Perinatology and reproductology: from research to practice

Algorithm for predicting the course of the neonatal period at high risk of intrauterine infection

Andrey Prishchepa — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-1
УДК 616.33-022.7-036.1-06-037:007

Objective of the study. To develop an algorithm for predicting the course of the neonatal period in cases of high risk of intrauterine infection.
Materials and methods. We formed a complete database (clinical and laboratory indicators, anamnesis, course of pregnancy,
delivery results, data on the course of the neonatal period, and others) regarding 201 pregnant women who were carriers of pathogens of perinatally significant infections (Herpes simplex 1, 2, Staphylococcus aureus, Candida albicans, and Chlamydia trachomatis). Of these, 50.3% (101) of the women gave birth to healthy children, and 49.7% (100) gave birth to children with intrauterine infection. The age of women who gave birth to children with intrauterine infections was ±25,5 (23-30) years, and for women who gave birth to healthy children, it was ±25 (24-28) years; the distribution of the indicator in both groups differs from normal (DKS=1,43, p=0.033 and DKS=1,94, p=0.001, respectively), and no statistically significant differences were found (U=0,233, p=0,816). The complex of conducted studies included clinical, microbiological, virological, biochemical, and statistical methods.
Results. From the obtained data, it is evident that using the model, 79% (11/14) of all healthy newborns were classified
correctly; among newborns with Apgar scores from 0 to 7, this indicator equals 76%. In general, using the constructed model
on the test set, 77% (23/30) of all cases were correctly classified (concordance coefficient). The value of the Somers' D correlation coefficient (Somers' D), which reflects the relationship between the actual frequency and that predicted by the logistic regression equation, is 0,464, p=0,004. Analysis of clinical and laboratory data using the mathematical model of logit regression allowed forming a set of risk predictors for the development of intrauterine infection with a high level of concordance exceeding 90%. This formed the basis for developing a computer program for calculating the risk of birth of children with intrauterine infection (IUI).
Conclusions. Thus, we managed to develop a program for screening prenatal prediction of intrauterine infections, which includes clinical predictors of intrauterine infection and regulatory-transport proteins in the blood of pregnant women and the amniotic fluid of parturient women. The created program for calculating the risk of IUI in the early neonatal period is recommended to be applied from the moment signs of live birth are determined, from the 22nd week of pregnancy, the term of premature birth, after the second ultrasound screening.

Clinical, metabolic and proinflammatory mechanisms of progesterone resistance formation in recurrent endometrial hyperplasia in women of late reproductive age

Alla Vitiuk — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-2
УДК 618.14-007.61-06:616.379-008.64:616-092-08

Recurrent hyperplastic changes of the endometrium in women of late reproductive age are increasingly associated with metabolic and inflammatory disturbances that may influence the response to hormonal therapy. In clinical practice, a considerable proportion of patients demonstrate incomplete regression of endometrial proliferation or repeated recurrence after conservative progestin treatment. Recent evidence suggests that obesity, insulin resistance, chronic low-grade inflammation, and altered progesterone receptor sensitivity may contribute to persistence of proliferative endometrial changes. Long-term metabolic imbalance accompanied by elevated inflammatory cytokines creates conditions that may reduce the effectiveness of progestin therapy and
support recurrent disease progression [8–12].
The objective: to evaluate the role of insulin resistance and systemic inflammation in the development of resistance to progestin therapy in women with recurrent endometrial hyperplasia and to identify clinical and metabolic predictors of treatment failure.
Materials and methods. A prospective cohort clinical and laboratory study was conducted involving 120 women aged 36–45 years. The main group consisted of 60 patients with recurrent non-atypical endometrial hyperplasia. Depending on treatment outcomes, patients were divided into responders (n = 34) and non-responders (n = 26). The comparison group included 30 women with primary endometrial hyperplasia, while the control group consisted of 30 apparently healthy women. The examination included clinical, ultrasound, histological, and laboratory assessment. Body mass index, waist circumference, carbohydrate and lipid metabolism parameters, HOMA-IR, insulin, IL-6, TNF-α, CRP, estradiol, and progesterone levels were determined.
Results. Patients with progesterone resistance demonstrated significantly higher levels of HOMA-IR, insulin, IL-6, TNF-α, and CRP compared with responders and the control group. The most pronounced changes were observed in women with obesity and abdominal fat distribution. A direct correlation was identified between HOMA-IR and endometrial thickness (r = 0.48; p < 0.001), as well as between IL-6 levels and recurrence frequency (r = 0.44; p < 0.01). Independent predictors of ineffective therapy included HOMA-IR > 3.5, IL-6 > 7 pg/mL, obesity, and decreased progesterone levels.
Conclusions. Insulin resistance and chronic systemic inflammation are important components of the pathogenesis of progesterone resistance in recurrent endometrial hyperplasia. Integration of metabolic and pro-inflammatory markers into clinical algorithms makes it possible to personalize treatment and predict the risk of recurrence.

Risk assessment of benign ovarian neoplasms in patients after hysterectomy

Maryan-Andrii Halandzhiy — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-3
УДК 618.1-089.87

Hysterectomy remains one of the most frequently performed surgical interventions in gynecological practice worldwide. Current trends in operative gynecology, driven by recent research, have shifted from routine prophylactic oophorectomy to ovarian preservation in women of reproductive and perimenopausal age (under 65 years) absent of genetic oncological risks. This strategy aims to prevent cardiovascular diseases, cognitive decline, and premature mortality associated with surgical menopause. However, preserving the gonads after uterus removal is not without risks: compromised blood supply and anatomical alterations can lead to «Residual Ovary Syndrome» and the formation of benign neoplasms, with incidence rates reaching 9–22 % in the long term. The lack of unified preoperative prognostic models for identifying high-risk patients in this specific cohort necessitates the search for new diagnostic markers and risk assessment tools.
The objective: the aim of this study was to develop and substantiate methods for assessing the risk of benign ovarian neoplasms in women who have undergone hysterectomy, based on a comparative analysis of clinical-anamnestic data and a panel of specific serum biomarkers.
Materials and methods. A clinical study was conducted at the bases of the Shupyk National Healthcare University of Ukraine (2019–2022), involving 83 patients with a history of hysterectomy. Participants were divided into two groups: Group I (Control, n = 63) included women with no detected ovarian pathology during follow-up; Group II (Main, n = 20) consisted of patients diagnosed with benign ovarian neoplasms (cysts, cystomas). The study assessed age, Body Mass Index (BMI), comorbidities, and serum levels of specific biomarkers using enzyme-linked immunosorbent assay (ELISA): Interleukin-6 (IL-6), Epidermal Growth Factor Receptor (EGFR), Cancer Antigen 125 (CA 125), Human Epididymis Protein 4 (HE4), and Cytokeratin 19 Fragment (Cyfra 21-1). Statistical analysis was performed using IBM SPSS 26.0, employing Student’s t-test, Mann-Whitney U-test, and ROC analysis with calculation of the Area Under the Curve (AUC) and Youden index to determine optimal cut-off values.
Results. Comparative analysis revealed no statistically significant differences between the groups regarding general clinical characteristics, such as age (45.98 ± 3.40 vs. 47.00 ± 5.14 years; p = 0.311) and BMI (28.26 ± 4.70 vs. 27.35 ± 6.11 kg/m2; p = 0.488), indicating the low predictive value of these traditional parameters. Conversely, highly significant differences (p < 0.001) were observed in the laboratory biomarkers. Patients with neoplasms exhibited elevated levels of IL-6 (17.02 ± 3.65 pg/ml vs. 11.06 ± 2.51 pg/ml in controls), CA 125 (3.96 ± 0.88 U/ml vs. 1.98 ± 0.51 U/ml), HE4 (1855.62 ± 216.27 pg/ml vs. 1460.09 ± 157.82 pg/ml), and Cyfra 21-1, alongside a significant decrease in EGFR levels (19499.6 ± 1405.9 pg/ml vs. 21999.5 ± 1070.4 pg/ml). ROC analysis confirmed the high diagnostic efficacy of the selected panel. CA 125 demonstrated the highest discriminatory ability (AUC = 0.962; 95% CI: 0.894–1.000) with an optimal cut-off value of > 3.30 U/ml, providing 90.0 % sensitivity and 100 % specificity. HE4 (AUC = 0.922; cutoff > 1629.57 pg/ml) and the pro-inflammatory cytokine IL-6 (AUC = 0.921; cut-off > 14.32 pg/ml) also showed excellent predictive potential.
Conclusions. Traditional risk factors (age, obesity, somatic history) are not effective predictors for the development of benign ovarian tumors in patients post-hysterectomy. A comprehensive evaluation of biomarkers CA 125, HE4, and IL-6 allows for the high-precision identification of at-risk patients. The implementation of the defined screening algorithm (specifically utilizing a CA 125 threshold > 3.30 U/ml) is recommended to optimize postoperative monitoring, facilitate timely diagnosis, and determine appropriate management strategies, thereby minimizing the need for repeated complex surgical interventions in women with preserved ovaries.

Early manifestation of genital prolapse in women aged 35–45 years: clinical and anamnestic signs of a suspected neurogenic component

Kostiantin Honchar — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-4
УДК 618.14-007.44-053.8:616.833-008.6

Genital prolapse is traditionally considered a condition associated with age, childbirth-related pelvic floor trauma, connective tissue weakness, and increased intra-abdominal pressure. However, in some women, symptoms occur as early as 35–45 years of age and may not correspond to the severity of obstetric history. This suggests the possible role of a neurogenic component in early pelvic floor dysfunction.
The objective: to determine the clinical and anamnestic features of early genital prolapse in women aged 35–45 years and to identify signs that may indicate a suspected neurogenic component of pelvic floor dysfunction.
Materials and methods. A clinical and anamnestic analysis was conducted involving 65 women aged 35–45 years with stage I–III genital prolapse. The main group included 35 patients with early prolapse and radiological signs of non-fusion of the L5–S1/S1–S2 vertebral arches, considered indirect signs of suspected occult neural tube defects. The comparison group included 30 women with genital prolapse without radiological or clinical signs of neural tube defects. Age at symptom onset, disease duration, prolapse stage, obstetric history, perineal discomfort, urinary symptoms, sexual discomfort, and subjective pelvic floor weakness were assessed.
Results. In the main group, prolapse symptoms appeared earlier, had a longer duration, and were more often associated with pelvic floor weakness, sexual discomfort, and lower urinary tract symptoms. Obstetric history did not always explain the severity of clinical manifestations. The most informative signs suggesting a possible neurogenic component were prolapse onset before 37 years of age, mismatch between parity and prolapse severity, and the combination of prolapse with pelvic discomfort, reduced muscular control, and sexual complaints.
Conclusions. Early manifestation of genital prolapse in women aged 35–45 years requires not only standard anatomical assessment but also careful evaluation of clinical and anamnestic signs of suspected neurogenic pelvic floor dysfunction. Recognition of these signs may help identify patients who require further functional assessment and individualized rehabilitation.

Comparative aspects of surgical treatment of patients with benign ovarian tumors who underwent hysterectomy

Oleksandr Zabudskіy — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-5
УДК 618.11-006.03-089:18.14-089.87

The objective: to study the comparative aspects of surgical treatment of patients with benign ovarian tumors after hysterectomy.
Materials and methods. A retrospective analysis of case histories and video recordings of operations of 83 patients operated on for benign ovarian tumors was conducted. All patients were admitted to the hospital on a planned basis with the diagnosis: «Benign ovarian neoplasm». 65 out of 83 patients complained of chronic pelvic pain and pain during sexual intercourse. All patients had previously undergone total or subtotal hysterectomy without appendages via laparotomic access due to uterine fibroids, adenomyosis, or recurrent dysfunctional uterine bleeding. Main group 1 – 48 patients were operated on for ovarian tumors via laparoscopic access. The comparison group consisted of 35 patients who underwent laparotomic surgery for ovarian tumors.
The complex of conducted studies included clinical, laboratory, instrumental, and statistical methods.
Results. In the main group of patients, 2 complications (6,25 %) were recorded: bladder injury – 1 (20,8/1000), hemorrhage – 1 (20,8/1000). During the extirpation of the cervical stump, a bladder injury occurred caused by laparoscopic scissors at the dissection stage due to dense adhesions between the bladder and the cervical stump. The length of the defect was approximately 1 cm. The complication was diagnosed intraoperatively by introducing a methylene blue solution into the catheterized bladder. The 0.5 cm bladder defect was sutured with double-row interrupted sutures. Vicryl was used as the suture material. In the postoperative period, continuous bladder catheterization was performed for 5 days. The postoperative period proceeded without complications. The patient was discharged from the hospital on the 7th day. Intraoperative hemorrhage developed during the performance of an adnexectomy using bipolar coagulation. Specifically, the preliminary coagulation was accompanied by deep tissue dissection. The difficulty of achieving hemostasis under the conditions of the developed hemorrhage lay in the small size of the ligament stump and, consequently, the difficulty in grasping the damaged vessel. The complication that arose did not require conversion; the bleeding was stopped via bipolar coagulation, with the blood loss volume amounting to 250 ml. During operations via laparotomic access for ovarian tumors, 5 complications (14.3 %) were registered: in 3 cases (85,7/1000), an injury to the small intestine occurred during the separation of adhesions, 1 – bladder injury, and 1 – intraoperative hemorrhage from the infundibulopelvic ligament during the mobilization of the ovarian tumor. A study of the catamnesis of these patients showed that no recurrence of the disease was detected during the follow-up period of 3 months to 3 years after the operation.
Conclusions. The results of the comparative analysis of different surgical treatment methods for benign ovarian neoplasms following hysterectomy demonstrate that laparoscopy enables adequate surgical intervention for ovarian neoplasms after hysterectomy to be performed in an anatomically precise and maximally sparing manner. The obtained findings should be utilized in the development of an algorithm for diagnostic and therapeutic-preventive measures.

Rehabilitation of women after artificial abortions

Ganna Kolesnyk — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-6
УДК 618.39-085-089.888.14-036.82

The objective: to develop and implement a complex of rehabilitation measures for women after artificial abortions.
Materials and methods. The object of our study was a group of 540 women after artificial termination of pregnancy. The patients were divided into two groups. The main group included 510 studied women whose pregnancy termination was performed followed by patient follow-up calls. A portion of the women (n = 30) underwent conventional hormonal research. Based on the analysis of medical documentation and dispensary examination of women in the main group, the frequency of dishormonal breast diseases (DHBD) after medical abortion was revealed, and the significance of risk factors was assessed; taking into account the data obtained, a test group of 30 women with the highest risk of developing dishormonal breast diseases after medical abortion was formed for rehabilitation. The complex of conducted studies included clinical, laboratory, and instrumental methods.
Results. When studying the hormonal status, it was found that the concentration of estradiol increases in parallel with the increase in the degree of dysplasia; in contrast, the level of progesterone-the main estrogen antagonist that inhibits proliferative-dysplastic processes - steadily decreases as the degree of epithelial dysplasia increases. Analysis of the nature of the disturbances showed that with the deepening of the degree of dysplasia, the number of patients with anovulatory cycles and a shortened luteal phase increases, while the number of patients with hypohormonal-type disturbances decreases. Based on the cyclicity of menstrual function, characterized by changes in proliferative and secretory processes, we applied a combination of estrogens and progestins for the treatment of proliferative dysplasias combined with hypohormonal syndrome, i.e., deficiency of both phases of the menstrual cycle. The administration of cyclic hormone therapy in physiological doses exerts a regulatory effect on the gonadotropic function of the pituitary gland and provides a substitution effect.
Conclusions. The prophylactic use of homeopathic or hormonal drugs after medical abortion significantly reduces the risk of DHBD (p < 0,05). Therefore, rehabilitation-the prevention of DHBD after medical abortion-is a justified and necessary measure. If the administration of a hormonal drug to a woman after termination of pregnancy is impossible due to the presence of extragenital pathology or the woman’s reluctance to undergo hormone therapy, a homeopathic drug is the drug of choice in such cases.

Tactics for predicting hyperproliferative processes of the uterus in women of reproductive age

Olga Leshchova — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-7
УДК 618.14-006.03-02:618.17/.5-037

The objective: to develop tactics for predicting hyperproliferative processes of the uterus in women of reproductive age.
Materials and methods. The study included 1002 women of reproductive age with hyperplastic processes of the endo- and myometrium and 80 healthy women who did not have pathology of the endo- and myometrium (control group). The main group consisted of 470 patients, who were divided into 3 subgroups: the 1st subgroup included patients with a combination of uterine leiomyoma and adenomyosis (n = 109); the 2nd subgroup – patients with uterine leiomyoma combined with endometrial hyperplastic processes (n = 179); the 3rd subgroup – patients having a combination of uterine leiomyoma, adenomyosis, and endometrial hyperplasia (n = 182). The comparison group consisted of 532 patients, who were divided into 3 subgroups: subgroup A – patients with isolated uterine leiomyoma (n = 147); subgroup B – with isolated adenomyosis (n = 143); subgroup C – with isolated endometrial hyperplastic processes (n = 242).
Results. The risk of leiomyoma occurrence in a patient with the presence of endocrine system diseases can be assessed using the following function: Risk of leiomyoma development: 1.979 • variable value for obesity + 0.102 • variable value for autoimmune thyroiditis + 0.064 • variable value for diabetes mellitus + 0.046 • age – 2.445. Variable values for diabetes mellitus, autoimmune thyroiditis, obesity: 0 – absence of the disease, 1 – presence. If the function value is closer to zero, the risk of developing uterine leiomyoma is minimal; if closer to 1, the risk is high.
Conclusions. Risk factors for the development of combined benign proliferative diseases of the endo- and myometrium in women of reproductive age include the presence of obesity, diseases of the cardiovascular system, gastrointestinal tract, and hepatobiliary system in the patient. Features of the clinical course of combined uterine hyperplastic processes, unlike solitary ones, are: a significantly higher frequency and intensity of pain syndrome, the prevalence of various forms of uterine bleeding and anemia caused by them, including severe degrees. Patients with the proliferative form of fibrocystic breast disease and combined hyperplastic diseases of the uterus belong to the high-risk group for developing breast cancer.

Features of clinical, echographic, and laboratory data in women with multiple hyperplastic processes of reproductive system organs against the background of thyroid pathology

Irina Netskar — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-8
УДК 618.1-007.61-036-=73.43-074

The objective: to establish correlations between clinical, echographic, and endocrinological data in women with multiple hyperplastic processes of reproductive system organs.
Materials and methods. To achieve the set goal, 74 women were examined. The main group included 54 patients with two or more hyperplastic processes of reproductive system organs (uterine fibroids, endometrial hyperplasia and polyps, adenomyosis, external genital endometriosis, fibrocystic mastopathy). The control group consisted of 20 women with an ovulatory menstrual cycle, with an average duration of 28.4 ± 0.8 days. The complex of conducted studies included clinical, echographic, and laboratory indicators.
Results. In women with multiple hyperplastic processes of reproductive system organs, a relative increase in blood estradiol levels was revealed; moreover, the highest values were observed in patients with anovulation compared to the control group (298,2 ± 11.7 pmol/L; 223,5 ± 11,7 pmol/L; p < 0,05). A large number of studies confirm the presence of estrogen alpha- and beta-receptors in normal and tumorous thyroid tissue. There are also data on the stimulating effect of estrogens on tumorous and unchanged thyroid cells regardless of the thyrotropic hormone level in the blood. It is known that estradiol increases the expression of cyclin D1, which plays a key role in the regulation of the cell cycle. In addition, estradiol triggers the mitogen-activated protein kinase cascade, which plays a key role in cell proliferation and differentiation. It can be assumed that in women with relative or absolute hyperestrogenemia, thyroid tissue hyperplasia develops due to the direct effect of estrogens on their own receptors in thyrocytes. Furthermore, estrogens are capable of increasing the sensitivity of thyroid gland cells to thyroidstimulating hormone by increasing the number of thyrotropic hormone receptors. In this study, a direct dependence of the thyroid gland volume on the blood estradiol level was revealed in women with multiple hyperplastic processes of reproductive system organs.
Conclusions. It should be noted that the results of this study allow considering the thyroid gland as a target organ for the influence of estrogens and linking diffuse and nodular enlargement of the thyroid gland, as well as the development of hyperplastic processes in reproductive system organs, with relative or absolute hyperestrogenemia.

Clinical and reproductive characteristics of women with thyroid dysfunction under conditions of active hostilities as a basis for individualized contraceptive choice

Liudmyla Sakaly — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-9
УДК 618.17-008.8:616.441-008.6:615.256.5:159.944.4:355.01

Thyroid dysfunction in women of reproductive age may affect menstrual function, ovulatory processes, psycho-emotional status, and reproductive planning, which necessitates an individualized approach to contraceptive choice [1–4]. Under conditions of active hostilities, the significance of this issue increases, as chronic war-related stress is associated with menstrual cycle disorders, psychovegetative manifestations, changes in reproductive intentions, and a growing need for reliable contraceptive counseling.
The objective: to assess clinical and reproductive characteristics, reproductive plans, the nature of menstrual cycle disorders, and the level of stress burden in women with thyroid dysfunction under conditions of active hostilities as a basis for individualized contraceptive choice.
Materials and methods. A descriptive analytical study was conducted involving 105 women of reproductive age with thyroid dysfunction who required counseling regarding the choice or correction of a contraceptive method. The patients were divided into three groups: Group I included 32 women with hypothyroidism or subclinical hypothyroidism; Group II included 28 women with hyperthyroidism, a history of thyrotoxicosis, or unstable thyroid status; Group III included 45 women with autoimmune thyroiditis and euthyroid or subclinically altered thyroid profile. The presence of children, reproductive plans, reasons for postponing pregnancy, menstrual disorders, and stress level were analyzed.
Results. Fifty-three women (50.5 %) had one or more children; however, 96 patients (91.4 %) did not plan pregnancy within the next 12 months. The main reasons for postponing pregnancy were the war situation and threat to life – 75.0 %, deterioration of well-being against the background of stress – 66.7 %, anxiety about a future pregnancy – 61.5 %, economic instability – 51.0 %, and absence of a permanent partner – 43.8 %. Menstrual cycle disorders were detected in 76 (72.4 %) women. A high level of stress was recorded in 48 (45.7 %) patients, most often among women with hyperthyroidism, a history of thyrotoxicosis, or unstable thyroid status.
Conclusions. Women with thyroid dysfunction under conditions of active hostilities have a high frequency of menstrual disorders, significant psycho-emotional burden, and a pronounced need for effective contraception. The obtained data substantiate the need for individualized contraceptive counseling, taking into account thyroid status, reproductive plans, menstrual function, and stress-associated psychovegetative changes.

Systematics of mental disorders in women with gynecological pathology

Nataliia Sukhostavets — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-10
УДК 618.1-02:616.89-008-055.2

The objective: to study the systematics of mental disorders in women with gynecological pathology.
Materials and methods. In this work, a clinical-psychopathological examination of 700 patients (aged 18 to 45 years, mean age – 32.1 ± 2.7 years) with gynecological pathology was conducted. The study was performed in inpatient and outpatient settings. The study group of patients with reproductive system pathology was formed according to accepted inclusion and exclusion criteria.
The study was conducted in accordance with the requirements of the Declaration of Helsinki of the World Medical Association on Ethical Principles for Medical Research Involving Human Subjects (2020). In case of compliance with all necessary criteria, women gave written informed consent to participate in the clinical-laboratory study. Psychiatric examination was conducted upon voluntary consent of the patients using the clinical method and objective data from available medical documentation.
Results. Non-pathological neurotic manifestations (adaptive reactions) are characterized by: asthenia (neurasthenia), anxious tension, autonomic dysfunctions, night sleep disturbances, occurrence and decompensation of somatic disorders, and a decrease in the tolerance threshold for various harmful factors. These manifestations are distinguished by partiality, do not combine into a syndrome, and there is a possibility of their complete self-correction. For neurotic reactions – feelings of anxiety and fear, polymorphic neurotic disorders, decompensation of personality-typological features. For neurotic states – stabilized and clinically formed disorders of the neurotic spectrum, predominance of depressive, neurasthenic, senestopathic-hypochondriacal disorders and obsessions, pronounced somatoform disorders. For pathological personality development – stabilization and development of personality changes, loss of direct connection of neurotic disorders with specific psychogeny, frequent decompensations of neurotic (pathocharacterological) disorders.
Conclusions. Strained activity of the mental adaptation barrier occurs within the framework of adaptive mechanisms and is a marker, especially at the initial stages, of the occurrence of physiological reactions aimed at preserving «psychic homeostasis» and forming the most rational programs of behavior and activity in complicated conditions. Prenosological states express a protective-adaptive function during the overstrain of the mental adaptation system. Their clinical manifestations are polymorphic short-term disorders of the neurotic level, personality decompensations, and vegetative-somatic dysfunctions alternating with periods of relative well-being.

Results of infertility treatment using assisted reproductive technology programs in patients with uterine fibroids

Olha Tkachenko — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-11
УДК 618.177-089.888-06:618.14-006.36-036.8

The objective: to evaluate the results of infertility treatment using assisted reproductive technologies in patients with uterine fibroids.
Materials and methods. The results of surgical treatment (disease recurrence, realization of reproductive function, course of pregnancy) were monitored for a period of up to 2 years after myomectomy in 510 patients with uterine fibroids. Patients included in the study underwent infertility treatment using the in vitro fertilization (IVF) + intracytoplasmic sperm injection (ICSI) protocol with controlled ovarian stimulation and transfer of native embryos into the uterine cavity (300 women – 58.8 %) or a cryoprotocol (210 patients – 41.2 %). The complex of conducted studies included clinical, laboratory, and instrumental methods.
Results. A statistically significant prevalence of submucous fibroid nodes was noted in the group with a failed current IVF attempt compared to the group with pregnancy resulting from IVF (13,4 % and 8,8 % respectively; p < 0,05), as well as the presence of a dominant node deforming the uterine cavity (37,1 % and 27,9 % respectively; p < 0.05) or located close to it (26,1 % and 19,3 % respectively; p < 0,05). Analysis of the nature of surgical interventions performed (surgical approach, frequency of myomectomies with opening of the uterine cavity, presence of fibroid conglomerates and adhesive process) revealed no significant differences in the study groups. At the same time, we noted a statistically significant prevalence of the share of surgical interventions involving the removal of fibroid nodes with signs of impaired blood supply in the group of patients with a failed subsequent IVF attempt compared to the group with pregnancy achievement (44,0 % and 26,3 % respectively; p < 0,05).
Conclusions. The risk factors for repeated failed ART programs in the group of patients with uterine fibroids with two or more ineffective ART attempts in history were found to be: woman’s age over 40 years during the ART program (OR 2.396, 95 % CI 1,120 5,124); duration of infertility over 5 years (OR 2.085, 95 % CI 1,044–4,164) and presence of 3 or more ineffective IVF attempts in history (OR 2.269, 95 % CI 1,011–5,094); presence of previously performed surgical interventions, such as uterine artery embolization (OR 2.979, 95 % CI 1,045–8,490) and ablation (OR 4.380, 95 % CI 1.129–16.985); submucous fibroid (OR 2.917, 95 % CI 1,825–4,661), presence of a dominant node located close to the uterine cavity (OR 1.822, 95 % CI 1,207–2,750), and presence of fibroid nodes with signs of impaired blood supply (OR 2.206, 95 % CI 1,069–4,552); combination of external genital endometriosis (OR 2.129, 95 % CI 1,061–4,274) and endometritis with uterine fibroids (OR 2.341 95 % CI 1,022–5,364).

The role of ovarian biopsy in assessing the state of ovarian reserve before assisted reproductive technologies

Olga Gavrish — 2026-06-19

DOI: 10.52705/2788-6190-2026-02-12
УДК 618.177-089.888.11-02:618.11-076:612.621.9

The objective: to assess the state of ovarian reserve before assisted reproductive technologies.
Materials and methods. This retrospective study included 45 women who sought assisted reproductive technologies. The main group (1C) included 15 women who had a history of ovarian tissue biopsy to determine their follicular reserve. All patients underwent ovarian biopsy during diagnostic laparoscopy. All patients in the main group presented to the department of assisted reproductive technologies after surgical intervention. The interval between ovarian biopsy and ovarian stimulation varied from 6 months to 3 years. The control group (2C) consisted of 30 women who sought assisted reproductive technologies during the same time period and had no history of surgical interventions on the reproductive system organs. The complex of conducted studies included clinical, laboratory, instrumental, and statistical methods.
Results. Significantly higher total reproductive losses were observed in the main group – 67 %, while in the control group this indicator was 30 %. In patients of group 1C (with a history of biopsy), the frequency of non-developing pregnancies and spontaneous miscarriages was 67 %. In the control group: 1 patient was diagnosed with an ectopic pregnancy (4 %), 3 with non-developing pregnancies (13 %), and the remaining 13 % were spontaneous miscarriages. Thus, it can be assumed that ovarian tissue biopsy cannot be considered a reliable functional test for determining ovarian reserve or recommended as a stage of infertility diagnosis for predicting in vitro fertilization efficiency in patients with infertility.
Conclusions. Ovarian biopsy performed on women suffering from infertility creates a group of patients with a «poor response» of ovaries to ovarian stimulation during in vitro fertilization. A «poor response» of ovaries to stimulation during in vitro fertilization is indicative in itself. At the current stage of development of assisted reproductive technologies, infertility treatment should begin with ovulation induction during in vitro fertilization. And only when evaluating the ovarian response to stimulation with exogenous gonadotropins and its ineffectiveness should the question of applying biopsy in such patients be raised.