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Obstetrics and Gynegology2024№4
Rationale for preoperative treatment of...

Rationale for preoperative treatment of advanced-stage endometrial ovarian cysts in infertile women

DOI
https://dx.doi.org/10.18565/aig.2023.300

Lipatov I.S., Tezikov Yu.V., Tyutyunnik V.L., Kan N.E., Martynyuk D.A., Belousov I.S.

1) Samara State Medical University, Samara, Russia; 2) Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia

Objective: This study aimed to optimize the preoperative treatment of advanced-stage endometrial ovarian cysts (EOC) in infertile women to ensure ovarian protection, improve endometrial receptivity, and normalize the pro-inflammatory status.
Materials and methods: A comprehensive examination and treatment were performed on 114 patients with stage III–IV EOC. Group I consisted of 65 infertile women who received differentiated treatment with GnRH antagonists or dienogest to overcome infertility preoperatively. The aim was to reduce the size of the EOC, decrease the severity of pain, preserve the ovarian reserve, normalize endometrial receptivity, and correct the inflammatory status. Group II consisted of 49 women who underwent surgical treatment for infertility, similar to the patients in Group I. The examination was conducted before the start of treatment/surgery, in the postoperative period, and after six months of waiting for spontaneous pregnancy. To obtain reference values for the studied parameters, control group III was formed consisting of 35 healthy women with intact ovaries and male factor infertility. These women underwent infertility treatment with ART.
Results: Changes in EOC size, ovarian reserve (antral follicle count, AMH, FSH, and E2 levels), sex steroid receptors, molecular markers of cellular transformation and apoptosis, levels of pro-inflammatory cytokines in the eutopic endometrium, and EOC capsules in the study groups demonstrated the protective effect of preoperative hormonal preparation against surgical trauma. These changes resulted in an increase in the spontaneous pregnancy rate by 9.3 times, pregnancy rate with the use of ART by 2.4 times, and live birth rate by 3.5 times.
Conclusion: This study demonstrated the advantage of the preoperative hormonal stage of treatment in infertile patients with advanced-stage EOC. This advantage was observed in relation to the structural and functional state of the EOC, preservation of the ovarian reserve, normalization of endometrial receptivity and pro-inflammatory state, and increased effectiveness in achieving pregnancy with favorable perinatal outcomes.

Authors' contributions: Lipatov I.S., Tezikov Yu.V., Martynyuk D.A., Belousov I.S. – material collection and processing, conception and design of the study, drafting of the manuscript, analysis of relevant literature; Tyutyunnik V.L., Kan N.E. – data interpretation, editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the 1Samara State Medical University.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Lipatov I.S., Tezikov Yu.V., Tyutyunnik V.L., Kan N.E., Martynyuk D.A., Belousov I.S. 
Rationale for preoperative treatment of advanced-stage endometrial ovarian cysts in infertile women.
 Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (4): 75-86 (in Russian)
https://dx.doi.org/10.18565/aig.2023.300

Keywords

endometrial ovarian cysts
infertility
preoperative hormonal treatment
estrogen and progesterone receptors
Ki-67
p53
pro-inflammatory cytokines
Full text (in Russian)

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Received 22.12.2023

Accepted 29.03.2024

About the Authors

Igor S. Lipatov, Professor, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine, Samara State Medical University, Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, i.lipatoff2012@yandex.ru, https://orcid.org/0000-0001-7277-7431,
Researcher ID: С-5060-2018, SPIN-code: 9625-2947, Author ID: 161371, Scopus Author ID: 6603787595.
Yurii V. Tezikov, Professor, Dr. Med. Sci., Head of the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine, Samara State Medical University,
Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, yra.75@inbox.ru, https://orcid.org/0000-0002-8946-501X,
Researcher ID: С-6187-2018, SPIN-code: 2896-6986, Author ID: 161372, Scopus Author ID: 6603787595.
Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Leading Researcher of Research and Development Service, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(903)969-50-41, tioutiounnik@mail.ru,
https://orcid.org/0000-0002-5830-5099, Researcher ID: B-2364-2015, SPIN-code: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500,
Natalia E. Kan, Professor, Dr. Med. Sci., Deputy Director of Science, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(926)220-86-55, kan-med@mail.ru, https://orcid.org/0000-0001-5087-5946, Researcher ID: B-2370-2015, SPIN-code: 5378-8437, Authors ID: 624900, Scopus Author ID: 57008835600.
Darya A. Martynyuk, 6th year student of the Institute of Clinical Medicine, Samara State Medical University, Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, martynuk.darya@yandex.ru, https://orcid.org/0009-0002-3253-7382
Ivan S. Belousov, 6th year student of the Institute of Clinical Medicine, Samara State Medical University, Ministry of Health of Russia, 443099, Russia, Samara,
Chapaevskaya str., 89, +7(846)958-24-18, beloucov_ivan@icloud.com, https://orcid.org/0009-0001-0889-0218

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