Object of study - hormones and metabolic disorders in infertility in patients with polycystic ovary syndrome (PCOS). The goal - on the basing on the establishment of a connection between disorders of hormonal homeostasis, carbohydrate and lipid metabolism, taking into account the state of endothelial function and body weight, to develop a strategy of correction of hormonal and metabolic disorders in the treatment of infertility in patients with polycystic ovary syndrome. Methods of research: general clinical, hormonal, biochemical, carbohydrate metabolism evaluation, endothelial function evaluation, instrumental and statistical. Equipment: medical scales RP-150 with the measurement of growth, diagnostic weights of the company Boyerer, photoelectric photometer KFK-3, spectrophotometer SF-46, Biosens express analyzer, immunoassay analyzer StatFax 2100, Ultrasound Systems Aloka prosound SSD-3500SX. The thesis is devoted to the determination of the peculiarities of pathogenetic relationships between hormonal profile, carbohydrate and lipid metabolism and the state of endothelial function in women with PCOS. Based on the results obtained, a new solution to the scientific and practical task of developing a strategy for correction of hormonal and metabolic disorders in the treatment of infertility in patients with PCOS is presented. An overview of the effect of excess body weight on pituitary-ovarian-adrenal system indices in women with PCOS is deepened. It has been shown that the presence of moderate hyperprolactinemia worsens hormonal and metabolic disturbances inherent in the classical phenotype of PCOS and is accompanied by disorders of the circadian rhythm of prolactin secretion. A high frequency of violations of carbohydrate metabolism, which is associated with body mass index and hyperandrogenemia, is established. It has been shown that in the presence of normal body mass there is a hidden dysfunction of the pancreatic β-cells and insulin resistance. It was revealed in 60,6% of patients, dyslipidemia, which is caused primarily by hyperandrogenemia and a violation of insulin sensitivity. The presence of endothelial dysfunction in young women with PCOS patients is proved. The role of hyperandrogenemia as the causal factor of endothelial function disorders is argued. Moderate hyperprolactinemia, dyslipidemia, overweight and insulin resistance have been shown to be additional factors that potentiate the development of endothelial dysfunction. An increase in Anti-Müllerian hormone (AMH) production, which is associated with hyperandrogenemia, a violation of insulin sensitivity and does not depend on prolactin levels, is determined. It is proved that AMH, may be a diagnostic criterion for PCOS and a prognostic marker for the reproductive response to different types of therapy. It has been established that disorders in the structure of the ovaries and hemodynamics are due to hyperandrogenemia, and insulin resistance aggravated structural disorders. Pathogenetically substantiated and developed integrated unified approaches to the correction of hormonal metabolic disorders and endothelial dysfunction as one of the stages in treatment of reproductive function in infertile women with PCOS. The degree of implementation: 24 acts of implementation in 10 regions of Ukraine. Field of application: endocrinology, obstetrics and gynecology, family medicine, educational process.
