Vol 12, No 3 (2025)

The increase in life expectancy and the trend toward postponing first pregnancy have stimulated the search for effective methods to extend the reproductive period in women and to improve their quality of life. This review analyzes current understanding of the physiological and molecular processes underlying ovarian aging, as well as contemporary anti-aging strategies aimed at enhancing ovarian reserve and maintaining fertility. Particular attention is given to the role of oxidative stress, mitochondrial dysfunction, and epigenetic mechanisms, including DNA modifications, along with innovative therapeutic approaches. Specifically, platelet-rich plasma (PRP) therapy (intraovarian injection of platelet-rich plasma), the use of stem cells for ovarian tissue regeneration, senotherapy targeting the elimination of senescent cells, and the prospects of mitochondrial donation technology to improve oocyte quality are discussed. Clinical and experimental studies demonstrating the efficacy of these strategies in preserving reproductive potential are presented, highlighting new opportunities in infertility treatment, quality-of-life improvement, and enabling later motherhood. Limitations and future research directions in this rapidly evolving field are also discussed.

Endometrial cancer remains one of the most prevalent malignant neoplasms of the female reproductive system. Despite advancements in diagnostics and treatment, aggressive subtypes of the disease are characterized by high rates of metastasis, recurrence, and decreased overall survival, underscoring the need for novel therapeutic targets. One such promising molecular factor is the receptor tyrosine kinase-like orphan receptor 1 (ROR1), which is normally expressed predominantly in embryonic tissues but reactivates in various malignancies, including endometrial cancer.

ROR1 plays a role in the activation of key signaling pathways such as PI3K/Akt/mTOR, MAPK, and Wnt/β-catenin, regulating processes like cell proliferation, apoptosis, invasion, and epithelial-mesenchymal transition. High ROR1 expression correlates with unfavorable clinicopathological features, including high tumor grade, advanced FIGO stages, and decreased overall survival. Moreover, ROR1 contributes to chemoresistance by activating anti-apoptotic Bcl-2 family proteins and supporting inflammatory microenvironment signaling.

This article provides a comprehensive review of the molecular mechanisms involving ROR1, its role in oncogenesis and endometrial cancer progression, and its potential as both a prognostic biomarker and therapeutic target. Current approaches to targeted therapy are discussed, including the application of antibody–drug conjugates such as zilovertamab vedotin, and their prospects for clinical implementation. Given the significance of ROR1 in endometrial cancer pathogenesis, its inhibition may serve as the basis for personalized treatment strategies aimed at overcoming resistance and improving prognosis in patients with aggressive forms of endometrial cancer.

Background: Preeclampsia is a multisystem complication affecting 2%–8% of pregnant women and makes a significant contribution to maternal and perinatal morbidity and mortality.

Aim: To determine the predictive value levels of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and the sFlt-1/PlGF ratio in forecasting the progression of preeclampsia severity within two weeks.

Methods: A prospective cohort study was conducted. It included 64 patients with singleton pregnancies complicated by elevated blood pressure (>140/90 mmHg) and/or proteinuria, who were admitted to City Clinical Hospital named after S.S. Yudin (Moscow) at 22–38 weeks of gestation. Venous blood samples were collected at admission to determine sFlt-1 and PlGF concentrations and the sFlt-1/PlGF ratio. Based on the clinical course and pregnancy outcome, patients were divided into two groups: group 1, 30 (54.5%) women with preeclampsia who experienced maternal deterioration and/or fetal compromise requiring early delivery; group 2, 25 (45.5%) women with stable preeclampsia whose pregnancies were successfully prolonged to term under treatment in accordance with clinical guidelines. Group 1 was further divided into two subgroups according to delivery timing: subgroup 1a, women who delivered within two weeks; subgroup 1b, women who delivered after more than two weeks.

Results: The analysis showed statistically significant differences between the groups (p < 0.01 and p = 0.011 in sFlt-1 levels and the sFlt-1/PlGF ratio, respectively), whereas no statistically significant differences were found in PlGF levels (p = 0.076). Threshold values for sFlt-1 and the sFlt-1/PlGF ratio indicating high risk of preeclampsia that required early delivery were 30,297 pg/mL and 3030, respectively. In the next stage, threshold values predicting preeclampsia progression within two weeks were determined as 23,497.0 pg/mL for sFlt-1 and 977.7 for the sFlt-1/PlGF ratio.

Conclusion: This study established threshold values of sFlt-1 and the sFlt-1/PlGF ratio, indicating a high risk of preeclampsia in patients with initial nonspecific symptoms. In addition, threshold values were identified that indicate a high probability of progression to severe preeclampsia requiring delivery within two weeks.

Background: Endometrial polyps are a common gynecological condition, occurring in 10%–24% of women of reproductive age, which often leads to infertility and menstrual disorders. Bipolar resection is considered one of the effective methods of polyp removal; however, it is accompanied by significant pain and prolonged recovery. Among the more effective and less painful approaches, the use of the thulium laser is considered a promising option, having already proven successful in modern urological practice.

Aim: To evaluate the efficacy and safety of thulium laser polypectomy in women of reproductive age.

Methods: The study, which included 46 women with endometrial polyps (23 in each group), compared two methods of polypectomy: thulium laser and bipolar resection. The following parameters were taken into account: procedure duration, pain level, time to menstrual cycle recovery, recurrence rate, and acceptability.

Results: Thulium laser treatment demonstrated shorter operation time (10.04 ± 0.97 min vs 13.86 ± 1.20 min), less pain, faster recovery of menstrual function (28.6 ± 2.9 days vs 34.65 ± 3.06 days), and a lower recurrence rate (8.69% vs 17.39%). Patient acceptability of the thulium laser was also higher (99.39% vs 92.39% at 1 month).

Conclusion: The findings indicate the benefits of thulium laser in the treatment of endometrial polyps and highlight the need for further studies to assess its long-term outcomes.

Background: Among the complications of miscarriage, the most common are inflammatory conditions, which may be associated with oxidative stress and antioxidant deficiency—a universal mechanism in the development of many conditions, including gynecological diseases.

Aim: The work aimed to investigate lipid peroxidation and antioxidant defense status in patients after first-trimester miscarriage during preventive anti-inflammatory therapy.

Methods: A total of 146 women of reproductive age (26.8±2.8 years) were divided into three groups after miscarriage. Group 1 (n=48) received combined prophylaxis, which consisted of antibacterial therapy (metronidazole±azithromycin) and physiotherapy (magneto–infrared–laser therapy of the pelvic area); Group 2 (n=45) received only physiotherapy; Group 3 (n=53) received only antibacterial therapy. Vaginal microbiome analysis revealed normal and conditionally pathogenic microbiota. Levels of lipid peroxidation (malondialdehyde and diene conjugates) and antioxidant defense system markers (catalase and superoxide dismutase activity) were assessed in all patients and in 30 healthy women, both before treatment and two weeks after therapy.

Results: Compared with healthy women, post-miscarriage patients had a 1.3-fold increase in malondialdehyde levels and a 1.2-fold increase in diene conjugates (p <0.05), as well as a 1.4-fold decrease in catalase and a 1.25-fold decrease in superoxide dismutase (p <0.05). The best outcomes were observed with combined antibacterial and physiotherapy treatment (no complications recorded). The rate of chronic salpingo-oophoritis exacerbation with physiotherapy alone and with antibacterial therapy alone was 4.4% and 5.3%, respectively (p >0.05).

Conclusion: Recovery of the antioxidant system after miscarriage occurs faster with combined therapy including antibacterial drugs and magneto–infrared–laser therapy. This approach significantly reduces the incidence of inflammatory complications.

This article presents a clinical case of a pregnant woman with cervical insufficiency who underwent laparoscopic cerclage prior to pregnancy due to recurrent miscarriages. The patient had a history of four pregnancies with unfavorable outcomes. Considering the complicated obstetric history, laparoscopic correction of cervical insufficiency was recommended. The first trimester proceeded without complications. In the second trimester, an ultrasound revealed signs of fetal intraventricular hemorrhage on the right. Reverse transcription polymerase chain reaction of cervical canal swab showed parvovirus B19. A case conference was held, and the decision was made to keep the pregnancy. The progress was monitored using ultrasound and Doppler ultrasound. Owning to the fetus’ condition, the patient was referred to a federal medical institution for delivery and specialized, high-tech medical care. Follow-up ultrasounds and Doppler examinations of the fetus prior to delivery showed no negative changes related to intraventricular hemorrhage. The patient underwent an emergency cesarean section at the Perinatal Center of St. Petersburg State Pediatric Medical University at 38 weeks and 6 days of gestation.

Abdominal pregnancy is a rare form of ectopic pregnancy, accounting for 0.1% of all pregnancies. This condition is associated with unfavorable outcomes due to the difficulty of diagnosis and the lack of standardized management strategies. This article describes a case of abdominal pregnancy resulting in live birth. The patient had been under antenatal observation from the early stages of pregnancy. Routine ultrasound examinations performed at standard gestational ages described a developmental anomaly (bicornuate uterus) as well as signs of placenta previa. In accordance with clinical routing, the patient stayed in a tertiary obstetric hospital from week 33 of gestation. On day 7 of inpatient care, she complained of girdle-like, dull epigastric pain and nausea. Instrumental and clinical-laboratory assessment established an additional diagnosis of chronic pancreatitis in incomplete remission. The patient was transferred to a multidisciplinary regional clinical hospital. The next day, a follow-up obstetric ultrasound revealed a decrease in the amniotic fluid index to 0 mm. Considering the absolute oligohydramnios, complete placenta previa, and placenta accreta, urgent cesarean delivery was performed. Intraoperatively, the diagnosis of abdominal pregnancy was established. A live preterm female infant was delivered.