Introduction. Iron deficiency (ID) is in almost 90% of pregnant woman by the third trimester, persisting in 55% of cases after childbirth. This study aims identification of deficiencies in the routine diagnostics and correction of iron deficiency anemia (IDA) in pregnant women, women in labor and postpartum.

Methods. the study included 150 pregnant women from 18 to 43 years old, in whom iron therapy during pregnancy and the postpartum period analyzed in a complex of blood-saving technologies.

Results. Serum ferritin (SF) detected only in 45% of pregnant women with anemia. In the first trimester, mild anemia diagnosed in 10% of women, moderate - in 0.6%; in the second trimester - in 47.3% and 1.2%, respectively. In the third trimester, mild anemia was in 94% of patients, moderate - in 4%. Correction of IDA in 94% of cases carried out with oral iron. In the postpartum period, all women have IDA: mild anemia in 82.7%, moderate in 15.3%, severe in 2% of cases. Mild anemia treated with oral iron, moderate - with intravenous iron in 61%, in other cases used oral iron.

Conclusion. An increased severity of IDA before childbirth, in spite of it’s correction during pregnancy; it is necessary to diagnose anemia by SF in all pregnant women, with an assessment of the oral iron therapy response by hemoglobin and tolerance; in the absence of a result, intravenous non-dextran iron is indicated in the required calculated dose. Complex correction of obstetric blood loss and postpartum anemia by autoerythrocytes, blood coagulation factors and rational IDA therapy with non-dextran high-dose intravenous iron will allow us to implement restricting approach of the use of donor blood components.

Introduction. Spontaneous preterm labor remains a significant problem in obstetrics, despite years of research in this area. According to official Russian statistic agency, the rate of preterm labor in Russia from 1980 to 2018 ranges from 3.9% (1980) with a slight decrease to 3,3% (2008) and an increase to 4,4% (2013, 2018).

Aim of the study. Evaluation of the effectiveness of using a vaginal pessary (VP) in pregnant women at risk of spontaneous preterm labor.

Materials and methods. The study included 40 pregnant women who, according to ultrasound, within the specified period revealed a shortening of the сervix to ^25 mm and were diagnosed with cervical incompetence. Retrospectively, 2 groups were identified: first study group, which included 20 pregnant women with a short cervix, using VP, and second group of 20 pregnant women, who did not use a vaginal pessary.

Results. In the group with VP, no early preterm labor were noted; the average weight of preterm newborns in study group was higher, which had a favorable effect on their condition after childbirth: in the study group, not a single newborn required to be in the NICU due to immaturity.

Сondusion. Using of VP in pregnant women with signs of cervical incompetence in compliance with the indications and conditions for this method in combination with progesterone, although it can not prevent all cases of preterm labor, but, apparently, it allows to reduce the frequency of it.

Objective of the study. Optimization of transfusion support of abdominal delivery in pregnant women at risk of obstetric haemorrhage using monitored management of haemostasis disorders.

Study materials. The study group consisted of 24 women of 23-47 years old with abnormal placental invasion (API) and bleeding during caesarean section at a gestational age of 32-36 weeks. Group 1 consisted of 14 patients, who were injected with tranexamic acid as part of combined therapy; Group 2 consisted of 10 women, who were injected with aminomethylbenzoic acid as part of combined therapy.

Results. All patients received instrumental autoerythrocyte reinfusion. Three patients of Group 1 (21.4%) with refractory bleeding received recombinant coagulation factor VIIa (Coagil, Russia) at a dose of 60 pg/kg body weight (average dose 6.6 ± 1.4 mg), a

decrease in bleeding was observed, the operative treatment was completed in the form of metroplasty. In the early stages of bleeding, eight patients were injected with a prothrombin complex concentrate of 600-1,200 IU before administration of fresh-frozen plasma (FFP), which allowed to reduce the volume of donor FFP in these patients. The study of hemostasis showed a very high inverse relationship between extent of blood loss and fibrinogen level in the groups of patients.

Conclusion. The use of factor VIIa in refractory major obstetric haemorrhage (MOH) in patients with API allows to reduce the blood loss, perform metroplasty, and preserve the woman’s fertility. Patient blood management (PCM) in pregnant women with API makes it possible to conduct organ-preserving treatment in 91.7% of women.

The review examined the biological role of magnesium in providing numerous physiological processes occurring in the human body, as well as in the physiological course of pregnancy. Magnesium deficiency is defined. It was found that tissues with a high concentration of magnesium are the brain, myocardium, connective tissue, muscles, uterus and especially placenta - in pregnancy. The reasons for the high incidence of magnesium deficiency in the population and in pregnant women in particular were discussed.

Modern reference values of magnesium level in different biological environments and expediency of complex evaluation of the body magnesium supply are presented.

Risk groups of pregnant women with hypomagnesemia in need of magnesium therapy courses have been determined. Efficiency of preeclampsia prevention in pregnant women who received three monthly courses of oral magnesium during pregnancy was shown. Reasonability of prophylaxis of widespread complications of pregnancy (reccurent pregnancy loss, etc.) with application of vitamin-mineral complexes containing magnesium and components of synergistic action is justified. When diagnosing magnesium deficiency, it is necessary to replenish it by means containing organic magnesium salts in combination with pyridoxine in adequate doses. The problem of bioavailability of various organic magnesium compounds in medicinal preparations is considered.

The Latest data of domestic and foreign scientific Literature, including those from the point of view of evidence-based medicine, showing the effectiveness of oral magnesium preparations for the prevention of obstetric complications, are presented.

Safety and preference of magnesium citrate use as the most bioavaiLabLe substrate for magnesium therapy in pregnant women is justified, recommendations on use of medicines are given.

The article presents the literary review of domestic and foreign sources on fetal programming. Intrauterine programming is the in utero phenomenon that determines the subsequent susceptibility of the body to chronic and acute diseases, which is laid down at the cellular and molecular levels. Currently, this direction is promising and relevant due to the decrease in fertility rates in many countries, the emergence of a large number of low birth weight children and the postponement of childbearing by women to a later age. The article discloses the influence of excess and underweight at birth on the frequency and structure of diseases in adulthood, as well as the key links in the formation of insulin resistance, type 2 diabetes mellitus, obesity, osteoporosis, diseases of the cardiovascular system, which are based on various disorders of intrauterine development. The reasons for these disorders are changes in the synthesis of fetal and placental hormones, which regulate metabolism (with a deficit in body weight - the catabolic orientation of metabolism), redistribute blood flow and control growth. The main factors influencing the programming of diseases in the fetus are: nutritional status of the mother, the functioning of the feto-placental system, stress, bad habits, the state of the endocrine and immune systems. Particular attention is paid to the intrauterine effect of hormones such as insulin, cortisol, growth hormone and the renin-angiotensin-aldosterone system. The present-day data on the role of essential amino acids, vitamins and microelements in the development of diseases in adulthood are presented. The negative influence of both insufficient and excess vitamins on the intrauterine development of the fetus is shown, and the optimal terms for correcting their balance are indicated.

Introduction. Thyroid gland dysfunction has significant effects on the course of pregnancy and unborn child’s health. But at the same time, pregnancy itself affects the production of thyroid hormones, especially on the top of already administered thyropathy, as well as against the background of iodine deficiency in the region.

Objective of the study. Assess the thyroid pathology profile and methodological approaches to optimization of care for pregnant women for timely prevention and early detection of thyroid gland dysfunction through the example of the operation of Woman’s Health Clinic in the iodine-deficient region (Republic of Bashkortostan).

Materials and methods. The analysis of thyroid function was carried out in 450 pregnant women, who were registered with the clinic in 2019. Both subclinical and manifest hypothyroidism was detected in 18.6 and 8.7% of pregnant women, respectively. Results of the study. The observation was carried out jointly by an obstetrician-gynecologist and an endocrinologist (along with the implementation of a set of studies regulated by the recommendations of the Ministry of Health of the Russian Federation). Of the total number of the observed patients, 438 pregnant women were living in the region with insufficient iodine intake (Republic of Bashkortostan). The results obtained significantly exceed the literature data, which necessitates the development and implementation of regional programs for early diagnosis of thyroid dysfunction and its timely management in pregnant women under conditions of iodine deficiency.

Mandatory examination of thyroid function in all women in the early stages of pregnancy has been introduced.

Conclusion. Taking into account the effect of ethnicity on TSH and the iodine status in the region of residence, it can be assumed that the reference TSH values during pregnancy may be different in different regions and in different categories of women. Diagnostic criteria and indications for prescribing replacement therapy using levothyroxine sodium to treat hypothyroidism in pregnant women remain open for discussion.

Iron deficiency status is one of the most common pregnancy complications in many countries of the world and requires timely diagnosis, prevention and treatment. The article describes the current understanding of etiology, pathogenesis, clinic and diagnosis of clinical manifestations and diagnostics of iron deficiency status during pregnancy. Particular attention is paid to the regulation of iron homeostasis and screening of iron status during pregnancy. According to modern concepts, the initial iron status determines the U-shaped risk curve for pregnancy complications and the effects of iron supplementation. On the one hand, iron deficiency status has a negative impact on the development of pregnancy complications and fetal pathology. When iron deficiency anemia is detected in the first trimester of pregnancy, the association with adverse outcomes is more obvious, but this ratio usually weakens with a detected decrease in hemoglobin in the second or third trimester of pregnancy. On the other hand, several potential mechanisms have now been identified by which excessive iron supplementation or high iron status during pregnancy can have an adverse effect on pregnancy outcomes.

The article shows the need for screening of iron status during pregnancy and rational ferroprophylaxis with a personalized approach. Recommendations for choice and use of iron supplements are provided with due account for clinical guidelines and modern evidence-based data. A review of international and domestic sources devoted to the range of problems is made, experience of credible clinical trials is generalized. The issues of dosage, bioavailability, safety of use during pregnancy and pharmaceutical compatibility of iron supplements are considered.

Postmenopause is an important stage in physiological aging of women, which is associated with a whole complex of vegetative-vascular, mental, and metabolic-endocrine disorders that develop against the background of the ovarian failure and general age-related involution of the body. While there are general mechanisms of development, the clinical symptoms of postmenopause are quite individual and their severity depends not only on endocrine changes, but also on the external factors (living conditions, health status, social functioning and subjective perception of aging).

The review describes the most typical symptoms of the menopausal transition: vasomotor (hot flashes and excessive sweating), urogenital (vaginal dryness, dyspareunia, dysuria), psychoemotional (irritation, unfounded aggression, sleep disturbances), cognitive disorders (memory loss, concentration problems).

The management of postmenopausal symptoms is important and should be carried out using hormone replacement therapy. The combined drugs containing 17p-estradiol and drospirenone have proved to be effective in reducing menopausal symptoms and safe in use, therefore they can be the drugs of choice to treat menopausal symptoms. The multicentre post-marketing study showed that the long-term use of low-dose E2 and DRSP in postmenopausal women significantly improved menopausal symptoms in 86% of respondents. In addition to prescribing pathogenetic therapy, an important aspect of specialized medical care provided to women in the peri- and postmenopausal period is the need to raise their awareness of the menopause problems, change their attitude to their own health, manage menopausal symptoms and improve the quality of life.

In recent years, there have been reports of the effect of vitamin D on the intensity of early manifestations of menopausal syndrome (hot flushes, mood instability and symptoms of depression, sleep disorders) in perimenopausal women. This review of Russian and foreign literature presents the latest data on the role of vitamin D in maintaining the physical and emotional health of women during this period of life. According to the results of the study, it was found that vitamin D significantly reduces the intensity of early manifestations of climacteric syndrome in perimenopausal women. Prevention of vitamin D deficiency has a positive effect on the health of women in perimenopause, reducing the severity of manifestations of menopausal syndrome.

On the basis of the studied literature data it is shown that the effect of calciferol on serotonin metabolism is similar to the effect of serotonin reuptake inhibitors, which are used in therapy of fever episodes.

Inclusion of vitamin D (if there is a deficiency of it) in the complex therapy helps to cope with depression and insomnia. A normal supply of vitamin D provides maintenance of an optimal concentration of intracellular calcium in nerve cells, which reduces the likelihood of depression. During the perimenopause, in addition to the normalization of physical health, it is necessary to maintain its mental component. It has been proven that taking vitamin D in addition to menopausal hormonal therapy can quickly improve the emotional background, sexual function and quality of life. But still, there are cases when taking vitamin D does not cause positive changes. Most often, this is due to polymorphism of vitamin D receptors. The problem needs further study, as there is no clearly formulated treatment tactics in such situations.

At the onset of menopause, the urogenital symptoms begin to develop simultaneously with vasomotor symptoms: vaginal soreness, itching and dryness, dyspareunia, etc. The development of atrophic changes in the urogenital tract greatly reduces the quality of life and is a risk factor for the development of recurrent urinary tract infections. More than 60% of postmenopausal women, who do not take systemic menopausal hormone therapy (MHT), suffer from vaginal atrophy experience symptoms.

The article discusses and evaluates effectiveness of various therapies for genitourinary syndrome of menopause (GSM). Nonhormonal lubricating gels are recommended as the first-line therapy. Local intravaginal administration of estrogens is used in moderate to severe vulvovaginal atrophy and in the absence of contraindications. Women with estrogen-dependent cancers can use low doses of local estrogen against the background of Tamoxifen therapy. New promising therapies for GSM are presented: ospemifene, an oral active selective estrogen receptor modulator (SERM), laser therapy, dehydroepiandrosterone.

Even though the urogenital atrophy is a common disease, administration frequency of local estrogens as therapy is low. Basic principles for treatment of urogenital atrophy include alleviation of symptoms and restoration of normal blood supply to the vaginal epithelium and urothelium wall and mucous membrane. The therapy should be initiated early and the response time to therapy will depend on the degree of baseline atrophy. Vaginal moisturizers and lubricants can be used in combination with or separately from natural estrogens in cases when patients have medical contraindications to estrogen treatment.

In the civilized world, there is a dilemma on how to relate to aging - to perceive it as a natural process characteristic of any living organism or to elevate it to the rank of a disease in order to try to develop methods of “treatment”. Age-related changes in a woman begin at about 40 years old and are associated with various hormonal changes. Often this stage in the life of the fair sex does not go unnoticed, it makes unpleasant corrections to the lifestyle with the need to change established habits and rules. Interestingly, in the era of information technology, women are not always sufficiently informed about the main age-related changes in their own body. The primary task of clinicians is to timely reveal the secrets of women’s health and help them adapt to the upcoming changes. Fluctuations in hormonal status are observed throughout a woman’s life. Contrary to the common misconception among women, it is completely incorrect to identify menopause with old age, because the hormonal function in women begins to fade long before the true aging. Climax is a multistage period of life, during which all systems of the female body adapt to the new conditions of estrogen deficiency.

In the treatment of climacteric disorders hormonal therapy with synthetic analogues of female sex hormones is used. Only preparations of bioidentical hormones have a real protective effect on metabolic disorders, osteoporosis, cardiovascular complications, cognitive disorders. According to clinical recommendations, approaches to the treatment of menopausal disorders should be clearly customized to the identified risks and expected benefits. Choosing the optimal composition and regime of MHT allows to increase efficiency and minimize possible risks. Clinicians should not forget about situations where there are restrictions or contraindications to the use of MHT. The presence of absolute and relative contraindications to MHT, as well as widespread hormoneophobia in our country in women have led to the development of alternative methods of treatment of menopausal disorders.

Premenstrual syndrome is a symptom complex characterized by repeated physical, psycho-emotional, behavioral symptoms that develop into the luteal phase of the cycle (2-14 days before menstruation) and disappear with its onset. The basis of the PMS diagnosis is the cyclical nature of pathological symptoms. The PMS diagnosis is established in accordance with ICD-10 criteria based on the analysis of frequency and severity of symptoms over two menstrual cycles. Differential diagnostics of PMS, and especially its most severe form - premenstrual dysphoric disorder, should be carried out first of all with various mental diseases, because in its clinical picture often it is psychoneurological symptomatology that prevails. It is necessary to exclude major depression, dysthymic conditions, generalized anxiety, panic disorder, bipolar diseases. Similar symptoms may have anaemia, autoimmune diseases, hypothyroidism, diabetes, convulsive conditions, endometriosis, chronic fatigue syndrome, and so on. The article notes the need for a comprehensive examination aimed at identifying gynecological and associated extragenital pathology with the involvement of related specialists. The existing recommendations for treatment of PMS, confirmed by randomized controlled studies, demonstrate the effectiveness of not only combined oral contraceptives, but also non-hormonal therapy, including phytopreparation containing the extract of Vitex sacred. Their application has yielded very positive results both in randomized controlled trials and in real clinical practice.

At the same time, PMS therapy should take into account the state of general and reproductive health of women, concomitant diseases, tolerance of treatment, etc. These principles should be the basis for prevention, diagnosis and treatment of women with PMS.

The article is devoted to the extremely pressing issue of the treatment of endometriosis, which is the object of a thorough study by scientists around the world. There is no drug that is 100% effective against endometrioid heterotopias and has no pronounced side effects either in our country, or abroad. In addition, the quality of evidence base generated on the basis of randomized clinical trials on the effectiveness of drug therapy for endometriosis is not sufficient in terms of research methodology.

The Russian clinical guidelines for the management of endometriosis postulate that operational intervention is the main stage in the treatment of this disease. The treatment of endometriosis is aimed to remove the endometriotic lesion, reduce pain intensity, treat infertility, prevent progression or recurrences of the disease.

There is currently no universal drug therapy for endometriosis, and the drug therapy used to treat it is nonspecific and primarily aims to reduce the severity of existing symptoms. The drug therapy for endometriosis is chosen on case-by-case basis, depending on the extent of the disease, clinical symptoms and the patient’s needs. In addition to the above, the choice of hormone therapy for endometriosis should take into account the efficacy of a drug, its individual tolerance, the cost of treatment, the doctor’s experience in using this drug, the patient’s compliance with the doctor’s recommendations.

The article presents possible algorithms for choosing strategies in the treatment of endometriosis using surgical and pharmaceutical methods. The authors discussed the principles and mechanisms of action of hormonal drugs intended for the treatment of endometriosis. The review and analysis of modern clinical data on the problem of treatment of endometriosis is presented.

Despite a certain breadth of expertise and simplicity in diagnosis of candidal vaginitis, current monitoring of the etiological disease structure and a variety of drugs for treatment, the problem of therapy for recurrent forms of this nosology is still unresolved.

Among the problematic non albicans (C. glabrata, C. kruzei) species, the strains mainly had a dose-dependent sensitivity to the main antimycotics (fluconazole, itraconazole, miconazole, ketoconazole,), i.e. their efficacy in vivo if taken at doses safe for humans is directly associated with the ability of the drug to accumulate in the mucous membrane, creating the necessary concentration for non albicans. In this regard, determining sensitivity of fungi in clinical practice is currently more justified for non albicans species. The studies of recent years arguing against assumptions concerning pathogenesis associated with the biofilm formation by fungi of the genus Candida on the surface of the vaginal mucosa may allow come closer to the pathogenetic substantiation of the use of local and systemic etiotropic therapy.

In this case, at least two factors should be taken into account: the yeast fungus may be resistant to the used antimycotic agent, which is characteristic mainly of non-albicans species, especially C. glabrata and C. krusei, and the invasion of the fungus pseudomycelium into the vaginal mucosa.

The article discusses the issues of etiotropic therapy for vulvo-vaginal candidiasis based on the current medical data. The authors provide recommendations for the use of systemic and local antimycotics and substantiated the expediency of their separate and combined use in certain clinical situations.

Introduction. To study the prevalence of human papillomavirus infection, the frequency and structure of cervical diseases in pregnant women and determine the risk factors for their development.

Material and methods. Screening for HPV was carried out among 2620 pregnant women. Of these, 682 (29%) had HPV. 182 pregnant women with HPV and 148 without HPV were included in the additional study program and were divided into groups depending on the presence or absence of cervical disease (CWD). The research methods were used: general clinical, the Kvant-21 test to determine HPV and STIs, microscopy of the vaginal discharge, determination of the composition of the vaginal microbiota by the Femoflor 16 method, cytological examination, extended colposcopy. We used the method of logit-regression models to identify risk factors.

Results. The prevalence of diseases of the cervix (DC) in HPV carriers was 89.4%. 72.1% of them had inflammatory DC compared to 21.4% in patients without HPV (p < 0.0001). The incidence of intraepithelial lesions was 17.4% versus 2.6%, respectively (p = 0.005). The most significant risk factors for developing DC in pregnant women, in addition to HPV infection of high carcinogenic risk, are: Lack of regular screening for cervical cancer before pregnancy (OR = 34.8), a history of bacterial vaginosis (OR = 15.9), the practice of interrupted sexual intercourse during sexual contacts (OR = 14.6). Factors indicating a low risk of these diseases are: participation in the annual screening of cervical cancer, stable partnerships (one sexual partner, marriage), age under 25, and condom use (OR less than 0.25).

Conclusion. The prevalence of DC in pregnant women against the background of HPV infection is high, predominantly inflammatory in nature and associated with certain socio-demographic and clinical-anamnestic risk factors.

According to world statistics, vulvovaginal candidiasis is a very common disease with a serious tendency to recurrence and chronic-ity, which makes it a fundamentally significant medical and social problem, the solution of which is becoming a priority task facing obstetricians and gynecologists. The attention of doctors should be focused on the search for optimal treatment regimens that meet all the requirements for therapeutic approaches, the introduction of which into clinical practice should lead to a significant decrease in the incidence of the disease and its chronicity in the population, and also on increase in the relapse interval, which will certainly be reflected in improving the quality of life of women. Analysis and comparison of the effectiveness of antifungal drugs on the modern pharmaceutical market, and the choice of the most effective and safe drug can be the key to success in combating the widespread prevalence of vulvovaginal candidiasis.

The article presents the etiological aspects of vulvovaginal candidiasis, demonstrating an increase in the importance of Candida non-albicans in the pathogenesis of the disease, which is confirmed by high rates of disease prevalence, including chronic and recurrent forms. The mechanisms of vulvovaginal candidiasis development and diagnostic methods that allow to assess the state of vaginal microcenosis most adequately are considered. The negative impact of vulvovaginal candidiasis on the course of pregnancy and possible outcomes for both the mother and the fetus are also described. Special attention is paid to the ability of fungi of the genus Candida to form associations of microorganisms - biofilms, which create an obstacle to many antifungal drugs. The problem of resistance of Candida fungi to a number of antifungal drugs is highlighted. Data on the uniqueness of the composition and action of sertaconazole and the effectiveness of its use, which is confirmed by studies, including in a group of pregnant patients, are presented. The article analyses indicators of safety of sertaconazole and criteria of continuity.

The problem of vaginal infections in women (BV and VVC) remains relevant due to both the high prevalence and the lack of effectiveness of antimicrobial therapy and the risk of recurrence. One solution is to use probiotics, in particular probiotic lactobacilli that protect the vaginal environment from pathogens. The group of vaginal lactobacteria is dominated by L. crispatus, L. iners, L. jensenii, L. gasseri. Lactobacteria in the vaginal environment provide important protective functions against pathogens due to the production of lactic and other organic acids that maintain pH < 4.5, high ability to adhere to epithelium and aggregation, with the formation of biofilm and biosurfactants, inhibition of binding and adhesion of pathogenic bacteria, as well as products of antimicrobial substances such as H2O2, bacteriocins, and regulation of local epithelial immunity. Probiotic lactobacteria can be used both vaginally and orally, effectively colonizing the vaginal environment. Several meta-analyses of randomized clinical trials (RCTs) were performed to evaluate the efficacy of probiotics in combination with antibiotics and in monotherapy. The efficacy of probiotics in BV was confirmed in 4 meta-analyses, which showed a significant increase in the frequency of treatment (RR more than 1.53), including in monotherapy without antibiotics (RR more than 2.57). The efficiency of probiotics in oral use exceeded vaginal forms. In one meta-analysis of RCTs the efficacy of probiotic lactobacteria in VVC was confirmed both in achieving a higher cure rate in oral and vaginal use (RR 1,41 and RR 1,11 respectively), and in reducing the frequency of relapse (RR 0,34). Probiotics are included in clinical recommendations of the USA, Canada with the level of evidence I-II, as well as in domestic recommendations as the second stage of treatment after antimicrobial therapy.

Thus, the use of probiotics represents an alternative strategy and helps to improve treatment results through the restoration of the vaginal ecosystem.

Candidiasis is the most common fungal infection predominantly affecting the mucous membrane. The fungus Candida causes these lesions. There are strains resistant to modern antimycotic drugs among Candida spp. Due to the increase in candidiasis prevalence and the widespread use of antifungal agents, the issue of effective treatment is becoming increasingly important.

Liability of C. albicans to antigenic mimicry and suppression of the immune response mediates the evasion of the fungus from the immune response and development of excessive inflammation. The evasion of the fungus Candida from the local nonspecific immunity factors contributes to the breakdown of the antibody response initiation and cellular reactions of the acquired immunity, which are of key importance for anti-candidiasis protection. Therefore, the lack of an adequate local immune response from the mucous membranes is a possible reason for the development of a recurrent vulvovaginal candidiasis.

Modern treatment for recurrent candidiasis in the formed risk groups involves the use of prophylactic aggressive etiotropic therapy, but at a lower dose, and the pathogenetically substantiated treatment involves regulating the local immune response in the vagina through the use of immunomodulatory drugs that inhibit the growth of fungi by activating the innate and acquired components of mucosal immunity. In addition, local immunomodulators contribute to the recovery of damaged mucous membranes and additional lubrication of tissues in contrast to antimycotics, which tend to increase the clinical manifestations of infection and dryness of mucous membranes when applied topically in the early stages of treatment.

Introduction. Failures and defects of implantation after IVF are to high extent determined by maternal factors, which are manageable. However, until now, medical tactics have not been clearly defined in identifying the most significant of them among patients who have failures and defects in implantation in previous IVF programs.

Objective. To summarize research literature and results of many years of our own research to determine medical tactics in patients with failures and defects in implantation in previous IVF programs when identifying significant maternal risk factors.

Material and methods. The analysis and collation of data have been performed on the basis of 80 literature sources with a focus on the papers of domestic authors, including publications with regard to their own study results.

Results. The most significant maternal risk factors for failures and defects of implantation after IVF were identified: chronic endomyometritis and thrombophilia. The pregravid preparation algorithm has been determined in patients with chronic endometritis and with previous failures and defects in implantation after IVF, including the use of antibacterial, antiviral, anti-inflammatory, immunomodulating and physiotherapy. We show the necessity for the prescription of low molecular weight heparins in patients with thrombophilia since the establishment of pregnancy after IVF has been shown.

Conclusion. Carrying out pregravid preparation in patients with chronic endometritis and prescribing low molecular weight hepa-rins from early pregnancy in patients with thrombophilia can increase the percentage of women who have become pregnant after IVF and have passed the embryonic threshold.

It has been found that men are infected with the coronavirus 1.5 times more often than women, but at the same time 95% of them have mild infection.

There are questions that require a scientific explanation: why are men infected more often and more susceptible than women, does the virus cross the blood-testicular barrier, can it be found in the seminal fluid, does SARS-CoV-2 have an effect on the production of androgens, is the testicle affected and what are the consequences of this damage, what is the direct effect of a virus and virus-associated problems (such as social problems, isolation, quarantine, psychological problems, sedentary lifestyle, etc.) primarily on sexual function, sexual behaviour and reproduction in general?

The review article examines the SARS-CoV-2 pandemic-associated situation in 2020 and its effect on the men’s health. The article provides data on epidemiology, aspects of pathogenesis, features of new coronavirus infection in men. The authors announced the international reproduction associations (ASRM, ESHRE, RAHR) recommendations for the implementation of assisted reproductive technology (ART) programs in the era of the pandemic. Different points of view on the effect of testosterone on the disease incidence in men are presented. The importance of sperm oxidative stress and antioxidant therapy for male infertility has been shown. The tasks of an international project for the study of SARS-CoV-2 coronavirus infection and its consequences on men’s health are outlined. An invitation to collaboration with domestic and foreign specialists in the field of urology and andrology under the aegis of the National Medical Research Center of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation has been published.

Introduction. Due to refinements of assisted reproductive technology, the number of multiple pregnancies has increased substantially. Therefore, transfer of a single embryo, as opposed to multiple embryos, is a top-priority task in ART-based infertility treatment. Time-lapse microscopy (TLM) is a tool for selecting quality embryos for transfer.

The aim of the study was to assess the outcomes of single-embryo transfer following embryo incubation in a TLM-equipped incubator in patients undergoing IVF and ICSI.

Methods. The study was carried out in 743 infertile women. Single-embryo transfer following incubation in a TLM-equipped incubator was performed in 282 patients, who formed the main group; the control group consisted of 461 patients undergoing singleembryo transfer following a traditional culture and embryo selection procedure. We assessed the quality of transferred embryos, the rates of clinical pregnancy and live birth rates.

Results. The groups did not differ in the proportion of IVF and ICSI cycles, terms of age and infertility factors. In the study group, there was a higher proportion of excellent quality embryos for transfer (p = 0.001), a higher proportion of cycles with elective embryo transfer (p = 0.001) and a higher proportion of cycles with cryopreservation of embryos (p <0.001). In the subgroup of non-elective embryo transfer with using of TLM, the clinical pregnancy rate was 10% higher than in the control group (p = 0.03). The live birth rates did not differ between the TLM group and the conventional culture group depending on the type of embryo transfer.

Conclusion. Our studies show that the use of time-lapse microscopy can increase the effectiveness of IVF and ICSI programs. Continuous monitoring with short intervals provides more information about the development of embryos than the standard daily assessment.

Introduction. The issues of connective tissue dysplasia are currently highly urgent, particularly when it comes to the increase in a woman’s life expectancy and high incidence rates of the disease. According to various sources, the incidence of undifferentiated connective tissue dysplasia (uCTD) reaches 80%.

The purpose and objectives. Determine laboratory criteria for the diagnosis of undifferentiated connective tissue dysplasia (UCTD) in women with genital prolapse.

Relevance. In clinical practice, a point-based approach to the UCTD is widely used, when each phenotypic sign is evaluated by a certain number of points, the sum of which allows you to rank the manifestations of the pathology by severity. At the same time, implicit phenotypic manifestations of UCTD, which are accompanied by failure.

Material and research methods. We conducted a survey of 204 women with genital prolapse, who were divided into 2 groups. The main group consisted of 97 women with signs of UCTD, a comparison group of 107 patients without UCTD. The age of women in the main group was on average 54.2(2.5) years, in the comparison group 56.3 (1.9) years (p > 0.05). At the time of the survey, all women were in menopause from 3 to 6 years. In addition to registering phenotypic stigmas, methods for diagnosing UCTD included determining the content of amino acids in the blood serum that are involved in the synthesis of collagen and elastin, estradiol, and hormonal parameters of the thyroid system. To evaluate changes in laboratory parameters: the content of amino acids in blood serum, estradiol, the hormonal profile of the thyroid gland.

Results. We analyzed the serum levels of amino acids (Proline, lysine, and hydroxyproline) involved in the synthesis of collagen and elastin.in women with undifferentiated connective tissue dysplasia, deviations in their content from the norm were detected. Conclusion. In women with prolapse of the genitals, it is necessary to diagnose UCTD, which must be confirmed by the amino acid profile, densitometry and hormonal diagnostics of the state of thyroid function.