[The role of health resort factors in preconception preparation of patients with reproductive disorders]. / Rol' sanatorno-kurortnykh faktorov v pregravidarnoi podgotovke patsientok s narusheniyami reproduktivnoi funktsii.

Reproductive dysfunction is a multifactorial problem, for the correction of which the most difficult are cases of pathology comorbidity. Individual preconception preparation, taking into account risk factors, is recognized as an effective measure to increase the chances of conception and prevent reproductive losses. OBJECTIVE: Optimization of treatment and rehabilitation measures at the preconception stage in patients with reproductive disorders. MATERIAL AND METHODS: The effectiveness of the use of natural and preformed physical factors in the preconception preparation of 180 women who underwent medical and rehabilitation measures in the health resort of the Altai Territory - the resort town of Belokurikha (Group 1, 79 patients) and outpatient conditions in the city of Barnaul (Group 2, 101 patients). Comprehensive spa treatment included climatotherapy, a combination of various methods: balneotherapy, peloidtherapy, physiotherapy and a prolonged course of herbal medicine. RESULTS: In patients of the 1st group, who underwent a course of rehabilitation treatment in a sanatorium-resort environment, compared with patients of the 2nd group, early reproductive losses were less common during pregnancy (7.1% and 20.7%, respectively; p=0.04) and more frequent term deliveries occurred (92.8% and 77.2%, respectively; p=0.02). The most significant predictors of the ineffectiveness of preconception preparation were the presence in patients of: chronic cystitis and autoimmune thyroiditis with hypothyroidism; oligomenorrhea at the time of pregnancy planning; aggravated by early reproductive losses and long-term wearing of intrauterine contraception history; burdened heredity for violation of carbohydrate metabolism. CONCLUSION: Comprehensive preconception preparation in the sanatorium-resort conditions of Belokurikha helps to increase the fertility of patients with reproductive disorders, the trophostimulating effect in the genital organs and the restoration of endometrial reception, which makes it possible to recommend this method for use in clinical practice.

[The preconceptional preparation of the patients presenting with chronic endometritis: the evaluation of the effectiveness of phyto- and physiotherapy]. / Pregravidarnaia podgotovka patsientok s khronicheskim éndometritom: otsenka éffektivnosti fito- i fizioterapii.

BACKGROUND: The necessity of the comparative studies with special reference to the preconceptional preparation of the patients presenting with chronic endometritis is self-evident bearing in mind the lack of common approaches to the preconceptional preparation of the patients with this condition. AIMS: The objective of the present study was the evaluation of the effectiveness of preconceptional with the use phyto- and/or physiotherapies for the treatment of the patients suffering from chronic endometritis. MATERIAL AND METHODS: This prospective study included 309 patients from the couples in the infertile marriage attributable to chronic endometritis. All the patients were divided into three group depending on the choice of the preconceptional preparation modality. Those comprising the first group (n=148) received 2.5 mg in days the aqueous extract of one-sided-wintergreen (Orthilia secunda) at a daily dose of 2.5 mg during three months. The patients of the second group (n=101) were given the combined physiotherapeutic treatment. The patients of the third group (n=60) refused any preconceptional preparation; therefore an expectant strategy was chosen to manage them. Part of patients of the first and second groups (n=30) underwent the immunohistochemical investigation aimed at evaluation of the methods employed in this study to the solution of the infertility problem. The data obtained were treated with the use of the Statistica 11.0 software package. RESULT: The preconceptional preparation of the patients suffering infertility associated with chronic endometritis with the use of the aqueous extract of one-sided-wintergreen in the combination with physiotherapeutic treatment resulted in the development of pregnancy in 72.9% and 81.2% of the participants in the study respectively and its completion with labors in 95.3% and 90.1% of the women respectively. The results of the immunohistochemical study involving the patients treated with the aqueous extract of one-sided-wintergreen alone gave evidence of the reduced frequency of frequency of leukocytic infiltration and leukocytic activity in dynamics of an experiment (CD 20+, CD138+, CD 56+, CD 16+, HLA-DRII+); simultaneously, an augmentation of the reception of endometrium to sex steroids. CONCLUSION: The preconceptional preparation of infertile women with the application of the aqueous extracts of one-sided-wintergreen can be recommended for the patients with chronic endometritis, especially in the presence of contraindications for physiotherapy. Phytotherapy made use of in the present study restored reception of endometrium to estrogens and alleviated the autoimmune manifestations of local immunity.