Method of predicting state of fertility in women of reproductive age with uterus myoma

FIELD: medicine.

SUBSTANCE: at lutein phase of menstrual cycle concentrations of 2-hydroxyestrone 16α - hydroxyestrone in urine, concentration of progesterone in blood serum are determined. Then, canonical value is calculated by formula: K=4.23-0.04×A+0.0016×B-0.18×C, where A is concentration of progesterone in blood serum on 20-21 days of menstrual cycle (lutein phase) (nmol/l), B - concentration of 2-hydroxyestrone in urine (nmol/l), C - concentration of 16α - hydroxyestrone in urine (nmol/l). If K is higher than -0.175, infertility is predicted, if K is lower than -0.175 - safe fertility.

EFFECT: methods application increases accuracy of predicting infertility and safe fertility in women with uterus myoma.

2 ex

 

The invention relates to medicine, namely to gynecology, and is intended for forecasting fertility (one of two alternative States, infertility and safe fertility) among women of reproductive age with uterine myoma.

In the structure of female infertility frequency of uterine fibroids, according to various researchers, is 30-51%. As the sole etiologic factor infertility, uterine fibroids diagnosed in 1-20% of women. About 10% of women with fibroids and infertility are subject to treatment with assisted methods of reproduction (IVF) [1, 2, 3, 8, 9].

Traditional forecasting reproductive dysfunction in women with uterine cancer based on the determination of the size of myoma nodes (large) and their localization (submucous, the region of the isthmus or pipe angles of the uterus), detected by ultrasound and endoscopic methods. However, reproductive disorders are identified and the small size of the tumor and in the absence of deformation of the uterus myoma node and its location outside of the pipe angles and the neck area[4, 5, 6, 7].

A known method for prediction of infertility in women with fibroids, based on double determination in serum hormones in folliculinum and luteal phase of the menstrual cycle (thyroid-stimulating th is Mona, thyroxine, triiodothyronine and prolactin) and comparing them with the value zero norm. Their ratio predict the possibility of pregnancy in the first 3 month, 6 or 18 months of sexual life [10].

However, myoma of the uterus refers to hormone-dependent tumors, its growth and activity are regulated primarily steroid hormones, which include estrogen and progesterone, are not considered in the prototype. Thyroid hormones and prolactin in less responsible for the growth of fibroids and its symptoms than estrogen (estradiol) and progesterone.

The objective of the invention is to improve the accuracy of forecasting fertility, including two alternative state - of infertility and safe fertility in women with fibroids.

The problem is solved by identifying women with fibroids concentration in the urine of 2-hydroxyestrone and 16α-hydroxyestrone and progesterone in the serum during the luteal phase of the menstrual cycle with the subsequent calculation of canonical values according to the formula

K=4,23-0,04×A+0,0016×-0,18×S,

where a is the concentration of progesterone in blood serum on the 20-21st day of the menstrual cycle (luteal phase), nmol/l,

At the concentration of 2-hydroxyestrone in urine nmol/l,

C - concentration of 16α-hydroxyestrone in urine nmol/L.

When is the canonical values To the more -0,175 projected infertility, when K is less -0,175 projected intact fertility.

The claimed solution differs from the prototype in that:

depends myoma activity,

- estimated pituitary-ovarian status,

- reveals the minimum number of the most informative indicators and models are built,

- calculated value of the model and To forecast the state of reproductive functions (preservation of fertility or infertility) for the particular women of reproductive age with a normal sex life.

Thus, the claimed method meets the criterion of "novelty."

The analysis of patent and literature the authors found that the proposed solution has features that distinguish it not only from the prototype, but also on other technical solutions in this and related fields. We have not found a technical solution to predict women's fertility, including alternative condition - intact fertility and sterility, using the application of mathematical-statistical methods with the construction of the canonical value with the above-mentioned informative indicators. Therefore, it is possible to make a conclusion about conformity of the proposed method the criterion of "inventive step".

The method is as follows.

Women in reproductive is TRASTA with myoma of the uterus during the luteal phase of the menstrual cycle (20-21 days) determine in urinary concentrations of 2-hydroxyestrone, 16α-hydroxyestrone and the serum progesterone concentration.

Calculate the value of K according to the formula

K=4,23-0,04×A+0,0016×-0,18×S,

where a is the concentration of progesterone in blood serum on the 20-21st day of the menstrual cycle (luteal phase) (nmol/l),

At the concentration of 2-hydroxyestrone in urine (nmol/l),

C - concentration of 16α-hydroxyestrone in urine (nmol/l).

When K is greater -0,175 predict infertility, when K is less -0,175 predict safe fertility.

Using multiple discriminant analysis identified the most significant of the above indicators with uterine cancer in women in the groups with good fertility and infertility and built the canonical equation. The magnitude of the correct classification of women with fibroids on fertility status using this equation amounted to 79.4 per cent, the sensitivity of the test to predict infertility in women with uterine myoma is 85.7%, a specificity of 69.2%.

Example 1

Female 29 years, within 5 years of suffering with infertility. 4 years ago the patient was first diagnosed with uterine fibroids. It was found 3 myomatous node in diameter from 3 to 6 cm, located subserous on the front surface and the bottom of the uterus. The woman was examined according to the standard, other factors of infertility were excluded. Of comorbidity were identified: diffuse osteopatia, chronic pyelonephritis, myopia of an average degree, compensated chronic tonsillitis, diffuse enlargement of the thyroid gland 1 degree from normal function. Weight 72 kg with height 165 see Menstrual cycle is regular, 6 days, 30 days, copious, painless.

The concentration of progesterone in the serum on day 21 of the menstrual cycle - 7,80 (nmol/l).

The concentration of 2-hydroxyestrone in urine - 10,70 (nmol/l).

The concentration of 16α-hydroxyestrone in urine - 8,03 (nmol/l).

The canonical value of variable K=2,49 that more -0,175, and this women is projected infertility.

Example 2

The women have uterine fibroids within 6 years (4 myomatous node located subserous on the front surface and the bottom of the uterus). At 3 and 4 years ago, the women spontaneously came 2 pregnancies ended by megabite. Then came the 3rd pregnancy and 10 months ago women odoratissimus vaginal delivery of a live full-term girl weighing 3650 g and a length of 52 see Of comorbidity have chronic gastritis, diffuse enlargement of the thyroid gland 1 degree from normal function. Weight - 74 kg with height 167 see Menstrual cycle is regular, already recovered after the end of breastfeeding.

The concentration of progesterone in blood serum is a 20 day of the menstrual cycle - 55,40 (nmol/l).

The concentration of 2-hydroxyestrone in urine - 43,53 (nmol/l).

The concentration of 16α-hydroxyestrone in urine - of 18.45 (nmol/l).

The value K=-1,24 that less - 0,175 and the woman predicted the preservation of reproductive function.

Thus, using multiple discriminant analysis identified the most informative indicators in women with fibroids, describing the maximum possible correct classification on the state of reproductive functions, and built the canonical value. The magnitude of the correct classification of women with fibroids using this equation was 79,4%, a sensitivity of 85.7%, a specificity of 69.2%.

Thus, the claimed method allows women of reproductive age with uterine cancer to predict the state of reproductive function (infertility or saved fertility) for the minimum number of the most informative tests, which reduces the cost of diagnostic tests, reduces the time and increases accuracy.

Literature

1. Baryshnikov YOU Programmed cell death (apoptosis). / Youerself, Uwishin // Ross. oncologic. log. - 1996. No. 1. - P.58-61.

2. Bershtein L.M. Hormonal carcinogenesis. / Lambertian. - SPb.: Science, 2000. - 198 S.

3. Beznosko GV Smooth myocytes of the myometrium during periods of accelerated growth in PR the Natal ontogenesis, during pregnancy and fibroids: author. dis. ... candles. the honey. Sciences: 14.00.01. Ivanovo. - 1997. - 25 S.

4. Galkin O. the Effect of isomers of thyroxine on the processes of free radical oxidation in subcellular fractions of brain cortex of rats. / Ovechkina, Vampish, Peuterey et al. // Probl. endocrinol. - 2000. - 47 so. No. 2. - P.32-33.

5. Grandberg I.I. Organic chemistry. - M.: bustard, 2002. - 672 S.

6. Kalinina E.V. Inhibitory effect of progesterone on glutathione-S-transferase P1-1 and its antiproliferative effect on cells lines To 562 erythroleukemia person. / Eveliina, Mdevice, Nperrin, Antipin // Oncology. - 2000. - Vol.46, No. 1. - S-73.

7. Kulakov V.I. Modern approaches to the diagnosis and treatment of female infertility. / Vigoleno, Yegorova // Obstetrics and gynecology. - 2002. No. 2. - P.56-59.

8. Protopopov N.V. Peculiarities of hormonal regulation of adaptive change in the postpartum period in women with fibroids. / Nowpeople, Omitama // proceedings of the VI Russian forum "Mother and child". - M - 2004. - S-198.

9. Tarusov BN. Biochemiluminescence lipids. / Bentayou, Zhuravlev A.I. // Biochemiluminescence. - M., 1965. - T. - S-132.

10. Application for invention No. 99113132/14, G01N 33/74 from 2001.04.27. A method for predicting fertility in women with fibroids.

A method for predicting the state of fertility in women Reprod the active age with uterine myoma, including the definition of sex hormones, myoma activity and the construction of mathematical models, characterized in that in the luteal phase of the menstrual cycle to determine the concentration of 2-hydroxyestrone and 16α-hydroxyestrone in urine, the concentration of progesterone in serum and expect the canonical value according to the formula
K=4,23-0,04×A+0,0016×B-0,18×C,
where a is the concentration of progesterone in blood serum at 20-21 days of the menstrual cycle (luteal phase) (nmol/l),
At the concentration of 2-hydroxyestrone in urine (nmol/l),
C - concentration of 16α-hydroxyestrone in urine (nmol/l),
when K is greater -0,175 predict infertility, when K is less than -0,175 - predict safe fertility.



 

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