Korop Z. Tactics of anovulatory infertility treatment in women with hyperandrogenism and obesity

Scientific work is devoted to restoration of genesial function at patientsof anovulatory infertility with hyperandrogenism and obesity on the basis of studying at them clinical-functional and endocrinologic features, and also improvement and introduction of algorithm of diagnostic and treatment-and-prophylactic actions with use of auxiliary genesial technologies. The role by hyperandrogenism and obesity in genesis of female sterility is investigated. Influence dishormonal and the dismetabolical of disturbances on the clinical course of female sterility is shown. The role of disturbances of secretion of peptide and steroid hormones in genesis of chronic anovulation is presented at various degree by obesity and hyperandrogenism. The frequency of hyperandrogenism and obesity with anovulatory infertility was studied. The connection between the level of the psychoemotional factor and the violation of the functional state of the hypothalamic-pituitary-ovarian system is analyzed. Hormonal, functional, and genetic markers have been established that have made it possible to reproduce the reproductive status of a woman. Data on the pathogenesis of anovulatory infertility associated with hyperandrogenism and obesity have been expanded, which allowed to scientifically improve the algorithm of preparation and correction of detected changes at the stage of preparation for programs of auxiliary reproductive technologiesCorrelation interrelations betweenhyperandrogenism and obesity, a dosage of Gonadotropinums and duration stimulation at patients with the excess hyperandrogenism and obesity are established. It allowed to prove scientifically advanced algorithm of carrying out auxiliary genesial technologies taking into account an index of body weight and existence of metabolic syndrome. Comparative aspects of frequency and structure of disturbances of genesial function at patients with obesity and hyperandrogenism are shown. The most informative markers of a condition of an ovarial reserve and the androgenic status at of anovulatory infertility. Criteria of indications and the distinctive moments of tactics of carrying out auxiliary genesial technologies at patients with various index of hyperandrogenism and obesity are developed. Patients with anovulatory infertility with hyperandrogenism and obesity have received a direct linear correlation between a strong woman's body weight and low density lipoprotein, total lipids, triglycerides, total cholesterol, leptin, insulin, interleukin-6 and tumor necrosis factor-alfa. The raised indexes of low density lipoprotein were detected in 1,2 times, triglycerides in 1,7 times, total cholesterol in 1,4 times, and in 1,4 times decreased the index of high density lipoprotein. A statistically significant reduction in the LDL cholesterol level was established, which is undoubtedly an additional positive result of the prescribed therapy and a positive correlation between the body mass index and the dose of gonadotropins (r = + 0.64; p = 0.013), as well as the body mass index and controlled ovarian stimulation ( r = + 0.62; p = 0.022). Using our improved algorithm for diagnostic and treatment-preventive measures allowed to reduce the manifestations of autoimmune reactions, to eliminate immune disorders that caused the normalization of the menstrual cycle, the onset of pregnancy, which was diagnosed in 15.2 % of women in the group of IA against 37.2 % - IB groups.