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Original Article

The prognostic value of progesterone-induced blocking factor in the early pregnancy loss

Nina Davidova et al.

Abstract

Background: Early pregnancy loss (EPL) is one of the significant issues of reproductology. It seems to be a purely immunological phenomenon, which concerns especially the first weeks of gestation. Embrioprotective factors are activated from the first day of pregnancy. One is progesterone-induced blocking factor (PIBF), which maintains the pregnancy.
Objective: To assess the prognostic value of PIBF in EPL, in naturally conceived women and in women undergoing In Vitro Fertilization (IVF).
Methods: This prospective observational study included 86 patients. Fifty naturally conceived women (Group A) and 36 pregnant women after IVF (Group B) were divided into three subgroups each: AI (patients with progressive pregnancy); AII (patients with EPL; AIII (patients with biochemical pregnancy (BP); BI (patients with progressive pregnancy), BII (patients with EPL), and BIII (patients with BP). Beta human chorionic gonadotropin (β-hCG), PIBF and progesterone (PG) levels were measured in women’s blood serum on the 12th to 14th day after ovulation and embryo transfer (ET), respectively. Statistical analysis was performed using a one-way ANOVA test. Differences were considered significant when p was <0.05.
Results: In subgroup AI, the mean level of PIBF was statistically significantly higher (15.94 ± 5.0 ng/mL) compared to patients with EPL (AII: 7.13 ± 5.04 ng/mL) and BP (AIII: 5.62 ± 2.76 ng/mL, p<0.05), but no significant difference was found in PIBF levels between women with EPL and BP (AII vs. AIII, p>0.05). Similarly, after IVF, PIBF was statistically higher in subgroup BI (30.14 ± 10.21 ng/mL) than in the EPL (BII: 21.11 ± 5.37 ng/mL, p<0.05) and BP subgroups (BIII: 20.72 ± 4.24 ng/mL, p<0.05). No significant differences were found in PIBF levels between EPL and BP subgroups (BII vs. BIII, p>0.05). There was no significant correlation between PIBF and PG in the subgroups of Groups A and B.
Conclusions: PIBF emerges as a prognostic indicator for EPL, encompassing even its preclinical stage. PG may be considered a prognostic marker for clinical pregnancy.

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Original Article

Therapeutic approaches of chronic endometritis at presence of adenomyosis

Natalia Pedachenko et al.

Abstract

Background: Adenomyosis as well as chronic endometritis (CE) are inflammatory diseases that attract attention due to their frequent prevalence among young women, causing dysmenorrhea, and abnormal uterine bleeding. Their combination leads to reproductive failure, affection of the psycho-emotional state, limitation of social activities (due to pelvic pain, polymenorrhagia, post-hemorrhagic anemia). This issue requires additional investigation to optimize diagnosis and treatment.
Objective: Investigate and compare the effectiveness of different treatment approaches for adenomyosis in combination with CE.
Methods: A study was conducted among 108 women with CE, among them 70 patients were diagnosed with uterine adenomyosis. Patients were divided into three groups: the main group 1 (MG1), the main group 2 (MG2) and the control group (CG). MG1 included women with adenomyosis and CE who received adenomyosis therapy with dydrogesterone. MG2 included women with adenomyosis and CE who took dienogest. The CG included all other patients with CE who received antibacterial therapy (doxycycline). All women underwent treatment control and evaluation of therapy effectiveness at 3 and 6 months after the end of therapy.
Results: After 3 months of treatment, 85.7% of MG1 and 82.9% of MG2 had a negative test for CE, compared to 86.8% of CG (p= 0.887), indicating that the difference between the groups was not statistically significant. Also, after 6 months patients were negative for CE in 93.9% of MG1, 91.4% in MG2, and 97.4% in CG (p=0.340), showing comparable distribution of patients with CЕ.
Conclusion: The study shows that in cases of adenomyosis and CE occurring simultaneously, the administration of dydrogesterone or dienogest has the same therapeutic effect on CE as antibacterial therapy.

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Review

The hormonal contraceptive choice in women with polycystic ovary syndrome and metabolic syndrome

Christian Battipaglia et al.

Abstract

Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting between 5 to 10 percent of women, characterized by anovulation and androgen excess. At least two of the following three Rotterdam criteria are needed to diagnose PCOS: 1) Irregular menstrual cycles or absence of ovulation, clinical signs of biochemical evidence of hyperandrogenism, 3) polycystic ovarian morphology. Patients with this disease tend to have a higher incidence of metabolic disorders such as insulin resistance, obesity, dyslipidemia and metabolic syndrome (MetS). Given the hyperandrogenic state and metabolic alterations of women with PCOS, it is essential to carefully tailor therapeutic options for optimal management. Among the available pharmacological interventions are hormonal contraceptives, insulin sensitizers (metformin or supplements such as carnitines, inositols or α-lipoic acid), antiandrogens (flutamide, finasteride, spironolactone and cyproterone acetate [CPA]) or drugs that induce ovulation (clomiphene citrate, letrozole or gonadotrophins injections). Treatment plans should consider each patient's unique characteristics, their metabolic status, manifestations of hyperandrogenism, and personal goals, such as menstrual regulation, weight control or aesthetic improvement desire. In patients who have no desire to become pregnant, the first therapeutic line in addition to lifestyle changes (diet and physical activity) is hormonal contraception. The best option is combined oral contraceptives (COCs) with anti-androgenic progestins like CPA, dienogest (DNG), nomegestrol acetate (NOMAC), drospirenone (DRSP), or norgestimate (NGM) paired with estrogens that offer a more effective control of hyperandrogenic symptoms and endometrial protection. Non-oral options such as the vaginal ring, transdermal patches, or progestin-only contraceptives, while offering menstrual regulation, are generally less effective in treating acne, hirsutism, and seborrhea. When androgen excess persists despite contraceptive use, anti-androgenic medications such as spironolactone, flutamide or finasteride, may help achieve optimal results. Moreover, in the presence of metabolic alterations, a combination therapy with insulin sensitizers and hormonal contraceptives, should be considered.

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