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FEATURES OF OVARIAN RESERVE IN PATIENTS WITH INFERTILITY AND OVARIAN
ENDOMETRIOSIS
Andriets A. V., Yuzko O.M.
The Higher State Educational Institution of Ukraine "Bukovinian State Medical University"
Abstract
The purpose of the study: - to study the peculiarities of the ovarian reserve of the patients with infertility and ovarian endometriosis on the basis of the investigated level of anti-Mullerian hormone in the blood and the echographic count of the number of antral follicles in the ovaries.
Materials and methods: An echographic number of antral follicles count(AFC) in the ovaries was performed among 100 patients (the main group) with infertility and ovarian endometriosis, 55 of them - the determination of
the level of anti-Mullerian hormone (AMH) in the blood. The control group consisted of 70 patients with infertility without endometriosis.
Results: Number of antral follicles in women with infertility and ovarian endomeriosis is reduced with age and is probably lower than at the primary and secondary infertility in the right (4,9 ± 0,007 and 3,4 ± 0,004) as well as in the left (4,6 ± 0,006 and 4,1 ± 0,005) ovaries compared to women without endometriosis (6,7 ± 0,28 and 7,0 ± 0,99, 6,1 ± 0,27 and 6,8 ± 0,28).
Anti-Mullerian hormone (AMH) of blood in the patients of the main and control groups was respectively 3,5 ng/ml and 3,3 ng/ml. There were 7 patients in the main study group with low level of AMH (12.7%), while there were 3 with (10.0%) in the control group.
Low level of AMH in the main group was in 11 patients (20,0%), and (30,0%) in 9 patients of the control group. The indicators of a sufficient level of AMH in the main group were in 25 patients (45.4%), and 14 (46.6%) in the control group. There were 12 patients with a high AMH level in the main group (21.8%), and 4 (13.3%) in the control group.
That is, the differences in the levels of AMH in patients in the main and control groups were not found. We found no correlation between the level of AMH in the blood of the examined patients and the object of "endome-trioma".
Conlusion: The number of antral follicles in infertility patients with ovarian endometriosis is lower compared with patients with infertility in the absence of endometriosis, but the level of anti-Mullerian hormone in the blood of patients with infertility in the case of ovarian endometriosis did not differ from its level in the blood of patients with infertility without endometriosis.
That is, the number of antral follicles in patients with infertility and ovarian endometriosis is not a probable indicator of ovarian reserve, which, in our opinion, is associated with the difficulty of counting follicles with altered topography of the ovary by endometrioma.
Keywords: infertility and ovarian endometriosis, the antral follicles, anti-Mullerian hormone, ovarian reserve.
Introduction: An important milestone in the study of the pathogenesis of infertility development in endometriosis of ovaries was the study of its correlation with the ovarian reserve [1], which is defined as the functional potential of the ovary, reflected by the number and quality of the follicles that have a good response to controlled ovulation stimulation by exogenous gonad-otropin [2]. Markers of the ovarian reserve are the level of anti-Mullerian hormone (AMH) in the blood, as well as the echographic number of antral follicles (AFC) [2,3]. It is shown that the level of AMH in blood serum can be a reliable marker for ovarian reserve [4,6] Moreover, AMH is the only marker of ovarian reserve that does not depend on the menstrual cycle and its level is not affected by combined oral contraceptives or agonist gonatotropin-releasing hormone [5].
The number of antral follicles may also be a probable diagnostic criterion for ovarian reserve, after surgical treatment [4]. The literature data on the efficacy counting of AFC as a marker of ovarian reserve in ovarian endometriomas are contradictory. This research is devoted to study this issue.
MATERIALS AND METHODS
Echography was performed on 100 patients (the main group) with infertility and ovarian endometriosis with the number of antral follicles count using a transvaginal sensor in the first phase of the menstrual cycle in each ovary. All measurements were performed in the morning at free urinary bladder. During the scan, we identified the number of antral follicles in diameter from 2 to 10 mm in each ovary.
Determination of the concentration of AMH in blood plasma on the 2-3rd day of the menstrual cycle was performed in 55 patients of the main group by immunofluorescence method using commercial sets of the company "IBL" on the fluoroimmunoassay analyzer 1420 VIKTOR of the firm "WALLAC OY" (Finland). Blood sampling for ANG study was taken from cubital vein in the morning on an empty stomach.
The control group consisted of 70 patients with infertility without endometriosis.
RESULTS OF THE STUDY AND THEIR DISCUSSION
Table 1
Number of antral follicles at the examined patients, depending on age (M ± m)
Main group, n=100 Control group, n=40
Patient's age, years Right Left Right Left
ovary ovary ovary ovary
20-28 5,3 ± 0,007 5,2 ± 0,007 7,8 ± 0,39* 7,5 ± 0,4*
29-38 4,1 ± 0,005 4,1 ± 0,005 6,1 ± 0,27* 6,8 ± 0,28*
Over 39 3,2 ± 0,003 3,2 ± 0,003 3,0 ± 0,15 3,0 ± 0,15
Average indicator AFC 4,5 ± 0,005 4,5 ± 0,005 6,6 ± 0,27 7,0 ± 0,28
Note: * p < 0,05.
According to the data shown in Table 1, in patients 0,007 Ta 5,2 ± 0,007, and the control group - 7,8 ± 0,39 with infertility at endometriosis of the ovaries of AFC Ta 7,5 ± 0,4, which statistically varied (p<0,05). in the age of 20-28 in the right and left ovary was 5,3 ± Women at the age of 29-38 also noticed a significant
difference in AFC: patients from the main group 4.1 ± 0.005 and 4.1 ± 0.005, and from the control group - 6.1 ± 0.27 and 6.8 ± 0.28 (p <0,05). With women aged over 39, no difference was observed in AFC: in the main group was 3.2 ± 0.003 and 3.2 ± 0.003, while in the control group it was 3.0 ± 0.15 and 3.0 ± 0.15 (p> 0.05). In general, AFC in patients of the main group was significantly lower than in the right (4.5 ± 0.005) and in
the left (4.5 ± 0.005) ovaries compared with the control (correspondingly 6.6 ± 0.27 and 7.0 ± 0.28, p <0.05).
Having conducted a correlation analysis of the association of AFC with the age of patients (Table 1) we found a reverse dependence, that is, with age, there was a gradual decrease in AFC in the ovaries of the examined patients, which coincided with the literature data on the general tendency of changes of AFC with age in women.
Table 1.
Dependance of AFC depending on the age of the patient with infertility at endometriosis, n=100, correlation coefficient - -0,256
Table 2
Distribution of the examined patients by the number of antral follicles detected (%)_
Number Main group, n=100 Control group, n=40
of antral Right Left Right Left
follicles ovary ovary ovary ovary
Under 5 32,0 33,0 40,0 42,5
From 5 to 12 49,0 45,0 50,0 47,5
Over 12 2,0 4,0 7,5,0 10,0
Follicles have not been visualized 16 18 2,5 0
According to the data shown in Table 2, AFC up to 5 in the right ovary of women in the main group was 32.0%, in the left - 33.0%, and in the control group, respectively, - 40.0% and 42.5%, which was indicative of a slightly better ovarian reserve in women of the control group. The number of antral follicles from 5 to 12 was determined in the main group in the majority (49.0% and 45.0%) of patients, which did not differ from the
control group (50.0% and 47.5%). Patients with AFC more than 12 in each ovary were more in the control group: 7.5% and 10.0% than in the group of infertility patients with endometriosis in the ovaries: 2.0% and 4,0%.
The follicles were not visualized in 16.0% and 18.0% of the patients in the main group compared with significantly lower control group (2.5% and 0%).
Table 3
The number of antral follicles in the examined patients depending on the type of infertility (M±m)
Number Main group, n=100 Control group, n=40
of antral Right Left Right
follicles ovary ovary ovary
Primary infertility 4,9 ± 0,007 4,6 ± 0,006 6,7 ± 0,28* 7,0 ± 0,29*
Secondary infertility 3,4 ± 0,004 4,1 ± 0,005 6,1 ± 0,27* 6,8 ± 0,28*
Note: * p < 0,05.
According to the data shown in Table 3, patients with primary and secondary infertility at endometriosis of the ovaries AFC was significantly lower (p < 0,05) in both the right and the left ovary (respectively, 4,9 ± 0,007 and 4,6 ± 0,006, 3,4 ± 0,004 and 4,1 ± 0,005) compared with the control group (6.7 ± 0.28 and 7.0 ± 0.29, 6.1 ± 0.27 and 6.8 ± 0.28).
Analyzing the data in the Table 4, we note that the average indicator of AMH in the blood of patients in the main and control groups was respectively 3.5 ng / ml and 3.3 ng / ml. With a decreased level of AMG in
The data presented in Tables 1 and 2 showed that there was an almost identical relationship between age of patients and AFC with AMH, that is, both indicators indicated a decrease in ovarian reserve of women with
the blood, the main group had 7 patients (12.7%), and in the control group 3 (10.0%). The low level of AMH in the blood of patients in the main group was discovered at 11 (20,0%), and in the control - at 9 patients (30,0%). Sufficient level of AMH in the blood of patients in the main group was 25 (45.4%), and in control - 14 (46.6%). With high levels of AMH in the blood of patients in the main group was 12 (21.8%), and in the control group - 4 (13.3%). There was no statistical difference in the levels of AMH in the blood of patients in the main and control groups (p> 0.05).
age. This is confirmed by a strong correlation between the level of AMH and AFC (Table 3) in the examined group of patients (correlation coefficient 0.616).
Table 2
Correlation between age of patients and AMG level, correlation coefficient -0.365
14
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25 30
Patient's age, years
35
40
45
Table 4
Level of AMH in the blood of examined patients, abs. (%)__
Level of AMH ng/ml Main group, n=55 Control group, n=30 Total
Under 1 7 (12,2%) 3 (10,0%) 10
1-1,9 11 (20,0%) 9 (30,0%) 20
2-4,9 25 (45,4%) 14 (46,6%) 39
5 and over 12 (21,8%) 4 (13,3%) 16
Average indicator 3,5 3,3
Total 55 30 85
Table 3
Relationship between AFC and AMH level in patients with infertility and endometriosis, correlation coefficient - 0.616
14
12
10
_ 8 :I3
! 6 ti
I 4
01
S 2
o £
.£2 'l. 01
0 ♦ 0,00
5,00 10,00 15,00 20,00 25,00 30,00 35,00 The number of antral follicles in both ovaries
We did not detect the dependance of AMH on the volume of the endometrium Table 4, which is probably due to the fact that AMH reflects the overall potential
of a woman, and the volume of endometriomas affects the AFC of the affected ovary.
Table 4.
Analysis of the influence of volume of endometriomas over the level of AMH in patients of the main
group, correlation coefficient - 0.056
14
0 50 100 150 200
Volu me of the endometriu m , cm3
CONCLUSIONS
The number of antral follicles in infertility patients with ovarian endometriosis is significantly lower in comparison with patients with infertility in the absence of endometriosis, but the level of anti-Mullerian hormone in the blood in patients with infertility and endometriosis of the ovaries did not differ from its level in the blood in patients with infertility without endometriosis. That is, counting the number of antral follicles in patients with infertility in the endometriomas of the ovaries is not a likely indicator of ovarian reserve, which, in our opinion, is associated
with the difficulty of counting follicles with altered topography of the ovary of the endometrium.
References
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2. Obstetrics and gynecology: In 4 t .: national textbook / pcs. aut for ed. acad. NAMS of Ukraine, prof. V.M. Zaporozhana - T. 4: Operative gynecology / V.M. Zaporozhan, T.F. Tatarchuk, I.Z. Gladchuk and
others; for ed. acad. NAMS of Ukraine, prof. V.M. Za-porozhana - K .: VSV "Medicine", 2014 - 696 pp.
3. Andreeva E.H. Clinical profile of Russian patients diagnosed with genital endometriosis receiving treatment with GnRH agonist. Results of the Russian open multicentre observational study / E.H. Andreeva, E.L. Yarotskaya, L.V. Adamyan // Problems of reproduction. - 2011. - No. 17 (2). - P. 50-62. [9/28 for 5 slips]
4. Kwee J, Schats R, McDonnell J, Themmen A, de Jong F, Lambalk C, Evaluation of anti-Müllerian hormone as a test for the prediction of ovarian reserve. Fertil. Steril. 2008;90(3):737-43.
5. Raffi F, Shaw RW, Amer S, National survey of the current management of endometriomas in women undergoing assisted reproductive treatment. F. Raffi, Human Reproduction. 2012;27(9):2712-9.
6. Hirokawa W, Iwase A, Goto M, Takikawa S, Nagatomo Y, Nakahara T, Bayasula B, Nakamura T, Manabe S, Kikkawa F, The post-operative decline in serum anti-Mullerian hormone correlates with the bilat-erality and severity of endometriosis. Human Reproduction. 2011; 26(4):904-10.
7. Raffi FI, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(9):3146-54.
ОСОБЕННОСТИ МИКРОБИОЦЕНОЗА ЩЕЛИ ПЕРЕЛОМА НИЖНЕЙ ЧЕЛЮСТИ ПРИ
ВОСПАЛИТЕЛЬНЫХ ОСЛОЖНЕНИЯХ
Гударьян А.А.,
доктор мед. наук, профессор кафедры хирургической стоматологии,
имплантологии и пародонтологии, ГУ «Днепропетровская медицинская академия МЗУ», г. Днепр
Мащенко И.С.,
доктор мед. наук, профессор кафедры хирургической стоматологии,
имплантологии и пародонтологии, ГУ «Днепропетровская медицинская академия МЗУ», г. Днепр
Идашкина Н.Г.,
зав. кафедрой хирургической стоматологии, имплантологии и пародонтологии, ГУ «Днепропетровская медицинская академия МЗУ», г. Днепр
Юнкин Я.О.
ассистент кафедры хирургической стоматологии, имплантологии и пародонтологии, ГУ «Днепропетровская медицинская академия МЗУ», г. Днепр
FEATURES OF THE MICROBIOCENOSIS IN THE LINE OF THE COMPLICATED MANDIBULAR
FRACTURES
Gudar'yan O.O.,
Professor at the Department of surgical dentistry, implantology and periodontology, SE "Dnipropetrovsk Medical Academy of Health Ministry of Ukraine", Dnipro
Maschenko I.S.,
Professor at the Department of surgical dentistry, implantology and periodontology, SE "Dnipropetrovsk Medical Academy of Health Ministry of Ukraine", Dn ipro
Idashkina N.G.,
Head of the Department of surgical dentistry, implantology and periodontology, SE "Dnipropetrovsk Medical Academy of Health Ministry of Ukraine", Dn ipro
Yunkin Ya.O.
Assistant at the Department of surgical dentistry, implantology and periodontology, SE "Dnipropetrovsk Medical Academy of Health Ministry of Ukraine", Dn ipro
Аннотация
В осложнении переломов нижней челюсти гнойным воспалительным процессом ведущая роль принадлежит стафилококковой инфекции, удельный вес которой составляет 74,1% и широкому спектру анаэробных бактерий. По мере прогрессирования воспаления с развитием посттравматического остеомиелита в 2-3 раза возрастает удельный вес смешанной аэробно-анаэробной флоры и Candida albicans. Abstract
Staphylococcal infection, whose specific gravity is 74,1%, and a wide spectrum of anaerobic bacteria play the leading role in complicating the mandibular fractures with a purulent inflammatory process. As the inflammation progresses with the development of posttraumatic osteomyelitis, the specific gravity of mixed aerobic-anaerobic flora and Candida albicans increases in 2-3 times.
Ключевые слова: перелом нижней челюсти, воспалительные осложнения, остеомиелит, микробиоценоз.
Keywords: mandibular fracture, inflammatory complications, osteomyelitis, microbiocenosis.
