RU2141361C1 - Method of treatment of anovulatory fertility at obesity - Google Patents

Abstract

FIELD: medicine, endocrine gynecology. SUBSTANCE: invention proposes the curative starvation for 10-14 days and an intravenous infusion of potassium chloride solution beginning from 5-6-th day of starvation and in the recovery period also. The total amount of infusion - 6-10. After the 1-st day after starvation ceasing bitemporal inductothermia in combination with infusions of sodium thiosulfate and injections of cerebrolysin are prescribed. EFFECT: enhanced effectiveness of treatment of women with anovulatory fertility at obesity. 2 ex

Description

 The invention relates to medicine, namely to endocrine gynecology, and can be used to treat primary and secondary infertility, the cause of which is anovulation.

 Known methods of treating endocrine infertility: the use of hormones (clostilbegit, synthetic progestins, chorionic gonadotropin), surgical treatment - wedge-shaped resection of the ovaries (V.P. Kozachenko. Gynecological endocrinology: Overview. - M., 1991). The disadvantages of these methods are their low efficiency, unstable effect, as well as complications (hirsutism, drug damage to the liver, adhesions of the genitals or in the pelvis after surgery).

 The closest analogue of the proposed method is the use of bitemporal inductothermy in combination with infusions of sodium thiosulfate and injections of cerebrolysin (copyright certificate N1296126 dated November 15, 1986).

 Its disadvantages are insufficient treatment effectiveness, since significant weight loss is not achieved and, as a result, steroidogenesis in adipocytes and overproduction of estrogens and / or androgens are supported in the body. Therefore, in patients with obesity, the effect is unstable, you have to repeat the courses every 3-4 months.

 The invention is aimed at solving the problem of improving the effectiveness of treatment.

The essential features of the proposed method:
restrictive signs - the use of bitemporal inductothermy, sodium thiosulfate, cerebrolysin.

 Distinctive features are therapeutic fasting for 10-14 days and intravenous infusion of 10% potassium chloride solution 10 ml daily or every other day from the 5-6th day of fasting and during the recovery period - only 6-10 times.

 With obesity, peripheral steroidogenesis, i.e. fat cells convert fractions of low-activity adrenal androgens into active androgens and / or estrogens (testosterone, estradiol), which disrupt ovulation. As a result, in 100% of cases, the function of the hypothalamic-pituitary system is disrupted, ovulation ceases. It is necessary to achieve a rapid and pronounced decrease in the mass of adipose tissue in order to stop peripheral steroidogenesis. Then the function of the hypothalamic centers that secrete gonadoliberins is restored, and the secretion of gonadotropins is restored. As a result of the course of therapeutic fasting, patients lose weight by 8-16 kg in 10-14 days. Ovulation is restored. Bitemporal inductothermy improves blood supply to the hypothalamic-pituitary complex, sodium thiosulfate eliminates brain edema that develops when the hypothalamus is damaged, and cerebrolysin provides amino acids necessary for brain regeneration. In the process of therapeutic fasting, endogenous intoxication occurs, one of the reasons for which is the loss of potassium and chloride, which prevents further weight loss, directly or indirectly (through the adrenal glands or the thyroid system), worsens the function of the generative system.

 The method is as follows. Conduct therapeutic fasting for 10-14 days; against the background of starvation from the 5-6th day and then in the first days of the recovery period (getting out of hunger), a 10% solution of potassium chloride 10 ml, 10 times, daily or every other day is administered intravenously. From the first day of getting out of hunger, bitemporal inductothermy of the right and left temporoparietal regions of the head is prescribed with a frequency of 39.87-41.49 MHz, a power of 20-30 V for 8-12 minutes and an additional 30% sodium thiosulfate solution is injected intravenously day for 10-15 days and intramuscularly cerebrolysin. Every other day for 15-20 days.

 Example 1. Patient A-va, 32 years old, complained of rare (after 3-6 months) periods, hair growth on the face and chest, dull headaches, progressive obesity. In adolescence, she underwent puberty and youthful dispituitarism, was regularly treated by an endocrinologist, as well as a gynecologist-endocrinologist about menstrual dysfunction. From 19 years of sex, at 22 years of age, the 1st pregnancy, which ended in childbirth. After childbirth, for six months, body weight increased by 25 kg, headaches worsened. Menstrual function did not normalize: menstrual irregular, after 3-6 months for 3-14 days, painful. Hirsutism and hypertrichosis appeared. In the following, infertility II was diagnosed, which was treated without effect with clostilbegit, courses of choriogonin, and vitamins. Hospitalized for therapeutic fasting. The condition is satisfactory. Moderate hirsutism and hypertrichosis. Height 163 cm, weight 97 kg, Quetelet index 38, gluteofemoral obesity. On the skin of the chest, shoulders, abdomen pink and whitish striae, on the face and back acne. Hypermastia. From the side of the heart, lungs - without pathology. HELL 140/100. Liver +2 cm, test consistency. On the craniogram, vascular pattern is strengthened, finger impressions, frontal bone hyperostosis, the Turkish saddle are not enlarged, a retroclinical ligament is calcified. Fundus: veins dilated. Consultation of a neurologist: mild insufficiency VII and XII n. The level of testosterone in the blood is 1.9 ng / ml, while the norm in women is from 0.2 to 0.9 ng / ml. Conclusion Ultrasound of the pelvic organs: uterus without pathology, polycystic ovary.

 Diagnosis: postpartum neuroendocrine syndrome, compensated intracranial hypertension, grade III obesity, menstrual dysfunction of the central genesis, polycystic ovarian degeneration, anovulatory infertility II.

 Conducted therapeutic fasting - a course of 14 days, from the 6th day of fasting, potassium chloride was intravenously injected daily - 10 infusions in total; from the first day of getting out of hunger, bitemporal inductothermy, sodium thiosulfate, cerebrolysin was prescribed.

 The patient lost 18 kg. The level of testosterone in the blood returned to normal. Menzes became regular after treatment. After 3 months, a pregnancy ended, which ended in childbirth.

 Example 2. Patient Peninsula, 29 years old, complained of persistent headaches, the absence of menstruation for 5 years, progressive obesity. A history of closed craniocerebral trauma. Menzes from the age of 14, always irregular. Married since 20 years. Against the background of irregular menstruation at 23, the first pregnancy occurred, which ended in childbirth. Subsequently, obesity, arterial hypertension and amenorrhea developed. At 25, she remarried, but no pregnancy occurred. Growth 158 cm, weight 102 kg, obesity III gluteo-femoral. Hypermastia. Internal organs without features. HELL 130/100. On the craniogram pronounced signs of intracranial hypertension. At the fundus, the arterioles are narrowed, the veins are dilated and full-blooded. Ultrasound of the pelvic organs: the uterus is normal, the ovaries are enlarged, the contours are uneven, the structure is heterogeneous, many small brushes. According to tests of functional diagnostics - anovulation; basal temperature monophasic. The level of estradiol in the blood in the dynamics from 69 to 116 ng / ml with a norm of 25 to 87 ng / ml in the follicular phase, the level of progesterone <0.1 ng / ml with a norm of 0.175-0.7 ng / ml.

 Diagnosis: hypothalamic syndrome, neuroendocrine form, a consequence of closed craniocerebral trauma, compensated intracranial hypertension, grade III obesity, menstrual dysfunction of the central genesis of the type of amenorrhea II, polycystic ovarian degeneration, infertility II. Conducted therapeutic fasting for 10 days. From the 5th day of fasting, potassium chloride was injected intravenously every other day, a total of 6 infusions. From the 1st day of the recovery period, bitemporal inductothermy, sodium thiosulfate infusion and cerebrolysin were started. As a result of treatment, body weight decreased by 12 kg, headaches decreased, estrogenemia returned to normal. A few months later, against the background of ongoing amenorrhea, a pregnancy occurred, ending in the birth of a healthy girl.

 Example 3. Patient K., 28 years old, complained of irregular periods, infertility, headaches, and obesity. A history of pubertal youthful dispituitarism. Married since 18 years, the first pregnancy ended in spontaneous miscarriage in the period of 8 weeks, then infertility occurred. Treated with synthetic progestins without effect. Body weight 101 kg with a height of 172 cm, obesity III degree gluteo-femoral. Moderate hirsutism. Hypermastia, weak persistent lactorrhea. Internal organs without features. HELL 120/80. Gynecologist examination: no pathology was found, anovulatory infertility. On the craniogram revealed a small Turkish saddle, internal frontal hyperostosis, coronary and occipital craniostenosis, increased finger impressions in the frontal, parietal, occipital areas. On the fundus plethora of veins. The level of testosterone in blood plasma is 1.2 ng / ml, estradiol is 87 ng / ml, progesterone is 0.05 ng / ml, prolactin is 780 Med / ml with a norm of from 170 to 500 Med / ml. Diagnosis: hypothalamic syndrome, neuroendocrine form (a consequence of puberty and youthful dispituitarism), compensated intracranial hypertension, craniostenosis, grade III obesity, menstrual dysfunction of the central genesis by the type of opsenorrhea, polycystic ovarian degeneration, anovulation, II infertility.

 Fasted for 12 days; from the 5th day of fasting, potassium chloride was administered intravenously daily, only 8 times, from the first day of getting out of hunger, bitemporal inductothermy, sodium thiosulfate infusion and cerebrolysin injection were performed. Under the influence of treatment, body weight decreased by 12 kg, menstrual function returned to normal, after 4 months a pregnancy ensued, which ended in the birth of a healthy girl.

 Reducing the duration of therapeutic fasting leads to insufficient loss of body weight (<8 kg), an increase in the duration of fasting is impractical, since endogenous intoxication is increasing. Conducting therapeutic fasting without a subsequent course of pathogenetic therapy is ineffective, since fat deposits are restored immediately after fasting is completed.

 The positive effect of the proposed method in the form of increasing the effectiveness of treatment is that in obese women the hypothalamic-pituitary system is normalized not only due to the effect of bitemporal inductothermy, the dehydration effect of sodium thiosulfate introduced intravenously, the improvement of trophic brain structures, and also due to a significant reduction in weight adipose tissue achieved in a short (3-4 weeks) period, which leads to inhibition of peripheral steroidogenesis, eliminates hypertestosteronemia and hyperestrogenism, restores ovulation. Due to the intravenous administration of a solution of potassium chloride, the development of electrolyte imbalance (hypokalemia) is not allowed and thereby endogenous intoxication is prevented. The value of the proposed method lies in the fact that it does not cause complications and adverse reactions. The method is simple, affordable, easily reproducible, does not require special equipment and high economic costs, is well tolerated by patients.

Claims (1)

 A method for the treatment of anovulatory infertility in obesity with bitemporal inductothermy in combination with infusions of sodium thiosulfate and injections of cerebrolysin, characterized in that the treatment is followed by fasting for 10-14 days and intravenous infusion of potassium chloride solution daily or every other day, starting from 5-6 -th day of fasting and in the recovery period, only 6 - 10 times.