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Chronic endometritis with impaired receptivity of uterine cavity epithelium (the “thin” endometrium) is considered the most common cause of recurrent implantation failures during in vitro fertilization (IVF). Chronic inflammation, accompanied by autoimmune mucosal reactions, may lead to a perverse immune response of lymphocytic cells with altered cascade of cytokine reactions, thus preventing efficiency of decontamination therapy, followed by potential inability to perform reproductive function in the patients. The article concerns our experience of complex preimplantation preparation of patients with recurrent implantation failures caused by chronic endometritis during a course of intrauterine administration of cavitated solution of recombinant interleukin 2 (rIL-2). Our aim was to assess some changes in local immune status in the patients with chronic endometritis and repeated implantation failures during complex preparation for the IVF procedure, using a cavitated solution of rIL-2.A study of the local immune changes of uterine cavity in the patients with recurrent implantation failures suffering with chronic endometritis was carried out under complex preparation for IVF with thawed embryos (n = 82). A control group included the infertile women with normal endometrial thickness (> 7 mm at M-echo), with excluded diagnosis of chronic endometritis (n = 30). Complex therapy included decontamination and contamination; hormone replacement therapy; intrauterine ultrasonic cavitation of rIL-2 solution. Dynamic assessment of the local immunity was tested in the endometrial biopsies. We performed analysis of the main subpopulations of immune lymphoid cells, morphological composition, phagocytic responses and cytokine status.he state of immunocompetent cells and cytokine profile of endometrial samples in the patients with chronic endometritis indicates a possible Th2 shift of the local immune response, with changing ratio of cytokines leading to impaired molecular, subcellular and cellular structures, which, along with fluctuating activity of other components of uterine cavity homeostasis, may determine a recurrent course of the disease with impaired endometrial morphology. Preimplantation preparation with intrauterine irrigation with a cavitated solution of rIL-2 in patients with recurrent implantation failures accomplished by chronic endometritis helps to improve the indices of local immunity, being more effective (an average of twofold), compared with the group of conventional preparation for IVF with thawed embryos. The treatment may promote the proliferative processes in epithelium of the uterine cavity thus contributing to increased potential of endometrium for implantation and occurence of clinical pregnancy.

Background. The relevance of the problem is related to the high prevalence of chronic endometritis (CE); its role in female infertility, implantation failures during assisted reproductive technology procedures, and recurrent miscarriage; as well as the lack of a unified strategy in the diagnosis and treatment of this pathology. The present systematic review with a meta-analysis focuses on evaluating the impact of CE and its therapy on the outcome of in vitro fertilization. In addition, the effect of CE of various severity on the outcomes of assisted reproductive technologies is analyzed. Objective. To analyze the effect of CE of varying severity and its treatment on the outcomes of in vitro fertilization. Methods. Using PubMed, Medline, Scopus, Embase, ELibrary, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry, and Russian Science Citation Index, a systematic search was conducted for articles published over the past 12 years that met the following criteria: randomized controlled trial examining the effect of CE of varying severity on fertility and ways to treat it. The following indicators were calculated: ongoing pregnancy/live birth, clinical pregnancy, and miscarriage rates. A total of 4145 patients (from ten studies) were included. A meta-analysis was performed using Stata 11.0 software (The Cochrane Collaboration, Oxford, UK). The heterogeneity was considered low at I2 50%. Results. Women with CE exhibited lower ongoing pregnancy/live birth (OR 1.97; p = 0.02) and clinical pregnancy rates (OR 2.28; p = 0.002) as compared to women without it. CE treatment increased the ongoing pregnancy/live birth (OR 5.33; p < 0.0001) and clinical pregnancy rates (OR 3.64; p = 0.0001). In vitro fertilization outcomes were comparable in women treated for CE and women without CE (ongoing pregnancy/live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Women with severe CE exhibited lower ongoing pregnancy/live birth (OR 0.43; p = 0.003) and clinical pregnancy rates (OR 0.40; p = 0.0007). Mild CE showed no significant effect on in vitro fertilization outcomes (ongoing pregnancy/ live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Conclusion. The conducted meta-analysis showed that CE significantly reduces the ongoing pregnancy/live birth and clinical pregnancy rates in infertile women undergoing in vitro fertilization. Noteworthy is that antimicrobial therapy in such patients improves the results of assisted reproductive technologies, which are comparable to those of patients without CE. The negative impact of this pathology on the implantation capacity of the endometrium is most often observed in the severe form, while its mild form has virtually no effect on the in vitro fertilization outcome.

Objective: assessment of the microbiome of the vagina and uterine cavity using a uterine catheter with a collet guide in infertile patients before the in vitro fertilization procedure. Materials and methods: samples of vaginal and endometrial scrapings obtained from 73 infertile women who had planned an in vitro fertilization (IVF) procedure were taken and studied. The samples were analyzed by V3-V4-V6 regions using the 16S rRNA gene sequencing method. Results: significant differences were found in the taxonomy of the endometrium and vaginal microbiome - coincidences in microbiological composition were detected in 18.2% of patients. Endometrial lactobacillus-dominant microbiocenoses occurred in 24.8% of women, vaginal — in 56.7%. Comparisons between patients with negative and positive IVF (onset of biological pregnancy) results failed to identify any microorganism associated with the success of the procedure, with endometrial microbiota biodiversity being higher among women who successfully exercised their reproductive function. The Shannon Equality Index (J) for pregnant and non-pregnant women was 0.76 (0.57–0.87) and 0.55 (0.51–0.64), respectively (p=0.002). Conclusion: the use of a developed uterine catheter with a collet guide for an adequate assessment of the endometrial microbiome is promising and justified. The correct assessment of the endometrial microbiocenosis contributes to the adequate diagnosis of pathological processes occurring in the uterine cavity, which will allow for proper therapy aimed at increasing the receptivity of the endometrium and, in the future, contributing to the realization of the reproductive function of a woman.

Background. Relevance of the study is related to the lack of a unified strategy for determining the risk of infectious complications of puerperium. Currently, the specialists use the collected data from studies documenting the main factors of infection in a population or cohorts of postpartum women. However, accuracy of these factors is not established and prognosis could not be personalized. The paper analyzes significant risk factors for the infectious complications associated with cesarean section (C-Section) and develops a model for their prognosis and an individual assessment of the risk of postpartum infection in order to take timely preventive measures. Objective. To identify predictors of postpartum purulent-inflammatory complications after cesarean section, to evaluate their predictive value, and to develop a statistical model for determining the risk of their occurrence.Methods. The cohort retrospective study (January 2019 to January 2022) was conducted in four obstetric health facilities of Krasnodar and was focused on analysis of medical records. Anamnestic, clinical and laboratory data of all women after cesarean section delivery were collected. Model: a patient diagnosed with any infection associated with cesarean section within 42 days after delivery — postoperative suture infection, endometritis, peritonitis, thrombophlebitis, sepsis. Infections were grouped to carry out a single risk assessment with an internal validation test and to develop a multifactor logistic regression model. All analyses were conducted using version R 3.2.3 (SPSS Inc., Chicago, IL) and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD).Results. Infection associated with cesarean section occurred in 2.50% of women (n = 548; 95% CI 2.6–3.5), suture disruption — in 0.59% (n = 129; 95%, CI 0.41–0.81), endometritis — 1.46% (n = 321; 95%, CI 1.15–1.94), peritonitis — 0.16% (n = 35; 95%, CI 0.11–0.20), thrombophlebitis 0.04% (n = 9; 95%, CI 0.01–0.05), sepsis 0.25% (n = 54; 95%, CI 0.15–0.35). The authors have identified 14 major variables with a high prognostic risk for the development of infectious complications of puerperium. The model differentiated women with and without purulent inflammatory complications of puerperium by internal validation (concordance index = 0.712, 95%, CI 0.672–0.755).Conclusion. The developed model can be used to accurately predict the risk of infectious complications after abdominal delivery and to identify high-risk patients. It ensures a differentiated approach with a possibility to expand studies and strengthen antibiotic therapy, which promotes reduction of surgical site puerperal infection.

Background. The relevance of the problem is supported by the lack of effective secondary prevention measures against human papillomavirus (HPV)-associated cervical intraepithelial neoplasia (CIN) and cervical cancer. The only currently verified treatment for lower genital neoplasia is destructive therapy, with the recurrence rate of viral infection remaining quite high even after such interventions. The preventive role of HPV vaccine at pre-existing cervical lesions is actively debated worldwide, but the evidence remains scattered and contradictory. The present study surveys the scientific publications available that evaluate the efficacy of human papillomavirus vaccination as a secondary prevention measure against related cervical pathology.Objectives. An evidence survey on the efficacy of adjuvant vaccination against human papillomavirus in patients undergoing destructive therapy for cervical intraepithelial neoplasia.Methods. We have conducted a 10 year-depth review of scientific literature on the adjuvant human papillomavirus (HPV) vaccination efficacy for reducing the recurrence risk of precancerous cervical neoplasia. The results are presented in form of the difference of mean or pooled 95% confidence-interval odds ratios (OR; 95% CI). Statistical analyses were conducted with Review Manager v. 5.4 (The Cochrane Collaboration, 2020).Results. Thirteen Russian- and English-language studies were selected for final analysis. A total of 21,702 cervical dysplasia patients were included: 5,941 (27.4%) received a perioperative HPV vaccine, while 15,761 (72.6%) only had surgical treatment. Recurrences of CIN I (mild cervical intraepithelial neoplasia; OR 0.45, 95% CI 0.27–0.73; p = 0.001) and CIN II (moderate cervical intraepithelial neoplasia; OR 0.33, 95% CI 0.20–0.52; p

Introduction. The article presents a comparative analysis of the treatment of patients with combined estrogen-dependent pathology of female reproductive system: fibrocystic mastopathy and endometrial hyperplasia without atypia. The experience of treatment with an indole-carbinol-containing drug as monotherapy while using a levonorgestrel-releasing intrauterine system is presented.Aim. To evaluate the clinical efficacy of indolecarbinol in the treatment of patients with combined estrogen-dependent pathology of the female reproductive system.Materials and methods. The authors studied the responses to the treatment of patients with fibrocystic mastopathy and simple endometrial hyperplasia (n = 65) with the indole-carbinol-containing drug at a dose of 400 mg once daily for 12 months. All patients were divided into two groups: Group I (n = 32) – women who refused hormone therapy (indole-carbinol monotherapy); Group II (n = 33) – the use of indole-carbinol while using the levonorgestrel-releasing intrauterine system. Diagnostic methods: clinical and laboratory examination, ultrasound examination of mammary glands and pelvic organs, mammography, nipple discharge cytology at baseline and 6 and 12 months after the start of therapy. Before study group assignment to treatment, all patients underwent hysteroscopy with endometrial biopsy and histological examination. Descriptive statistics were used to evaluate the data: p-values below 0.05 were considered statistically significant.Results and discussion. The presented experience in treating women with combined pathology of the female reproductive system (fibrocystic mastopathy and endometrial hyperplasia without atypia) with the indole-carbinol-containing drug showed high clinical efficacy in mastopathy (relief of mastodynia (83.0 ± 1.6%), improvement of the ultrasound view of BI-RADS (66.1 ± 1.4%), reductions in mammographic density (66.1 ± 2.1%, p < 0.05)), high tolerability and satisfactory compliance. This drug combined with hormone therapy is recommended for the treatment of endometrial hyperplasia.Сonclusion. The use of indole-carbinol in the treatment of benign hyperplastic processes in mammary glands and endometrial hyperplasia is pathogenetically substantiated and shows high clinical efficacy

Introduction. Vaginal infections of nonspecific etiology caused by microbiocenosis disorder is one of the leading aspects of gynecological morbidity in recent times. According to research statistics, the incidence of such disease varies from 30 to 80% among all inflammatory lower genital tract diseases in women. Aim of the study: to present the experience of preparation for ART in patients with chronic endometritis against the background of mixed forms of vaginal dysbiosis. Material and methods. The results of treatment with a drug containing metronidazole and miconazole nitrate (vaginal suppositories once a day at bedtime for 7 days) were studied in combination with natural micronized progesterone in 36 women with infertility caused by endometrial receptivity disorder due to chronic endometritis against the background of vaginal dysbiosis, in whom pre-implantation preparation with embryo transfer was carried out after the end of the therapy. The following were used: assessment of microbiota status of urogenital tract – PCR (femoflor-16), measurement of vaginal environment pH, Hay/Ison criteria, endometrial pipelle biopsy and endometrial immunohistochemical evaluation of endometrial receptivity (LIF, LIF-R) on the 3rd and 7th days after LH peak. Conclusion. The presented experience of complex local therapy of women diagnosed with “Infertility against the background of chronic endometritis and vaginal dysbiosis“ using a drug containing metronidazole and miconazole and natural micronized progesterone in the form of vaginal gel can be useful for practicing obstetricians-gynecologists and other interested specialists.

Because of the conducted microbiological research cervic-vaginal zone with carriers of human papilloma virus identified local factors homeostasis that contribute to the progression of the process with a cervical lesion as cervical intraepithelial neoplasia. The comparative analysis of prophylactic use of eubiotiks and acid glycyrrhizinic drug for the prevention of HPV-associated lesions of the cervix.