Рецепт. 2019; : 425-431
Показатели овариального резерва у женщин с расстройствами менструального цикла, принимавших оральные контрацептивы
Аннотация
У 51 женщины 20–32 лет, 16 из которых по данным анамнеза принимали оральные контрацептивы (КОК) продолжительностью 6–12 месяцев для улучшения качества жизни вследствие колебаний продолжительности цикла от 20 до 90 дней, исследованы уровни половых гормонов, в том числе изучены показатели овариального резерва, содержание фолликулостимулирующего (ФСГ) и антимюллерова гормонов (АМГ) в крови, объем яичников и число в них антральных фолликулов. У женщин, ранее принимавших оральные контрацептивы, не вы- явили достоверного снижения овариального резерва, а также различий в частоте наступления беременности по сравнению с женщинами, не получавшими данную группу препаратов. Однако при приеме КОК обнаружили статистически значимо более низкие уровни эстрадиола, фракций тестостерона в периферической крови и объем яичников по данным сонографии. У пациенток, принимавших вышеуказанные гормональные препараты, математически не установили взаимодействия между АМГ и показателями овариального резерва, известные в норме между содержанием в крови АМГ и ФСГ, а также рассчитанные нами для женщин, не использовавших оральные контрацептивы. В группе женщин с приемом КОК вычислили статистически значимую прямую зависимость средней силы между уровнем в крови АМГ и толщиной эндометриального слоя, что может свидетельствовать в пользу изменения как пролиферативных процессов, так и секреции ЛГ в отдаленном периоде терапии комбинированными эстроген-гестагенными препаратами. Скрининговое исследование АМГ показано женщинам с дисфункцией яичников, откладывающим деторождение, и регистрация его низкого уровня может служить поводом для страховочного криосохранения ооцитов.
Список литературы
1. ZHordanidze D., Nazarenko T., Fanchenko N. (2011) Diagnosticheskaya znachimost’ urovnei gormonov v perifericheskoi krovi i follikulyarnoi zhidkosti pri stimulyatsii yaichnikov v programmah EKO [Diagnostic significance of hormone levels in the peripheral blood and follicular fluid during ovarian stimulation in IVF programs]. Vestnik RDN, seriya meditsina, 2, pp. 63–67.
2. Paskar’ S., Boyarskii K. (2017) Epidemiologicheskie aspekti besplodnogo braka (obzor literaturi) [Epidemiological aspects of sterile marriage (literature review)]. Problemi reproduktsii, vol. 23, no 5, pp. 23–26.
3. Popova E., Ryazantseva E., Ruleva O., Zazarskaya I., Grineva E. (2010) Antimyullerov gormon kak prediktor menstrual’nogo otveta pri lechenii zhenschin s sindromom polikistoznih yaichnikov s pomosch’yu izmeneniya obraza zhizni i terapii metforminom [Anti-Mullerian hormone as a predictor of the menstrual response in the treatment of women with polycystic ovary syndrome with lifestyle changes and metformin therapy]. Vestnik reproduktivnogo zdorov’ya, no 12, pp. 24–29.
4. Umarova M. (2013) Sostoyanie somaticheskogo i reproduktivnogo zdorov’ya zhenschin, prinimavshih v yuvenil’nom periode oral’nie kontratseptivi [The state of somatic and reproductive health of women who took oral contraceptives in the juvenile period] (PhD Thesis), SPb., 21 p.
5. Broekmans F.J., Visser J.A., Laven J.S., Broer S.L., Themmen A.P., Fauser B.C. (2008) Anti-Mullerian hormone and ovarian dysfunction. Trends. Endocrinol. Metab, vol. 19, no 9, pp. 340–347.
6. Chabbert-Buffet N., Marret H., Agostini A., Cardinale C., Hamdaoui N., Yassoun D., Jonville-Bera A.P., Lambert M. (2018) CNGOF guidelines for clinical practice. Gynecol Obstet Fertil Senol., vol. 48, no 12, pp. 760–776.
7. D’Arpe S., Di Felicianotonio M., Canderelieri M., Franceshetti S., Piccioni M.G., Bastianelli C. (2016) Ovarian function during hormonal contraception assessed by endocrine and sonographic markers: a systematic rewiew. Reprod Biomed Online, vol. 33, no 4, pp. 436–448.
8. De Villiers T.J., Pines A., Panay N., Gambacciani M., Archer D.F., Baber R.J., Davis S.R., Gompel A.A., Henderson V.W., Langer R., Lobo R.A., Plu-Bureau G., Sturdee D.W. (2013) Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric, vol. 16, pp. 316–37.
9. Javaprakasen K., Campbell B.K., Hopkisson J.F., Clewes J.S., Johnson I.R., Raine-Fenning N.J. (2008) Effect of pituitary desensitization on the early growing follicular cohort estimated using anti-Mullerian hormone. Hum. Reprod., vol. 23, no 11, pp. 2577–83.
10. Bas-Lando M., Rabinowitz R., Farkash R., Alqur N., Rubinstein E., Schonberger O., Eldar-Gava T. (2017) Prediction value of anti-Mullerian serum levels and antral follicle count in hormonal contraceptive (HC) user and non-HC users undergoing IVN-PGD treatment. Gynecol. Endocrinol., vol. 33, no 10, pp. 797–800.
11. Somunkiran A., Yavuz T., Ycell O., Ozdemir I. (2007) Anti-Mullerian hormone levels during hormonal contraception in women with polycystic ovary syndrome. Eur J Obstet Gynecol Report Biol., vol. 132, no 2, pp. 196–201.
Recipe. 2019; : 425-431
Indicators of Ovarian Reserve in Women with Menstrual Disorders Taking Oral Contraceptives
Abstract
Indicators of ovarian reserve in women with menstrual disorders taking oral contraceptives 51 women of 20–32 years old had been were studied for investigation sex hormones levels, including the ovarian reserve indicators. There are 16 of them took contraceptives during of 6–12 months for improving the quality of life due to menstrual disorders. In women who had previously taken oral contraceptives (COCs), there was no significant decrease in ovarian reserve, incidence of pregnancy in compressing with women who did not receive this group of drugs. However, in women taking COCs, levels of estradiol, testosterone and ovarian volume were statistically lower in compressing with women who did not receive this group of drugs. In the patients taking COCs interaction between AMH and ovarian reserve indicators did not mathematically establish. For women who didn’t use oral contraceptives correlation between AMH and FSH were calculated. In the group of women taking COCs, a statistically significant direct correlation was found between the AMH in blood and M-echo. It may indicate changes in both proliferative processes and LH secretion under COCs-therapy. The AMG screening study is indicated for women with ovarian dysfunction, postponing childbearing, and registration of its low level may be a reason for the safety of cryopreservation of oocytes.
References
1. ZHordanidze D., Nazarenko T., Fanchenko N. (2011) Diagnosticheskaya znachimost’ urovnei gormonov v perifericheskoi krovi i follikulyarnoi zhidkosti pri stimulyatsii yaichnikov v programmah EKO [Diagnostic significance of hormone levels in the peripheral blood and follicular fluid during ovarian stimulation in IVF programs]. Vestnik RDN, seriya meditsina, 2, pp. 63–67.
2. Paskar’ S., Boyarskii K. (2017) Epidemiologicheskie aspekti besplodnogo braka (obzor literaturi) [Epidemiological aspects of sterile marriage (literature review)]. Problemi reproduktsii, vol. 23, no 5, pp. 23–26.
3. Popova E., Ryazantseva E., Ruleva O., Zazarskaya I., Grineva E. (2010) Antimyullerov gormon kak prediktor menstrual’nogo otveta pri lechenii zhenschin s sindromom polikistoznih yaichnikov s pomosch’yu izmeneniya obraza zhizni i terapii metforminom [Anti-Mullerian hormone as a predictor of the menstrual response in the treatment of women with polycystic ovary syndrome with lifestyle changes and metformin therapy]. Vestnik reproduktivnogo zdorov’ya, no 12, pp. 24–29.
4. Umarova M. (2013) Sostoyanie somaticheskogo i reproduktivnogo zdorov’ya zhenschin, prinimavshih v yuvenil’nom periode oral’nie kontratseptivi [The state of somatic and reproductive health of women who took oral contraceptives in the juvenile period] (PhD Thesis), SPb., 21 p.
5. Broekmans F.J., Visser J.A., Laven J.S., Broer S.L., Themmen A.P., Fauser B.C. (2008) Anti-Mullerian hormone and ovarian dysfunction. Trends. Endocrinol. Metab, vol. 19, no 9, pp. 340–347.
6. Chabbert-Buffet N., Marret H., Agostini A., Cardinale C., Hamdaoui N., Yassoun D., Jonville-Bera A.P., Lambert M. (2018) CNGOF guidelines for clinical practice. Gynecol Obstet Fertil Senol., vol. 48, no 12, pp. 760–776.
7. D’Arpe S., Di Felicianotonio M., Canderelieri M., Franceshetti S., Piccioni M.G., Bastianelli C. (2016) Ovarian function during hormonal contraception assessed by endocrine and sonographic markers: a systematic rewiew. Reprod Biomed Online, vol. 33, no 4, pp. 436–448.
8. De Villiers T.J., Pines A., Panay N., Gambacciani M., Archer D.F., Baber R.J., Davis S.R., Gompel A.A., Henderson V.W., Langer R., Lobo R.A., Plu-Bureau G., Sturdee D.W. (2013) Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric, vol. 16, pp. 316–37.
9. Javaprakasen K., Campbell B.K., Hopkisson J.F., Clewes J.S., Johnson I.R., Raine-Fenning N.J. (2008) Effect of pituitary desensitization on the early growing follicular cohort estimated using anti-Mullerian hormone. Hum. Reprod., vol. 23, no 11, pp. 2577–83.
10. Bas-Lando M., Rabinowitz R., Farkash R., Alqur N., Rubinstein E., Schonberger O., Eldar-Gava T. (2017) Prediction value of anti-Mullerian serum levels and antral follicle count in hormonal contraceptive (HC) user and non-HC users undergoing IVN-PGD treatment. Gynecol. Endocrinol., vol. 33, no 10, pp. 797–800.
11. Somunkiran A., Yavuz T., Ycell O., Ozdemir I. (2007) Anti-Mullerian hormone levels during hormonal contraception in women with polycystic ovary syndrome. Eur J Obstet Gynecol Report Biol., vol. 132, no 2, pp. 196–201.
