Dissertation for obtaining the scientific degree of Doctor of Philosophy in the
field of knowledge 22 Health care in the specialty 222 Medicine. - P.L. Shupyk
National University of Health Care, Kyiv, 2024.
The dissertation is devoted to the issues of diagnosis and treatment of early
cervical lesions in patients with infertility by obtaining new data on the peculiarities
of cervical immunity and the possibilities of therapeutic influence on them.
Infertility in a couple, which is defined as the absence of pregnancy during 12
months of regular active sexual life without contraception, affects 10% to 17% of all
couples in the world. The true incidence of infertility is difficult to identify, mainly
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because of the social orientation of the disease. From 40 to 50% of all cases of
infertility in a couple are associated with female factors.
The causes of female infertility have various origins. Genetic, endocrine,
anatomical, and immunological abnormalities, as well as their combinations, can be
the cause of reproductive failure [144]. In 85% of all couples seeking help for
infertility, one of the factors or their combination is found. Currently, in the practical
field, ovulation disorders (as part of the polycystic ovary syndrome, in particular),
fallopian tube patency disorders (as a result of their previous ligation, inflammatory
infectious process), and endometriosis are identified as the main female causes of
infertility. About 70% of all women with ovulatory dysfunction have polycystic
ovary syndrome (PCOS). The remaining 15% of couples have no identified cause of
infertility (Carson S, Kallen A. 2021).
Modern methods of treating infertility include stimulation of ovulation
(gonadotropic hormones of various origins, estrogen antagonists), reconstructive
operations on fallopian tubes and various types of assisted reproductive technologies
(ART). ART is used in the case of unexplained infertility, obstruction of both
fallopian tubes, lack of effect from other treatment methods, and in women older
than 38 years (Orumaa M. et al, 2019).
Early cervical lesions (ECL) can be considered an integral result of disorders
of hormonal and immune regulation, as well as vaginal biocenosis, i.e. leading
mechanisms of implementation of the fertile function. Cervical intraepithelial
lesions (CIN) of the I-III degree, as well as the non-invasive stage of cervical cancer,
belong to RCU. The frequency of ECL in Europe is at the level of 6-7% (Kurtay S,
2022), in Africa - 12-13% (Kyrgiou M. et al., 2022). 95% of all cases of cervical
lesions and cervical cancer are associated with human papillomavirus (HPV)
(Stelzle D et al., 2020). The prevalence of infection with it in the world varies
between 11-13%, the highest is in Africa (24%), in Europe (21%), in Latin America
(16%), depends on young age, numerous sexual partners, hormonal contraception
and smoking . It has been calculated that it takes 10 to 20 years for cervical epithelial
lesions associated with HPV to turn into cervical cancer in women with a normal
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immune system, and 5 to 10 years in women with a compromised immune system
[81]. The mechanism of HPV's oncogenic action is based on its ability to be
incorporated into the cellular genome, that is, to affect the cycle of cell division,
while at the same time avoiding the systemic immune response [56]. The treatment
of RCU is a controversial issue, with recommendations ranging from a one-year
follow-up period in young women with CIN 1 without risk factors to surgical
removal of the altered epithelium. Surgical methods are divided into excisional
(removal of the cervical segment with altered epithelium) and ablative (destruction
of pathologically altered epithelium) [121]. Both methods affect the ability of the
cervix to perform the obturation function during pregnancy and the dilatation
function during childbirth.
Thus, infertility and ECL have a fairly high prevalence in the population, as
well as a mutual influence, the research and minimization of which this study is
devoted.
The purpose of the study is to improve the diagnosis and treatment of early
cervical lesions in women with infertility based on the study of mutual pathogenetic
influence.
Research materials and methods.
The study was conducted according to the principle of cohort prospective.
Taking into account the formulated goal, the study included patients who applied to
the Kyiv City Center of Reproductive Medicine during the years 2019-2023 and did
not become pregnant. The criterion for inclusion in the study was the absence of
pregnancy in a couple under the condition of regular sexual life without
contraception for 1 year.
