Simrok-Starcheva D. Pathogenetically based approaches to endosurgical stimulation ovulation in women with polycystic ovarian syndrome.

In the present research work we present the theoretical basis and a new solution of scientific problems of modern gynecology pathogenesis of sound approach to endoscopic treatment of PCOS in women of reproductive age. Established that inhibin A is significantly reduced in women with PCOS comparing with women who has normoovulyatory cycle. Indicators of inhibin A levels negatively correlated (r = -0,5) with gonadotropins and with a moderately positively correlated with estradiol levels (r = 0,3). The level of AMH in 2.52 times higher compearing with healthy women (p 0,02), corresponding to an ultrasound of a larger pool of antralnofolikular and abuse of dominant follicle selection. AMH levels positively correlated with the number of follicles in the ovary and has a negative feedback to inhibin A. Endosurgical intervention in women with PCOS of reproductive age is justified pathogenesis and socially determined in women who wish to improve reproductive function. Endosurgical methods restore ovulatory menstrual cycle in women 85.7 %. Pregnancy occurred in 24.7 % of patients with PCOS after surgery, but it was the most effective in women who applied the laser energy - 53.6 %, higher than the overall rate of 1.6 times and 2.5-3.0 times using termokauterization (20.3 %), and laparoscopic resection of the ovaries (15.3 %). Traditional wedge resection of the ovaries reduces ovarian reserve, reduced functionally activation of corpus luteum due to shortage of ovarian tissue. In a study of women for endosurgical treatment should be assessed ovarian reserve ovary, based on indicators of AMH and inhibin A. By reducing the levels of these parameters is possible to use only laser drilinga and termokauterization, performing wedge resection is contraindicated.