L.V.Borovkova, I.E.Holmogorova, V.D.Uchaikina, E.V.Chelnokova
Nizhny Novgorod State Medical Academy
N.A.SEMASHKO MPO (MEDICAL PUBLIC OFFICE) REGIONAL CLINICAL HOSPITAL NIZHNY NOVGOROD
SCENAR-THERAPY CLINICAL EFFECTIVENESS FOR THE PATIENTS WITH TUBAL-PERITONEAL INFERTILITY
Background. Tubal-peritoneal factor occupies the first place in the structure of ethiopathogenetic reasons of fertility and it counts in about 40-60% of all female fertility cases [1, 2]. Main reasons of tubal-peritoneal fertility are inflammatory diseases (both of the bacterial and viral genesis) and adhesions formation in the postoperative period. Many researchers note that it is rather difficult to restore fertility in this group of patients even by using endosurgical methods of treatment. Registered rate of pregnancy coming after reconstructive plastic surgeries done using operative laparoscopy doesn’t exceed 21-28% [3, 4]. We can conclude that judging by ways of increasing the effectiveness of tubal infertility treatment and postoperative adhesive process, progress will be determined not only by perfecting the surgical technique itself (which has reached almost 100% effectiveness in eliminating the anatomic fallopian tubes blocking), but more than that, by the postoperative rehabilitation therapy success (which is meant for correcting the impaired tube function with a restored lumen and preventing the postoperative adhesive process).
Chronic inflammatory diseases of the female pelvic organs cause systematic changes in the female body involving not only inner genitals, but almost all homeostasis links. Psycho-emotional sphere, autonomic body regulation, immunological status, gonadotropic and ovarian hormones metabolism and secretion [5,6] become involved into the pathological process. The methods of treatment used appear to be not so successful, which is caused by the persisting principle of the predominant influence upon the organ pathology. The state of central regulation mechanisms (psycho-emotional state, autonomic nervous regulation) and a concomitant extragenital pathology character are not always taken into consideration [1,2].
So, we are looking for the methods of treating the patients with tubal-peritoneal infertility, which would not only eliminate the mechanic fallopian tubes blocking, but would also have optimizing influence upon all homeostasis parameters.
Research objective: To evaluate SCENAR-therapy clinical effectiveness for the patients with infertility of tubal-peritoneal genesis.
Methods of statistical analysis of the material: Statistical data was processed in a Statistica 6.0 program. The regulacy check was done using the Kolmogorov and Smornov’s criterion. Actual data is presented as <average + standard deviation> (?+?). We used Student’s t-criterion for dependent groups to determine dependent samples differences reliability taking a regular distribution law. If the analyzed samples’ distribution differed from the regular one, we used the Wilcoxon criterion for dependent groups. We took a critical level equal to 0.05 in our research.
Data for study and discussing it
We have done a complex examination of 111 women with tubal-peritoneal infertility (aged 29-39, (28.4 + 1.7) on average). Total infertility duration was from 1 to 15 years (8.3 + 2.1 years on average). We traced back that 15% of patients had the II degree adhesive process, 51% – III degree, 34% – IV degree respectively. All examined women were divided into 3 groups: the first group (the control group) included women who had just undergone laparoscopy (30 women), the second group included women who had just undergone laparoscopy and SCENAR-therapy (39 women), and the third group included women who had undergone only SCENAR therapy (42 women) (the infertility factor was revealed on the uteroturbography).
We used SCENAR 97.4+, 97.5 (or SCENAR-1-NT) and SCENAR-DE devices with vaginal probes in the treatment. SCENAR influence was done according to the general rules taking into consideration the clinical picture, combining and interchanging influence modes and methods in IDM and SDM, and also using SCENAR-DE with vaginal probe. The patients from the second group were treated on the second day after the laparascopy. The courses included 10-15 sessions depending on the clinical picture. The patients from the third group underwent treatment in the second phase of the menstrual cycle (10-15 sessions).
Table 1. Restoring the uterine tubes patency and getting pregnant after tubal-peritoneal infertility depending on the method of treatment and infertility duration.
|Total percentage of restoring the uterine tubes patency||33% (10)||56% (22)||64% (27)|
|Infertility up to 3 years||40% (4)||60% (6)||83% (10)|
|Infertility up to 3-5 years||40% (4)||57% (8)||62% (8)|
|Infertility more than 5 years||20% (2)||53% (8)||53% (9)|
|Total percentage of pregnancies||23% (7)||51% (20)||45% (19)|
|Infertility up to 3 years||40% (4)||50% (5)||58% (7)|
|Infertility up to 3-5 years||20% (2)||57% (8)||54% (7)|
|Infertility more than 5 years||10% (1)||47% (7)||29% (5)|
As we can see in Table 1, the patients from the second group (51%) and from the third group (45%) achieved the best results in restoring the uterine tubes patency and getting pregnant.
We also analyzed the mechanism of SCENAR influence upon the main homeostasis parameters.
We investigated the general antioxidant activity of blood serum and the intensity of free-radical acidification process using software biochemoluminometer BCL-06M. The SCENAR-therapy resulted in lipid peroxidation (LPO) products suppression, which produced antimitotic and cytotoxic influence upon living cells and tissues. We also marked the increasing antioxidative system (AOS) activity, catalase and superoxide dismutase (SOD) ferments and the intoxication decrease (Table 2). Given parameters depended on the fertility restoration methods.
Table 2. AOS and LPO Status Before and After SCENAR-Therapy
|Before the treatment||After the treatment||Before the treatment||After the treatment||Before the treatment||After the treatment|
|SOD (act.un./g Hb)||93.92+26.14||94.12+21.07||92.55+41.59||134.9+49.12||85.49+25.1||111.39+29.53|
N o t e. Differences reliability according to the Student’s t-criterion: between the indices before and after the treatment, as well as between the control group and other groups, with ?<0.05.
After finishing the tubal-peritoneal infertility treatment, in the control group, where only laparascopy was used, there is a 2.1% decrease in LPO activity and an 8.7% increase in blood indices. There is an 8.8% LPO activity decrease and 17% AOS indices increase in the second group (laparascopy+SCENAR). There is a 4.6% LPO activity decrease and 17.8% AOS indices increase in the group where only SCENAR was used as a treatment.
Complex examination of the patients with tubal-peritoneal infertility included ultra sound investigation of small pelvis organs with small pelvis vessels Doppler velocimetry. We noticed slight blood flow changes in small pelvis vessels by Doppler velocimetry in the control group: there was only a 1.4% increase of the resistance index in the uterine arteries and a 9.5% increase in the ovarian arteries; laparascopy+SCENAR group – 5.3% and 18.4%; the third group – 5.8% and 18.7% correspondingly.
All patients in different groups underwent autonomic status dynamics investigation (Table 3). 100% of women had an autonomic dysfunction before the treatment.
Table 3. Autonomic Status Dynamics of Patients (Me (interquartile range), where Me is a median line)
|Autonomic function (point*)||Laparascopy (control)|
|Before the treatment||22 (20-31)||25 (20-28)||24 (22-29)|
|After the treatment||22 (20-31)||7 (6-10)||10 (7-11)|
*0-15 points – normal autonomic status, >15 points – dysautonomia.
N o t e. The differences reliability according to Wilcoxon criterion: between the indices before and after SCENAR-therapy with ?<0.05.
Autonomic status in the second and the third groups normalized after SCENAR-therapy. The indices in the first group didn’t change.
We also used a cardiointervalography (CIG) method in analyzing the autonomic status. We analyzed CIG parameters and found out that SNS tonus prevailed in all patients, and the function of the parasympathetic part decreased. Regulatory systems tension index also deviated from the norm and was considerably higher.
The autonomic tonus of the patients from the second and the third groups re-distributed by the end of the treatment. It occurred mainly due to the decrease of sympathetic ANS influence (hypersympathicotonia change into sympathicotonia or eutonia). There was no such redistribution in the patients from the control group.
The psychological state was analyzed before and after the treatment in all patients. All psychological weightness index components improved (anxiety, depression, self-control, health in general, emotional security, vital power). There was a 16% increase in the first group, 48% – in the second and 43% in the third one.
We also analyzed the dynamics of indices that influence the patients’ lives considerably (paramenia, dyspareunia, pains in the intermenstrual period, defecation disorders). The positive dynamics was more considerable in the groups where SCENAR-therapy was used as compared with the control group.
Conclusion. From the data given above, we may conclude that SCENAR therapy produces an optimizing influence upon the patients’ autonomic status (decreases the sympathetic ANS part influence and activates a parasympathetic ANS part), their psycho-emotional state, hemodynamic indices in the small pelvis organs, free-radical and general antioxidative activity, which improves homeostatic indices and quality of patient’s life as well as fertility restoration results.
SCENAR-therapy lets us improve the uterine tubes patency and rate of getting pregnant spontaneously. SCENAR-therapy results after the laparascopy, as well as without it, let us exclude laparascopy as a method of fallopian tubes correction provided that there are no hydrosalpinxes and that infertility period doesn’t exceed 3 years.
Evaluating SCENAR-therapy clinical effectiveness for the patients with tubal-peritoneal infertility lets us make a conclusion that it is an adequate method of rehabilitation treatment.