OPTIMIZATION OF THE TREATMENT OF WOMEN WITH PROLACTINOMAS SUFFERING FROM ENDOCRINE INFERTILITY

*Kh.K. Nasirova and Z.Yu. Khalimova

ABSTRACT

Fertility is a person’s ability to reproduce, in accordance with the UN international demographic dictionary.[2,8] Infertility is the absence of pregnancy with regular sexual intercourse during the year, without observing any contraceptive measures.[3,5] Despite active scientific activity aimed at developing various schemes for the treatment of infertility, the development of assisted reproductive technologies, its prevalence is quite high, according to various authors, 12-18%.[2,11] The highest rates of primary infertility (inability to give birth to a first child) - over 2.5% of all women - were obtained for a number of developing countries and for Moldova. The lowest - 0.5-0.7% - for the countries of South America (Peru, Bolivia, Venezuela, Ecuador) and Poland. In Russia, secondary infertility covers 3.2% of all women aged 20-44 (for comparison: in the USA, Norway and Finland, this share is 1%, that is three times lower). Primary infertility in Russia is 1.9%, which coincides with the global average.[5] According to various studies conducted in Uzbekistan, the proportion of women suffering from primary infertility, from among the married, is from 4.9% to 5.3%. Residents of African countries (9-12% of all women) suffer the most from secondary infertility. At least this problem characteristic to the highly developed countries. So, in Finland, Norway and the USA, this figure does not exceed 1% of women. At the global level, the number of infertile couples in 2010 was estimated at 48.5 million. Of these, 29.3 million cannot give birth to another child, in addition to existing children. In 2010, 1.9% of women aged 20-44 years “at risk of pregnancy” in the world were unable to give birth to their first child (primary infertility), according to a study by Victoria Sakevich. And 10.5% of women who already have children could not give birth again (secondary infertility). Coverage of primary infertility ranges from a minimum of 1.5% in Latin America to a maximum of 2.6% in the North Africa / Middle East region. Experts note a high level of primary infertility in Eastern and Central Europe and Central Asia - 2.3%. In the same region, the most depressing situation with secondary infertility is 18%. There are many causes of infertility, for each woman they are individual, often have a combined character. Therefore, the treatment of a patient with infertility is long, accompanied by high material costs.[7,16] The influence of the pituitary adenoma on menstrual irregularities and reproductive function remains an urgent problem of modern endocrinology and gynecology.[2,15] The pituitary adenoma is a benign neoplasm originating from the glandular tissue of the adenohypophysis, which can cause hyper- or hyposecretion of hormones.[13,22] Between all intracranial tumors it is the third most common after gliomas and meningiomas.[1,4] The percentage of this disease between all primary CNS tumors is from 7.3 to 18% and is detected at the age of 20 to 50 years. It is more common in women 20-30 and 50-60 years old.[2.21] In addition to serious neurological disorders, this pathology can lead to no less serious violations of the reproductive function of women. Prolactinomas are most common among pituitary adenomas and make up 40-50% of them. This is a hormonally active tumor that secrets an increased amount of prolactin.[8,12] It is observed in women of childbearing age 6-10 times more often than in men. Normally, prolactin, along with follicle-stimulating (FSH) and luteinizing hormones (LH), has a regulatory effect on the fertile function of women. The functions of prolactin include: - synchronizes follicular maturation and ovulation together with LH; - supports the existence of the corpus luteum and the formation of progesterone through participation in the synthesis of cholesterol; - prepares the mammary glands for lactation; - regulates the volume and composition of amniotic fluid.[10,19]

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