[STATE-OF-THE-ART OF REALIZATION OF THE FERTILITY POTENTIAL IN THE WOMEN OF LATE REPRODUCTIVE AGE].

Biological potential of childbearing in the women of late reproductive age is limited by natural impairment and loss offertility. Despite a considerable progress in clinical application of new diagnostic and reproductive technologies, the problem of infertility remains a most serious challenge. Women's age is one of the main factors responsible for the outcome of in vitro fertilization. The low effectiveness of in vitro fertilization programs is attributed to discoordination in the hypothalamic-pituitary system, depletion of ovarian resources, and deterioration of quality of reproductive material. Bearing in mind the role of melatonin in synchronizing circadian and seasonal biorhythms and regulating physiological and pathological processes, it is natural to suggest its role in the enhancement of efficiency of in vitro fertilization programs for women of late reproductive age.

[Melatonin secretion in women of advanced reproductive age].

The patient's age is a key factor determining success of in vitro fertilization. The ovarian reserve and oocyte quality are known to decrease with age. Much attention has been given recently to the role of epiphysis and its hormone, melatonin, in synchronization of daily and seasonal biorhythms in anti-stress protection and neuroregulation of reproductive processes. The aim of our work was to study melatonin levels in infertile women of reproductive age. We also measured sex hormones, anti-Mullerian hormone, FSH, and LH in blood and melatonin sulfate in urine at 8 points (RIA). Women of advanced reproductive age showed markedly reduced melatonin secretion due to functional disorders in the hypothalamic-pituitary-gonadal axis. Results of the study suggest the necessity of prescription of exogenous melatonin to the patients included in assisted reproduction programs for the improvement of their efficacy.

[The psychic state of women suffering infertility in the old reproductive age].

A total 60 infertile women aged 36-42 years treated by ART were examined to evaluate their psychic condition using CES-D and Spielberg-Khanin scales, SF-36 questionnaire. 15 (25%) patients were found (CES-D) to have mild depressive disorder; it was more pronounced in one woman. More than half of the patients exhibited enhanced anxiety, with 32 (53.3%) and 19 (31.6%) having generalized and strong anxiety respectively. Estimation of the quality of life revealed difficulties in maintaining social contacts up to complete isolation, low self-assessment of psychic health and prospects for recovery. It is concluded that comprehensive diagnostics and combined treatment are needed to manage infertile women of old reproductive age with the use of both traditional and psychocorrective methods.