RISK FACTORS OF ENDOMETRIOSIS-ASSOCIATED INFERTILITY AND A COMPUTER PROGRAM FOR PREOPERATIVE DIAGNOSIS OF ENDOMETRIOSIS IN INFERTILITY
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Abstract
The aim was to assess risk factors for endometriosis-associated infertility and to create a computer program for preoperative diagnosis of endometriosis in infertile patients.
Materials and methods. Clinical-anamnestic and molecular-genetic characteristics of 150 patients with endometriosis-associated infertility and 150 patients with tubal-peritoneal infertility were studied. All patients included in the study underwent clinical and genetic examination. The most significant risk factors were selected using binary logistic regression. A computer program was created based on these data.
Results. The most significant factors in the preoperative diagnosis of endometriosis in infertile patients were chronic pelvic pain (χ2 = 21.677, p <0.001), age (χ2 = 14.172, p <0.001) and concomitant gynecological diseases (χ2 = 11.185, p = 0.001) , living in the city (χ2 = 6.788, p = 0.009), the presence of dyspareuria (χ2 = 6.954, p = 0.008), AUB (χ2 = 3.848, p = 0.050), the age of sexual debut (χ2 = 4.271, p = 0.039), a history of salpingectomy (χ2 = 1.126, p = 0.04). Based on the data obtained with the use of logistic regression and ROC-analysis, a computer program «Preoperative diagnosis of endometriosis in infertile patients» was create, which has a sensitivity of 81.5 %, specificity of 71.4 %, and a predictive probability of 91.2 %.
Conclusion. Thus, the results of the study made it possible to identify the main risk factors for endometriosis-associated infertility and to create a computer program for the preoperative diagnosis of endometriosis, which has a high prognostic value.
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Author Biographies
Лариса Николаевна Данилова, Kuzbass Clinical Emergency Hospital named after M.A. Podgorbunsky, Kemerovo
head of the gynecology departmentНаталья Владимировна Артымук, Kemerovo State Medical University
Artymuk Natalia Vladimirovna
MD, PhD, professor, deputy editor of the journal Mother and Baby in Kuzbass.
She is the Head of the Department of Obstetrics and Gynaecology №2, the Deputy Editor-in-Chief. She is also the President of the Kemerovo regional public organization “Association of obstetricians and gynecologists”, the chief obstetrician-gynecologist of the Siberian Federal district; the member of the Board of the Russian Society of Obstetricians and Gynaecologists, the member of the European Society of Contraception and Reproductive Health, the European Society of Gynaecological Oncology and the International Society of Gynecological Endocrinology.
She has graduated from Kemerovo State Medical institute with honors. She studied in clinical residency in obstetrics and gynecology at School of Arenberg (Salzburg, Austria) and School of Bloomberg (Johns Hopkins University, Baltimore, USA). One is a specialist in ultrasound diagnostics in obstetrics and gynecology, endocrinology and endoscopic surgery. In 1996 in Barnaul she defended her PhD thesis and her doctoral thesis in 2003 in Moscow.
Her priorities are: endocrine gynecology, infertility, cervix uteri pathology, menopausal disorders, disorder of menstrual function, endoscopic and abdominal gynecological surgery.
She deals with reproductive health problems, non-surgical and surgical treatment of benign neoplasms of genital organs. She is an author of more than 450 scientific works, including 3 monographs and study manuals for doctors. She has her highest medical qualification category in “Obstetrics and gynecology”.
References
Senapati S, Barnhart K. Managing Endometriosis Associated Infertility. Clin Obstet Gynecol. 2011; 54(4): 720-726. doi: 10.1097/GRF.0b013e3182353e06
Endometriosis: A Concise Practical Guide to Current Diagnosis and Treatment Editors: Liselotte Mettler, İbrahim Alkatout, Jörg Keckstein and Ivo Meinhold-Heerlein Publisher: Endo Press GmbH (Edition 1). 2018. Number of pages: 480 ISBN: 978-3-89756-819-8
Yin Mon Khine, Fuminori Taniguchi, Tasuku Harada. Clinical management of endometriosis-associated infertility. Reprod Med Biol. 2016; 15: 217-225. doi: 10.1007/s12522-016-0237-9
Pantou A, Simopoulou M, Sfakianoudis K, Giannelou P, Rapani A, Maziotis E et al. The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization. J Clin Med. 2019; 8(4). pii: E548. doi: 10.3390/jcm8040548
Hyejin Hwang, Youn-Jee Chung, Sa Ra Lee, Hyun-Tae Park, Jae-Yen Song, Hoon Kim et al. Clinical evaluation and management of endometriosis: guideline for Korean patients from Korean Society of Endometriosis. Obstet Gynecol Sci. 2018; 61(5): 553-564. https://doi.org/10.5468/ogs.2018.61.5.553 pISSN 2287-8572 eISSN 2287-8580
Vargas E, Aghajanova L, Gemzell-Danielsson K, Altmäe S, Esteban FJ. Cross-disorder analysis of endometriosis and its comorbid diseases reveals shared genes and molecular pathways and proposes putative biomarkers of endometriosis. Reprod Biomed Online. 2020; 40(2): 305-318. doi: 10.1016/j.rbmo.2019.11.003
Bozdag G, Alp A, Saribas Z, Tuncer S, Aksu T, Gurgan T. CYP17 and CYP2C19 gene polymorphisms in patients with endometriosis. Reprod Biomed Online. 2010; 20(2): 286-290. doi: 10.1016/j.rbmo.2009.11.007
Artymuk N, Zotova O, Gulyaeva L. Adenomyosis: genetics of estrogen metabolism. Horm Mol Biol Clin Investig. 2019; 37(2): /j/hmbci.2019.37.issue-2/hmbci-2018-0069/hmbci-2018-0069.xml. doi: 10.1515/hmbci-2018-0069
Artymuk NV. Endometriosis. Pathogenesis, diagnosis, treatment /NV Artymuk, VF Bezhenar, YuD Gimbut [and others]. M.: GEOTAR, 2020. 352 p. (Артымук Н. В. Эндометриоз. Патогенез, диагностика, лечение / Н.В. Артымук, В.Ф. Беженарь, Ю.Д. Гимбут [и др.]. М.: ГЭОТАР, 2020. 352 с.)
Li YG, Wang X. Association of the CYP1B1 gene polymorphism with susceptibility to endometriosis. Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2009; 26(1): 66-69. doi: 10.3760/cma.j.issn.1003-9406.2009.01.015
Trabert B, Schwartz SM, Peters U, et al. Genetic variation in the sex hormone metabolic pathway and endometriosis risk: an evaluation of candidate genes. Fertil Steril. 2011; 96(6): 1401-1406.e3. doi: 10.1016/j.fertnstert.2011.09.004
Barbosa AM, de Souza SR, Frare AB, et al. Association of CYP1A1 (cytochrome P450) MspI polymorphism in women with endometriosis. Genet Mol Res. 2016; 15(3): 10.4238/gmr.15038389. Published 2016 Aug 26. doi: 10.4238/gmr.15038389
Blakemore J, Naftolin F. Aromatase: Contributions to Physiology and Disease in Women and Men. Physiology (Bethesda). 2016; 31(4): 258-269. doi: 10.1152/physiol.00054.2015
Painter JN, Nyholt DR, Krause L, et al. Common variants in the CYP2C19 gene are associated with susceptibility to endometriosis. Fertil Steril. 2014; 102(2): 496-502.e5. doi: 10.1016/j.fertnstert.2014.04.015
Wang HS, Wu HM, Cheng BH, et al. Functional analyses of endometriosis-related polymorphisms in the estrogen synthesis and metabolism-related genes. PLoS One. 2012; 7(11): e47374. doi:.10.1371/journal.pone.0047374
Yi K, Yang L, Lan Z, Xi M. The association between CYP19 polymorphism and endometriosis risk: a system review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016; 199: 42-48. doi: 10.1016/j.ejogrb.2016.01.010
Cardoso JV, Machado DE, Ferrari R, Silva MCD, Berardo PT, Perini JA. Combined Effect of the PGR +331C > T, CYP17A1 -34A > G and CYP19A1 1531G > A Polymorphisms on the Risk of Developing Endometriosis. Efeito combinado dos polimorfismos PGR +331C > T, CYP17A1 -34A > G e CYP19A1 1531G > A no risco de desenvolvimento da endometriose. Rev Bras Ginecol Obstet. 2017; 39(6): 273-281. doi: 10.1055/s-0037-1604097
Zotova OA, Artymuk NV. Adenomyosis: clinical picture, risk factors, problems of diagnosis and treatment. Gynecology. 2013; 15(6): 31-34. (Зотова О.А., Артымук Н.В. Аденомиоз: клиника, факторы риска, проблемы диагностики и лечения //Гинекология. 2013. Т. 15, № 6. С. 31-34)
Endometriosis: A Concise Practical Guide to Current Diagnosis and Treatment Editors: Liselotte Mettler, İbrahim Alkatout, Jörg Keckstein and Ivo Meinhold-Heerlein Publisher: Endo Press GmbH (Edition 1). 2018. Number of pages: 480 ISBN: 978-3-89756-819-8