2.03.94, with complaints of violation of the menstrual cycle (a delay of up to 2-3 months). Married 20 years. Infertility for 4 years. for 1.5, Treated periodically, taking ascorbic acid, with the goal of losing body mass conducted diet (no effect was observed).

History of frequent actual respiratory diseases, twice ached suppurative otitis media in 13 years and 17 years. The phenotype of the female satisfactorily developed Breasts. Differs slight growth of hair around the nipples and inner thighs. In somatic status revealed no pathology.

St. genitalis: hair Growth on the male type, uterus and vulva developed normally, the ovaries are enlarged (5 x 6), painless, fugolastic consistency.

Radiography of the skull (7.03.94 year): enhanced vascular pattern, on the vault of the skull is marked finger depressions, Turkish saddle is not changed.

Ultrasound of the pelvic organs 15.03.94: ovaries dimensions 5.0 x 6.0 x 3.5 cm, with dense tunica. In the ovarian parenchyma has cystic treniruysya follicles. The Mature follicles are absent.

Ds: the polycystic ovary syndrome in combination with hypothalamic syndrome.

18.0,94 were surgery: laparotomy. Wedge resection of the ovaries. The operation is performed with the removal of 2/3 of the ovarian tissue. The uterus hypoplasia dense. Fallopian tube pass is inessence, which was 10,1106quantum/min

On the tenth day the patient was discharged from the hospital. She appointed rigevidon, trisiston. After three months, re-taken by the blood, defined chemiluminescence - 7,9106quantum/min

Drugs cancels, the patient is allowed to get pregnant. One month after drug withdrawal pregnancy, which was uneventful, 24.04.95 happened, delivery in time, through the birth canal. The baby was born on Apgar scale 8-9, discharged with a diagnosis of healthy.

Example 2. Patient M-VA, 24 years old, was admitted 5.04.94, with complaints of violation of the menstrual cycle (a delay of up to 6 months). and infertility for 5 years. Married 18 years. With 20 years notes increased hair growth on the legs and face.

Menstruation began at 13 years of age, irregular.

Objective: height 155 cm, moderate power (weight 54 kg). The female phenotype, hypoplasia of the mammary glands. Increased growth of hair on the legs, thighs, buttocks, around the nipples, upper lip. Somatic and neurological status without pathology.

St. genitalis: growth of pubic hair on the male type, uterus and vulva developed normally, the ovaries are enlarged, painless, dense bezbol vault of the skull is marked finger depressions.

Ultrasound of the pelvic organs 11.04.94: ovaries dimensions of 5.0 x 6.2 x 3.7 cm, with dense tunica. In the ovarian parenchyma has cystic treniruysya follicles, but Mature follicles was not detected.

Ds: the polycystic ovary syndrome in combination with hypothalamic syndrome.

15.04.94 were surgery: laparotomy. Wedge resection of the ovaries. The operation is performed with the removal of 2/3 of the ovarian tissue. The uterus hypoplasia dense. The fallopian tubes are permeable when retrograde hydrotubation.

From the cubital vein taken blood to determine setosum chemiluminescence - 9,9106quantum/min

On the tenth day the patient was discharged from the hospital. She appointed rigevidon, trisiston. After three months, re-taken by the blood, but the performance chemiluminescence remained at the same level - 9,7106quantum/min

The medication is recommended to continue. Patient drugs illegally stopped accepting. After eighteen months of pregnancy, which from an early period proceeded against the background of placental insufficiency and was interrupted in the period of 18 weeks.

Example 1 allows us to conclude that when the value of sutasoma chemiluminescence 7,9106th and ended with the birth of a healthy child. Example 2 confirms the fact that when the amount of chemiluminescence above 7,9106quantum/min no optimal conditions for nidali ovum and favorable pregnancy.

Thus, it was established that the level of sutasoma chemiluminescence in blood 7,9 + 0,2106quantum/min and lower in women with PCOS indicates the recovery of the reproductive system and used as an objective criterion of the latter.

The intended way of surveyed 37 women with the syndrome PKA suffering from infertility within 2-6 years. All 36 women became pregnant, of whom 26 had normal pregnancy and childbirth, pregnancy ended with the birth of a healthy child (group 1), 11 women (group 2) pregnancy proceeded with complications and even in 5 of the last pregnancy was interrupted before the deadline. Data aggregation is presented in the table.

The table shows that there are statistically significant differences honey investigated by females of the 1st and 2nd groups after treatment. Moreover, the magnitude of chemiluminescence are neprekraschauschihsya diagnostic intervals.

The inventive method has the advantages of the CSOs surgical and medical treatment and to determine the readiness of the organism to pregnancy:

2) to provide suitable during pregnancy:

3) to prevent the birth of a sick child.

The simple way available for widespread use in clinical practice.

The way to restore reproductive function in women with polycystic ovary syndrome, including wedge resection of the ovaries and drug treatment, characterized in that after the operation, measure the chemiluminescence of blood appoint estrogen-gestagennye drugs for 3 to 4 months, then re-measure the chemiluminescence of blood and when the value of sutasoma chemiluminescence 7,9106quantum/min and below estrogen-gestagennye drugs overturned and allow the patient to get pregnant.

 

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