RESUMO
There is a statistically significant difference in the frequency of implantation in the group of patients with endometriosis associated with infertility compared with the control group. This has been confirmed by a number of different studies. The aim of the study to expand the understanding of the pathogenesis of implantation failures in patients with infertility associated with endometriosisMaterials and research methods: The present study included 83 women aged 29 to 43 years (the average age was 33 ± 3.2 years) with a diagnosis of endometriosis (ICD10 code N80.9 Endometriosis, unspecified), as well as infertility (ICD10 code N 97.8, Female infertility of other origin) and repeated implantation failures. All patients of the studied cohort underwent an immunohistochemical study of endometrial biopsy samples taken by the pipel-biopsy of the endometrium during the period of the supposed "implantation window".Research results: Significant decrease in the immunological labeling of VEGF-A in samples from the ERIF group by â¼2.7 times in comparison with EF group (p < .05), the indices of expression of the proapoptotic protein CASP3 are increased in the samples of the ERIF group in comparison with the EF group (by â¼2.7 times, p < .05) and significant decrease in the expression of HOXA10 in the stromal and glandular compartments (2.4 times; 57.2 vs. 23.5%, p < .05).Conclusion: On the basis of the obtained results of the study, it should be concluded that the basis of implantation impairment in patients with repeated implantation failures associated with endometriosis lies in angiogenetic and apoptotic disorders and leads to implantation failure in the eutopic endometrium due to desynchronous transformation of the epithelial-mesenchymal compartment and disruption of endometrial trophism.
Assuntos
Implantação do Embrião/fisiologia , Endometriose/metabolismo , Endométrio/metabolismo , Infertilidade Feminina/metabolismo , Adulto , Endometriose/complicações , Feminino , Proteínas Homeobox A10/metabolismo , Humanos , Infertilidade Feminina/etiologia , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
OBJECTIVE: To study the relationship between vitamin D deficiency, VDR gene polymorphism rs10735810 (A > G), and a missed abortion in the first trimester of gestation; to determine the predictors of its risk. RESEARCH METHODS: 178 women aged between 18 and 41 were surveyed. The main group consisted of patients with miscarriage (n = 101), verified at the hospital stage (O02.0; O02.1), which were stratified by I group (n = 58, patients with the first miscarriage) and II groups (n = 43, patients with repeated miscarriage). The control group (n = 77) consisted of women with a successful pregnancy (Z34.0), which subsequently ended in delivery at term with a live fetus. Patients were surveyed and data was extracted from primary medical records. The level of 25(OH)D in the blood serum was investigated by mass spectrometry (n = 99). Genotyping for the vitamin D receptor gene polymorphism rs10735810 (VDR A > G) was performed for 177 patients. Statistical data analysis was performed via Statistica 10 and SAS JMP 11 application packages, using single-factor prediction for quantitative and binary factors, ROC analysis, and CHAID decision tree construction. RESULTS OF THE STUDY: WE found that patients with miscarriage in the first trimester of gestation (n = 60) more frequently than those in the control group (n = 39) had vitamin D insufficiency (93.3% versus 76.9%, p = .0183) including its deficiency, occurring at 25(OH)D of blood <20 ng/ml (71.7% versus 51.3%, p = .0392). This pattern was found in patients with the first miscarriage, where significant differences in the frequency of vitamin D deficiency were also detected in comparison with the control group (80.0% versus 51.3%, p = .0026). No direct correlation was found between the frequency of miscarriages in the first trimester and the variant of the polymorphism of the vitamin D receptor gene (VDR A > G [rs10735810]); the GG genotype in patients with repeated miscarriages was even less frequent compared to the control group (14.0% versus 23.7%, p = .3344). However, the decision tree has identified four risk classes and has determined that the highest risk of missed abortion in the cohort studied is formed by three predicates: smoking, serum level 25(OH)D < 6.5 ng/ml and VDR AA and GG genotypes. CONCLUSION: The data obtained show that vitamin D insufficiency plays a pathogenetically significant role in early reproductive losses associated with miscarriages, both first and recurrent.
Assuntos
Aborto Habitual/etiologia , Polimorfismo de Nucleotídeo Único , Receptores de Calcitriol/genética , Deficiência de Vitamina D/complicações , Vitamina D/análogos & derivados , Aborto Habitual/sangue , Aborto Habitual/genética , Adolescente , Adulto , Feminino , Humanos , Gravidez , Fatores de Risco , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Adulto JovemRESUMO
The aim of the study was the analysis of immune inflammatory processes in the development of the pelvic pain syndrome associated with adenomyosis. For morphological examination were used 54 fragments of the myometrium obtained from patients after hysterectomy with pelvic pain on a background of diffuse adenomyosis of II-III degree, and 20 patients with painless form of adenomyosis. The identification of the macrophages distribution was held by means of an immune-hysto-chemical analysis of MAT (monoclonal antibody) for CD68. (Clone PG-M1, 'Diagnostic BioSystems', USA). The results of the study showed a significantly higher expression of CD68 (49.3 ± 2.3 vs. 21.2 ± 1.7 units. p < .01) in patients with painful adenomyosis form in areas of the ectopic endometrium, in the perivascular regions of the myometrium, as compared to those areas in women with painless group. We assume that these factors increase neurogenic inflammation and sensitivity of nociceptors in myometrium, activation of peripheral nerve fibers and, can act as triggers of the pelvic pain syndrome associated with adenomyosis.
Assuntos
Adenomiose/complicações , Miométrio/metabolismo , Dor Pélvica/etiologia , Adenomiose/metabolismo , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Biomarcadores/metabolismo , Feminino , Humanos , Inflamação/metabolismo , Linfócitos/metabolismo , Macrófagos/metabolismo , Dor Pélvica/metabolismoRESUMO
Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. There is evidence that both follicular and luteal phase abnormalities can result in LPD cycles. The aim of this randomized prospective noncomparative study is to evaluate the effectiveness of combination therapy in patients with LPD. This prospective study included 35 women of the reproductive age. They were diagnosed with the LPD with sonographically and laboratory-verified methods. The age of patients was 36 ± 0.46 years. The results of the study sonographically demonstrated an increase in the diameter of the corpus luteum from 1.36 ± 0.32 (initially) to 2.16 ± 0.21 mm after combination therapy. In addition, there was a statistically significant increase in the level of estrogens and progesterone in the corresponding phases of the menstrual cycle. Thus, the combination therapy for patients with LPD contributes to the recovery of cyclic events in the hypothalamic-pituitary-gonadal system, which determines the restoration of the endocrine function of the ovaries and promotes adequate secretory rearrangement of the endometrium in women of reproductive age.
Assuntos
Didrogesterona/uso terapêutico , Infertilidade Feminina/tratamento farmacológico , Fase Luteal/efeitos dos fármacos , Hidrolisados de Proteína/uso terapêutico , Adulto , Corpo Lúteo/diagnóstico por imagem , Didrogesterona/farmacologia , Endométrio , Estrogênios/sangue , Feminino , Humanos , Infertilidade Feminina/diagnóstico por imagem , Progesterona/sangue , Estudos Prospectivos , Hidrolisados de Proteína/farmacologia , Resultado do TratamentoRESUMO
Objective. To study features of histamine metabolism in patients with chronic pelvic pain associated with external genital endometriosis. Methods. For quantitative assessment of histamine level in peripheral blood was taken from 100 patients which than was centrifuged. In blood serum histamine concentration was determined by enzyme-linked immunosorbent assay method with reagents «Histamine ÐLISA¼ on the machine BAE-1000 Histamine (Labor Diagnostika Nord - LDN, Hermany). A pain syndrome was assessed by Visual Analog Scale (VAS), quality of life assessment - by Endometriosis Health Profile Questionnaire (EHR-30), level of anxiety was determined by Spielberger-Khanin questionnaire. The results. Showed statistically higher histamine level in patients with severe pain according to VAS. After assessment of results obtained from Spielberger-Khanin questionnaire 100% experimental group's women with external genital endometriosis (n = 60) were noted to be have high level of state and trait anxiety, then 40% women of control group (n = 16) have moderate level of anxiety. The incidence of depression in women with chronic pelvic pain was 58.3% (n = 35) and the main part (n = 20) were women with severe stage of pelvic pain according to VAS. Conclusions. Psycho emotional condition of women with external genital endometriosis associated pelvic pain characterized by higher depression and anxiety levels, with significant decrease quality of life. Direct relationship also was found between pain syndrome intensity and histamine level in peripheral blood in patients with external genital endometriosis.
Assuntos
Ansiedade/sangue , Dor Crônica/sangue , Endometriose/sangue , Histamina/sangue , Dor Pélvica/sangue , Adolescente , Adulto , Ansiedade/psicologia , Dor Crônica/psicologia , Endometriose/psicologia , Feminino , Humanos , Dor Pélvica/psicologiaRESUMO
OBJECTIVE: To observe the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) in treatment of chronic pelvic pain associated with adenomyosis (AM) and in prevention of its recurrence. METHODS: A prospective continuing study including 180 patients with chronic pelvic pain associated with AM who received insertion of LNG-IUS who were divided into three groups depending on the pain severity. The visual analog scale (VAS) was used for pain assessment before and during the treatment and transvaginal ultrasonic measurement of the uterine size, while various side effects, were observed and recorded. RESULTS: After placement of LNG-IUS, scores of pain and ratio of severe pelvic pain decreased significantly compared with baselines (p < 0.01), the scores of VAS were 9.0 ± 0.8, 6.5 ± 2.8, 4.3 ± 1.8, 3.3 ± 2.2, 2.2 ± 2.1, 2.2 ± 1.8, 1.4 ± 1.6 and 1.3 ± 1.3 at 0, 3, 6 and 12 months, respectively. During 12 months after placement of LNG-IUS, scores of pain had improved significantly compared with preceding period (p < 0.01). We found no universal dependent factors predicting improvement of pain, which was neither relevant with simultaneous changes of menstruation patterns nor with adverse effects (p > 0.005). CONCLUSION: The obtained results allowed to confirm the possibility of using LNG-IUS in the treatment of pelvic pain syndrome associated with AM, particularly with mild and moderately severe pelvic pain syndrome. This is a cost effective, reversible and long-term treatment for women with pelvic pain associated with AM, which reduces the need for surgical interventions.
Assuntos
Adenomiose/complicações , Dor Crônica/tratamento farmacológico , Anticoncepcionais Femininos/farmacologia , Dispositivos Intrauterinos Medicados , Levanogestrel/farmacologia , Avaliação de Resultados em Cuidados de Saúde , Dor Pélvica/tratamento farmacológico , Adulto , Dor Crônica/etiologia , Anticoncepcionais Femininos/administração & dosagem , Feminino , Humanos , Levanogestrel/administração & dosagem , Pessoa de Meia-Idade , Dor Pélvica/etiologiaRESUMO
AIM: The study of peculiarities of expression of vascular endothelial growth factor (VEGF) in the tissues of the endometrium and myometrium in patients with adenomyosis, associated with chronic pelvic pain syndrome. MATERIALS AND METHODS: Uterus macro-preparations obtained after hysterectomy in 60 patients with pelvic pain on a background of diffuse adenomyosis II-III degree were used for morphological examination, and macro-preparations received from 30 women with adenomyosis without pain syndrome. The diagnosis of adenomyosis was confirmed by sonography and magnetic resonance imaging. The expression of VEGF in tissues of the endometrium and myometrium was determined using the immune-histochemical method. The significance of differences of the compared parameters was determined using the criterion of Wilcoxon and Mann-Whitney. The differences were considered statistically significant when p < 0.05. RESULTS: It was found that a higher expression of VEGF is characteristic for patients with pelvic pain associated with adenomyosis, compared to women with adenomyosis and abnormal uterine bleeding, both in epithelial cells of ectopic endometrium (14.7 ± 1.6% against 10.7 ± 1.6%, p < 0.01), and in smooth myocytes of the myometrium (12.6 ± 1.4% against 9.6 ± 1.2%, p < 0.01) and in the stromal cells of the myometrium (10.1 ± 1.9% versus 7.4 ± 1.8%, p < 0.01). CONCLUSIONS: An increased expression of VEGF in the tissues of the uterus is one of the most important pathogenetic mechanisms of algogenesis with adenomyosis, associated syndrome of chronic pelvic pain, compared to the silent form of the disease.
Assuntos
Adenomiose/metabolismo , Dor Crônica/metabolismo , Neovascularização Fisiológica/fisiologia , Dor Pélvica/metabolismo , Útero/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adenomiose/complicações , Dor Crônica/etiologia , Feminino , Humanos , Dor Pélvica/etiologiaRESUMO
Methods. For morphological studies it were using fragments of walls 60 uterus, received after hysterectomy in patients with pelvic pain on a background of diffuse adenomyosis II-III degree, and 30 uterus of women with painless form of adenomyosis. Expression of vascular endothelial growth factor (VEGF) was measured in endometrial and myometrial tissues using immunohistochemistry. The results showed a significantly higher expression of VEGF in patients with adenomyosis pain phenotype compared to the same in women with silent form in the epithelial cells of ectopic endometrium (14,7 ± 1,6 vs. 10,7 ± 1,6%, p<0,01) in the smooth muscle cells of the myometrium (12,6 ± 1,4 vs. 9,6 ± 1,2%, p<0,01), in the stromal cells of the myometrium (10,1 ± 1,9 vs. 7,4 ± 1,8%, p <0,01).
Assuntos
Adenomiose/metabolismo , Dor Crônica/metabolismo , Regulação da Expressão Gênica , Miométrio/metabolismo , Dor Pélvica/metabolismo , Fator A de Crescimento do Endotélio Vascular/biossíntese , Adenomiose/patologia , Adulto , Dor Crônica/patologia , Feminino , Humanos , Miométrio/patologia , Dor Pélvica/patologiaRESUMO
Objective: to analyze the role of inflammatory and immune reactivity in the development of adenomyosis and its associated pain. Methods. For morphological studies it were using fragments of walls of 56 uterus received after hysterectomy in patients with pelvic pain on a background of diffuse adenomyosis II-III degree, and 30 patients with painless form of adenomyosis. To identify, evaluate the amount and spatial distribution of macrophages, T-helper cells and natural killer cells it was using MAbs to CD68, CD4, CD56 respectively. The results of the study showed a significantly high expression of CD68 (49,3 ± 2,3 vs. 21,2 ± 1,7 conv. units, p<0,01), CD56 (47,4 ± 2,7 vs. 17.2 ± 1.8 conv. units, p<0,01, p<0,05) and CD4 (52,1 ± 2,2 vs. 19,9 ± 2,5 conv. units, p<0,01) in patients with painful form of adenomyosis in the regions of ectopic endometrium and in the regions of perivascular growth in myometrium compared to those areas in women with painless adenomyosis. Conclusions: Adenomyosis is a chronic inflammatory disease accompanied by dysfunction of the uterine immune reactivity. Inflammatory and immune processes in the uterus with adenomyosis contribute to the persistence and growth of endometrial implants. In adenomyosis, associated with chronic pelvic pain syndrome, there is increase in the number of activated macrophages, natural killer cells and T-helper cells in the perivascular regions and in areas of remodeling of the myometrium are carriers of the nerves, which leads to increased neurogenic inflammation and sensitivity of nociceptors, activation of peripheral nerve fibers and the generation of pain.