Method for enhancing effectiveness of infertility treatment caused by small-scale external genital endometriosis

FIELD: medicine.

SUBSTANCE: method involves carrying out laparoscopy and administering Danazol at a dose of 400 mg twice a day for 6 months. Danazol treatment being over and normal prolactinemia being observed in biphasic menstrual cycle, Parlodel is administered at a dose of 2.5 mg twice a day for three menstrual cycles long period.

EFFECT: enhanced effectiveness in normalizing hormone background and pregnancy taking place.

 

The invention relates to medicine, namely gynecology, and can be used to increase the effectiveness of pharmacological treatment of infertility caused by low forms of external genital endometriosis.

The known method of treatment, which consists in conducting patients with suspected diagnosis: infertility due to small forms of external genital endometriosis, laparoscopy with excision of its foci, followed by hormonal therapy. The most frequently used therapy antigonadotropin - Danazol 400 mg per day for 6 months. In the detection of giperprolaktinemii 6 months after administration of Danazol use Parlodel at a dose of 2.5 mg 2 times a day (Wpoty, Lgutwillig, Conservative gynecology. Medical news Agency, Moscow, 2001, str. Reference Vidal, medicines, Russia, 1999, fifth edition, B-85).

The disadvantage of this method is the reduced efficiency - fertility restoration in 26% of cases. Using Parlodel in the combined treatment of infertility caused by low forms of endometriosis when norscopolamine, two-phase menstrual cycle and the duration of the second phase of the menstrual cycle 10-14 days, is unknown.

The technical result of the invention is to improve the effectiveness of treatment devil who lode.

The technical result is achieved by the fact that additional 6-12 months after the end of the traditional treatment of Parlodel at a dose of 2.5 mg 2 times a day for three menstrual cycles.

The method is as follows.

After carrying out of a laparoscopy and confirm the diagnosis of small forms of external genital endometriosis patients histologically prescribed therapy with danazol for 6 months, after 6 months or more when restoring regular menstrual cycle and no pregnancy assess hormonal function of the female genitalia by monitoring basal body temperature, determine the levels of follicle-stimulating hormone, luteinizing hormone, prolactin, thyroid stimulating hormone, thyroxine and triiodothyronine. When detecting a biphasic basal body temperature, duration of the second phase of 10-14 days, the levels of FSH, LH, thyroid stimulating hormone, thyroxine, triiodothyronine, prolactin, relevant standards, the sperm of the husband without pathological changes appoint parlodel at a dose of 2.5 mg 2 times a day during 3 menstrual cycles.

Example 1. BO, aged 22, No. East. 27355, was admitted to the gynecological Department No. 1 of the Municipal health institutions, Voronezh City clinches the th hospital №9 (ambulance)", 14.11.01 with a diagnosis of Primary infertility of unknown origin.

At admission (14.11.01,) there were complaints about the lack of pregnancy, if regular sex life for 1.5 years. From the anamnesis: menstruation of 14 to 3 days after 28 days, moderate pain, sexual life with 20 years without contraception. Gynaecologic and somatic diseases in anamnesis no notes. The last menstruation - 1.11.01. When viewed in the mirrors cervix net, selecting bright, vaginally: cervix conical outer jaws closed, the body of the uterus is normal in size, firm, mobile, painless, region appendages by palpation is not changed. In smears from the vagina, cervical canal and the urethra on flora and purity revealed ballerina rich flora on the background of individual cells in the field of view, in the biochemical analysis of blood shifts were not available, urinalysis and blood without pathology. Laparoscopy 14.11.01: endometriosis on the peritoneum Red pocket (small forms), hemorrhagic effusion 5 ml. Uterus correct form 7×3.5×4 see Right ovary 3×2×2 with ripening follicle. The right fallopian tube is viewed all over, length 12 cm, fimbria expressed, the color of the pipe is normal, methylene blue has penetrated into the tube and poured into the abdominal cavity. The left ovary 3×2×1,5 with foci of endometriosis, the left fallopian tube DL is Noah 12 cm is viewed all over, the methylene blue solution penetrated into the tube and poured into the abdominal cavity. Produced coagulation foci of endometriosis. Discharged from the hospital 17.11.01 in satisfactory condition with the recommendations of the receiving danazol 400 mg / day within 6 months after the laparoscopy. The patient was referred to the antenatal clinic in October 2003 with complaints of lack of pregnancy after taking danazol in may 2002. During examination, the patient was detected two-phase menstrual cycle, according to the measurement of basal temperature, the duration of the second phase of the menstrual cycle of 10 days, the sperm of the husband without pathological changes, follicle-stimulating hormone and 3.5 IU/l, luteinizing hormone is 6.5 IU/L, prolactin - 12 ng/ml, triiodothyronine - 2.6 nmol/l, t - 54 nmol/l, thyroid-stimulating hormone - 3.8 mkme/ml the Patient was assigned to parlodel at a dose of 2.5 mg 2 times a day for three menstrual cycles. In December 2003, the patient came a desired pregnancy.

Example 2. DL, 30, No. East. 26457, was admitted to the gynecological Department No. 1 of the Municipal health institutions in Voronezh "City clinical hospital №9 (ambulance)" 10.09.01 was diagnosed with secondary infertility of unknown origin.

At admission (10.09.01,) there were complaints about the lack of pregnancy PR is regular sex life for 4 years. From the anamnesis: menstruation of 14 to 5 days after 28 days, moderate pain, sexual life with 20 years without contraception. Miscarriage - 1 in 1997 in pregnancy 5-6 weeks. Gynaecologic and somatic diseases in anamnesis no notes. The last menstruation - 24.08.01. When viewed in the mirrors cervix net, selecting bright, vaginally: cervix conical outer jaws closed, the body of the uterus is normal in size, firm, mobile, painless. The area of the appendages by palpation is not changed. In smears from the vagina, cervical canal and the urethra on flora and purity revealed ballerina reasonable flora on the background of 4-8 cells in field of view, in the biochemical analysis of blood shifts were not available, urinalysis and blood without pathology. Laparoscopy 10.09.01: endometriosis on the peritoneum Red pocket 1-2 mm in diameter (small forms), hemorrhagic effusion 5 ml. Uterus correct form 7×3.5×4 see Right ovary 3×2×2 with ripening follicle. The right fallopian tube is viewed throughout the length of 12 cm, fimbria expressed, the color of the pipe is normal, methylene blue has penetrated into the tube and poured into the abdominal cavity. The left ovary 3×2×1,5, left fallopian tube with a length of 12 cm is viewed all over, the methylene blue solution penetrated into the tube and poured into the abdominal cavity. Manufactured coagu Asia foci of endometriosis. Discharged from the hospital 17.09.01 in satisfactory condition with the recommendations of the receiving danazol 400 mg / day within 6 months after the laparoscopy. The patient was referred to the antenatal clinic in September 2002 with complaints about the lack of pregnancy after taking danazol in may 2002. During examination, the patient was detected two-phase menstrual cycle, according to the measurement of basal temperature, the duration of the second phase of the menstrual cycle of 10 days, the sperm of the husband without pathological changes, follicle-stimulating hormone and 2.7 IU/l, luteinizing hormone - 7,0 IU/l, prolactin - 20 ng/ml, triiodothyronine - 1.6 nmol/l, thyroxine - 86,2 nmol/l, thyroid-stimulating hormone - 0,66 km mkme/ml the Patient was assigned to parlodel at a dose of 2.5 mg 2 times a day for three menstrual cycles. In August 2003, the patient came a desired pregnancy.

Thus, the positive effect of the proposed method is to increase the effectiveness of treatment of infertility caused by low forms of external genital endometriosis, which is associated with a therapeutic effect parlodel affecting the production of prolactin in the latent hyperprolactinemia in this category of patients.

The proposed method of increasing the effectiveness of treatment of infertility caused by low forms of external GE is falnoga endometriosis, allows you to optimize hormone therapy and improve treatment of this disease.

The way to increase the effectiveness of treatment of infertility caused by low forms of external genital endometriosis, including laparoscopy, followed by the appointment of danazol dose of 400 mg 2 times a day for 6 months, characterized in that it further after taking danazol in 6-12 months when norscopolamine, two-phase menstrual cycle, when the duration of the second phase of 10-14 days, appoint parlodel at a dose of 2.5 mg 2 times a day for three menstrual cycles.



 

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