Акушерство и Гинекология Санкт-Петербурга. 2018; : 55-61
Синдром поликистозных яичников и дефицит витамина D
Аннотация
XXI век стал веком экологического и, соответственно, репродуктивного нездоровья, поскольку любые неблагополучные факторы внешней среды негативно влияют на гормональный гомеостаз. Увеличение количества бесплодных пар и возрастающая потребность в ВРТ - реалии современного мира, причем эффективность ЭКО не возросла. В структуре причин бесплодия пальму первенства сейчас-держат эндокринные, и при этом в структуре причин женского бесплодия порядка 20-40 % отводится бесплодию, связанному с отсутствием овуляции. Причиной 75 % всех ановуляторныхнарушений является синдром поликистозных яичников (СПКЯ). Вместе с тем патогенез ановуляции и методы ее эффективного преодоления при СПКЯ по-прежнему до конца не изучены, что вызывает многочисленные версии и контраверсии в терапии данного заболевания,отраженные в данном литературном обзоре.
Согласно заключениям современных исследований, СПКЯ очень часто сочетается с дефицитом витамина D (у 67-85% женщин с СПКЯ отмечается разной степени выраженности дефицит витамина D) [1]. В данной статье рассмотрены как вопросы патогенеза СПКЯ, так и связи низкого уровня витамина D при СПКЯ с нарушением репродуктивной функции, проведен обзор мировых исследований по определению эффективности терапии СПКЯ с помощью витамина D, целесообразности его включения в алгоритм лечения ановуляторно-го бесплодия, что позволит расширить представление о патогенезе развития ановуляции при СПКЯ, повысить эффективность преодоления бесплодия, связанного с ановуляцией при СПКЯ.
Список литературы
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Obstetrics and Gynaecology of Saint-Petersburg. 2018; : 55-61
Polycystic ovary syndrome and vitamin D deficiency
Abstract
The XXI century has become the century of ecological and, consequently, reproductive ill health, as any unfavorable factors of the environment negatively influence hormonal homeostasis. The increase in the number of infertile couples and the growing need for ART - the realities of the modern world, and the effectiveness of IVF has not increased. In the structure of the causes of infertility, the palm of the championship is now endocrine, and in the structure of the causes of female infertility of about 20-40%, infertility is associated with the lack of ovulation. The cause of 75% of all anovulatory disorders is polycystic ovary syndrome (PCOS). However, the pathogenesis of anovulation and methods for its effective overcoming in PCOS are still not fully understood, which causes numerous versions and contraversies in the therapy of this disease, reflected in this literature review.
According to the findings of modern research, PCOS is very often combined with a vita min D deficiency (67-85% of women with PCOS have a varying degree of vitamin D deficiency) [1]. This article considers both the pathogenesis of PCOS and the low level of vitamin D in PCOS, with a violation of the reproductive function, a review of the world studies on the efficacy of PCOS therapy with vitamin D, the feasibility of its inclusion in the algorithm for the treatment of anovulatory infertility, which will expand the presentation on the pathogenesis of the development of anovulation in PCOS, to increase the effectiveness of overcoming infertility associated with anovulation in PCOS.
References
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11. Ebrahimi S.O., Reiisi S., Parchami Barjui S. Increased risk of polycystic ovary syndrome (PCOS) associated with CC genotype of miR-146agene variation. GynecolEndocrinol. 2018; 11:1 -5.
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18. Huang C.C., Tien Y.J., Chen M.J., Chen C.H., Ho H.N., Yang Y.S. Symptom patterns and phenotypic subgrouping of women with polycystic ovary syndrome: association between endocrine characteristics and metabolic aberrations. Hum Reprod. 2015;30(4):937-946.
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23. Muttukrishna S., McGarrigle H., Wakim R., Khadum I., Ranieri D.M., Serhal P. Antral follicle count, anti-Mullerian hormone and inhibin B: predictorsofo-varian response in assisted reproductive technology? Br J ObstetGynaecol. 2005; 112:1384-1390.
24. Van Rooij I.A., Baroekmans F.J., Scheffer G.J., Looman C.W., Habbema J.D., De Jong F.H. et al. Serumanti-Mullerian hormone levels best reflect the reproductive decline withage in normal women with proven fertility: a longitudinal study. FertilSteril. 2005; 83:979.
25. Pierre A., Peigne M., Gynberg M., Arouche N., Taieb J., Hesters L. et al. Fanchin loss of LH-induced down-regulation ofanti-Mullerian hormone receptor expression may contribute toanovulation in women with polycystic ovarian syndrome. Hum Reprod. 2013; 28:762-769.
26. Carlsen S., VankyE., Fleming R. Anti-Mullerian hormone concentrations inan-drogen-supressed women with polycystic ovary syndrome. HumReprod. 2009; 24:1732-1738.
27. Homburg R., Ray A., Bhide P., Gudi A., Shah A., Timms P., Grayson K. Therelation-ship of serum anti-Mullerian hormone with polycystic ovarianmorphology and polycystic ovary syndrome: a prospective cohort study.Hum Reprod. 2013; 28:1077-1080.
28. Pellatt L., Hanna L., Brincat M., Galea R., Brain H., Whitehead S. et al. Granulosa cell production of anti-MuEllerian hormone is increased inpolycystic ovaries. J ClinEndocrinolMetab. 2007; 92:240-245.
29. Pellatt L., Rice S., Mason H.D. Anti-MuEllerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction 2010; 139:825-833.
30. PellattL., RiceS., DilaverN., HeshriA., Galea R., BrincatM. et al. Anti-MuEllerian hormone reduces folliclesensitivity to follicle-stimulating hormone human granulosa cells. FertilSteril. 2011; 96:1246-1251.
31. Di Clemente N., Goxe B., Remmy J., Cate R., Josso N., Vigier B., Salesse R. Inhibitory effect of MAH upon the expression of aromatase and LHreceptors by cultured granulose cells of rat and porcine immatureovaries. Endocrine. 1994; 2:553-558.
32. Laven J.S., Mulders A.G., Visser J.A., Themmen A.P., De Jong F.H., Fauser B.C. Anti-MuEllerian hormone serum concentrations in normo-ovulatory andanovula-tory women of reproductive age. J ClinEndocrinolMetab. 2004; 89:318-323.
33. Pigny P., Merlen E., Robert Y., Cortet-Rudelli C., Decanter C., Jonard S. et al. Elevated serum level of anti-MuEllerian hormone in patientswith polycystic ovary syndrome: relationship to the ovarian follicleexcess and to the follicular arrest. J ClinEndocrinolMetab. 2003; 88:5957-5962.
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