Àim of the study
To give explanation of the influence of electro-impulse therapy (EIT) with
the help of SCENAR-device on hypotalamo-hypophiso-ovarian (HHO), immune system,
hemodynamics of the organs in the small pelvis and to evaluate its effectiveness for
restoration of fertility and decrease of the recurrence frequency of the diseases in
patients with EGE.
Materials and methods
241 patients with EGE at the age from 21 to 37 with primary (79%) and
secondary (21%) infertility were examined and treated. The duration of the infertility was
from 2 to 10 years (7,8 +- 0,9 years). EGE was determined by laparoscopy, conducted in the
early lutein phase of the menstrual cycle, confirmed by the results from histological
examination.
According to the Classification of the American society on fertility 60
(24.8%) of the patients were with 1st degree of severity of ÅGE, 50 (20.7%) - with 2nd
degree, 111 (46%) - with 3rd degree and 20 (8.5%) - with 4th degree. All patients had no
occlusion of the uterine tubes. Adhesions in the small pelvis were found out in 41% of the
patients (at 1st, 2nd, 3rd, 4th degree of severity – respectively 22%, 26%, 49%, 80%).
A laparoscopy was made to all patients on the first stage of the treatment
according to the spread of EGE: a coagulation of EGE sites, resection of the endometrial
cists of the adnexa with a coagulation of the bed, incision of the adhesions. On the
second stage of the treatment the patients with EGE were divided into two groups.
In the first group – 141 patients took hormonomodulizing preparations for
6 months (progestines – 55 patient; antigonatotropines – 51 patients; gonadotropines
agonists – 36 patients).
In the second group 100 patients were treated by EIT with SCENAR device (Russia) from 1 to
3 courses according to the long scheme: 20 procedures in the first menstrual cycle and 7
procedures in the second menstrual cycle. The interval between the courses was 1 month.
The distribution of the patients by the degree of severity of EGE was adequate in both
groups. 50 healthy fertile women represented the control group. The character of the
menstrual cycle in all patients was studied by clinical parameters and some functional
diagnostics tests (determining the rectal temperature and the cervical number).
The status of the HHO system was determined by the concentration of the
luteinizing hormone (LH), the folliculo-stimulating hormone (FSH) and the steroid hormones
(estradiol, progesterone, testosterone) in the blood by radio-immune assay before and
after the treatment in 50 patients from each group. The immunologic status was determined
by the composition of leucocytes subpopulations by cytofluorometry using monoclonal
antibodies (CD3, CD4, CD8, CD14, CD16, CD19) and by the level of immunoglobulines in the
peripheral blood by radial immunodiffusion in acryl gel (Manchini) in 50 patients from
each group before and after the treatment.
Doplerometric examinations with qualitative assessment of the blood flow in
the vessels of the small pelvis were done to all patients before and after the treatment.
Statistical analysis of the obtained results was carried out by Fisher’s non-parametric
and ?-square methods.
Results
The examination showed that the main symptoms of EGE were algodismenorhea in
81.7% and dyspareunia in 40%, whose expression was not dependent on the spread of the EGE.
The functional diagnostic tests showed that in 95% of the patients with EGE the two phase
menstrual cycle was preserved with incomplete ovulation and deficiency of the lutein phase
in 20% of the cases.
The results of the hormonal examinations in EGE indicate the predominance of
dysfunctions of central genesis in the HHO system with an increase of the basal levels of
LH and FSH, with decrease of their ovulatory peaks. As a consequence there were relative
hyperestrogenia in the 1st and 2nd phase of the menstrual cycle, incomplete ovulatory peak
of estradiol, decrease of progesterone level in the middle and in the 2nd phase of the
menstrual cycle.
The immunologic examinations showed a depression of the T-cell and an
activation of the B-cell related immunity and as a consequence – increase of the
immunoglobulins of M and G class in the blood.
Analysis of doplerometric examination results of the patients with EGE
showed high-resistant blood flow in all studied vessels in the small pelvis indicating an
insufficient viscularization of the dominant follicle.
The recurrence rate of the disease after the hormonomodulizing therapy in a
period from 6 months to 1.5 years was 38.2% (22.8%, 33.3%, 37.7% and 60% at ², ²²,
²²², and ²V degrees of severity respectively). Only 25.5% of the patients with EGE
become pregnant 6 months to 1 year after the hormonomodulizing therapy.
No recurrence of the disease was detected up to 1.5 years in the patients
with EGE, treated with EIT in the postoperative period. 68% of the patients become
pregnant (82%, 79%, 35% and 22% at ², ²², ²²², and ²V degrees of severity
respectively).
It was found out that in the realization of the EIT took part both the local
reflex mechanisms and the general reaction of the body to the influence of the external
factor.
The local effect is expressed in activation of microcirculation processes
and improvement in the trophic of tissues not only in the zone of the local influence (a
stable, moderate hyperemia) but also in the viscera, conected with the given zone of the
skin on principle of the skin-visceral reflex.
The general influence of the EIT is expressed in the activation of the
non-specific mechanisms of the immune defense with increase of the quantity of the
T-activated leucocytes, normalization of the immunoglobuline balance. A decrease of the
basal levels of LH, FSH and estradiol and an increase of their ovulatory peaks occur in
the HHO system.
Thus EIT , applied in the second stage of the treatment on patients with
EGE, has an optimizing influence on HHO system, immune system, hemodynamic indexes in the
organs of the small pelvis which leads to normalization of the homeostatic indexes and to
a considerable decrease in the disease recurrence and an increase in the fertility. |
