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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">akusherstvo</journal-id><journal-title-group><journal-title xml:lang="en">Obstetrics, Gynecology and Reproduction</journal-title><trans-title-group xml:lang="ru"><trans-title>Акушерство, Гинекология и Репродукция</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2313-7347</issn><issn pub-type="epub">2500-3194</issn><publisher><publisher-name>IRBIS LLC</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.17749/2313-7347/ob.gyn.rep.2025.697</article-id><article-id custom-type="elpub" pub-id-type="custom">akusherstvo-2641</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ОRIGINAL ARTICLES</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group></article-categories><title-group><article-title>Clinical and immunological characteristics of women with infertility and/or a history of recurrent pregnancy loss</article-title><trans-title-group xml:lang="ru"><trans-title>Клинико-иммунологическая характеристика женщин с бесплодием  и привычным выкидышем в анамнезе</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2849-5426</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бурдули</surname><given-names>А. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Burduli</surname><given-names>A. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Бурдули Анна Георгиевна, к.м.н.</p><p>117997 Москва, ул. Академика Опарина, д. 4</p></bio><bio xml:lang="en"><p>Anna G. Burduli, MD, PhD. </p><p>4 Akademika Oparina Str., 117997 Moscow</p></bio><email xlink:type="simple">burdulianna@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9201-2281</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тетруашвили</surname><given-names>Н. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Tetruashvili</surname><given-names>N. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тетруашвили Нана Картлосовна, д.м.н., проф.</p><p>117997 Москва, ул. Академика Опарина, д. 4</p></bio><bio xml:lang="en"><p>Nana K. Tetruashvili, MD, Dr Med Sci, Prof. </p><p>4 Akademika Oparina Str., 117997 Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8194-2419</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Балмасова</surname><given-names>И. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Balmasova</surname><given-names>I. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Балмасова Ирина Петровна, д.м.н.</p><p>127006 Москва, Долгоруковская ул., д. 4</p></bio><bio xml:lang="en"><p>Irina P. Balmasova, MD, Dr Med Sci. </p><p>4 Dolgorukovskaya Str., Moscow 127006</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3504-2406</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Донников</surname><given-names>А. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Donnikov</surname><given-names>A. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Донников Андрей Евгеньевич, к.м.н.</p><p>117997 Москва, ул. Академика Опарина, д. 4</p></bio><bio xml:lang="en"><p>Andrey E. Donnikov, MD</p><p>4 Akademika Oparina Str., 117997 Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0002-2903-1225</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Крашенинникова</surname><given-names>Р. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Krasheninnikova</surname><given-names>R. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Крашенинникова Регина Викторовна</p><p>117997 Москва, ул. Академика Опарина, д. 4</p></bio><bio xml:lang="en"><p>Regina V. Krasheninnikova, MD. </p><p>4 Akademika Oparina Str., 117997 Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8922-2878</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Калинина</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kalinina</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Калинина Елена Анатольевна, д.м.н., проф.</p><p>117997 Москва, ул. Академика Опарина, д. 4</p></bio><bio xml:lang="en"><p>Elena A. Kalinina, MD, Dr Med Sci, Prof.</p><p>4 Akademika Oparina Str., 117997 Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии  имени академика В.И. Кулакова» Министерства здравоохранения Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБОУ ВО «Российский университет медицины» Министерства здравоохранения Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Russian University of Medicine, Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>19</day><month>01</month><year>2026</year></pub-date><volume>19</volume><issue>6</issue><elocation-id>836–848</elocation-id><permissions><copyright-statement>Copyright &amp;#x00A9; Burduli A.G., Tetruashvili N.K., Balmasova I.P., Donnikov A.E., Krasheninnikova R.V., Kalinina E.A., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Бурдули А.Г., Тетруашвили Н.К., Балмасова И.П., Донников А.Е., Крашенинникова Р.В., Калинина Е.А.</copyright-holder><copyright-holder xml:lang="en">Burduli A.G., Tetruashvili N.K., Balmasova I.P., Donnikov A.E., Krasheninnikova R.V., Kalinina E.A.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.gynecology.su/jour/article/view/2641">https://www.gynecology.su/jour/article/view/2641</self-uri><abstract><sec><title>Aim</title><p>Aim: to conduct a comprehensive analysis of clinical, anamnestic and immunological characteristics of women with infertility and/or a history of recurrent pregnancy loss.</p></sec><sec><title>Materials and Methods</title><p>Materials and Methods. A cross-sectional study included 302 women of reproductive age with a history of infertility and/or recurrent pregnancy loss by enrolling those who was planning pregnancy and directed for preconceptional councelling in 2023–2024. Patients were divided into 3 groups depending on whether they had experienced infertility (n = 108), recurrent pregnancy loss (n = 141), infertility and recurrent pregnancy loss (n = 53). The study flowchart included the collection of gynecological and obstetric histories, as well as ultrasound examination of the pelvic organs in follicular phase. Expression of innate immunity gene mRNAs was carried out: interleukins (IL) IL-1β, IL-10, IL-18, tumor necrosis factor-alpha (TNF-α), Toll-like receptor 4 (TLR4), GATA-binding protein 3 (GATA3), cluster of differentiation 68 (CD68), β2-microglobulin. Based on the mRNA expression profiles of the studied genes, the integral inflammation index (II) was calculated automatically using binary logistic regression software. A local inflammatory reaction in the cervical mucosal scraping was recorded when the II value exceeded 60 %. Statistical analysis was performed using R v 4.4.3. In hypothesis testing, differences were considered statistically significant at p &lt; 0.05.</p></sec><sec><title>Results</title><p>Results. The prevalence of inflammatory endometrial pathology (chronic endometritis diagnosed by ultrasound) was comparable among groups 1, 2, 3 (16.7; 19.9; 18.9 %; p &gt; 0,05). A greater incidence of ultrasound detected intrauterine adhesions was found in group 2 with combined infertility and recurrent pregnancy loss (17,0 %) compared to infertility group 1 (4.6 %; p = 0,022) and comparable to recurrent pregnancy loss group 3 (14.9 %; p &gt; 0,05). Uterine septal removal was performed more often in group 2 (17.0 %) than in group 1 (1.9 %; p = 0,003). Endometriosis was diagnosed more often in group 2 (24,5 %) than in group 3 (7.8 %; p = 0,009). Reproductive history in combined pathology group 2 compared to infertility group 1 showed higher number of pregnancies (4.0 [3.0; 4.0] vs. 1.0 [0.0; 1.0]; p &lt; 0.001), proportion of spontaneous miscarriages (50.9 % vs. 5.6 %; p &lt; 0.001), prevalence of secondary infertility (24.5 % vs. 11.1 %; p &lt; 0,001) and in vitro fertilization attempts (1.0 [0.0; 3.0] vs. 0.0 [0.0; 2.0]; p = 0.002). We found the difference in IL-1β gene expression in group 1 and group 3 (4.6 [3.5; 5.3]) vs. 4.9 [4.1; 5.8]; p = 0,044). This may suggest different mechanisms underlying endometrial-embryonic dialogue disorders with common inflammatory background: the general index of local inflammation was high in all groups (more than 60 %).</p></sec><sec><title>Conclusion</title><p>Conclusion. Prevalence of ultrasound chronic endometritis signs in groups 1, 2, 3 was up to 20 %. Patients with infertility and/or recurrent pregnancy loss, with chronic endometritis, concomitant dysbiotic disorders and activated local immunity need to correct vaginal microbiocenosis before pregnancy in order to prevent infectious and inflammatory complications. It is necessary to develop a screening program based on the characteristics of gynecological, obstetric, reproductive history, morbidity and local inflammatory gene expression levels. Our data confirm the importance of an integrated approach in assessing a role of infectious factor in origin of reproductive disorders.</p></sec></abstract><trans-abstract xml:lang="ru"><sec><title>Цель</title><p>Цель: провести комплексный анализ клинических, анамнестических и иммунологических данных у женщин с бесплодием и/или привычным выкидышем в анамнезе.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. Проведено поперечное одномоментное исследование среди 302 женщин, обратившихся для прегравидарного обследования в период 2023–2024 гг. Пациентки были распределены на 3 группы: группа 1 – 108 женщин с трубно-перитонеальным бесплодием, группа 2 – 53 пациентки с бесплодием и привычным выкидышем, группа 3 – 141 женщина с привычным выкидышем. В схему исследования входил сбор гинекологического, акушерского анамнезов, анализ данных ультразвукового трансвагинального исследования органов малого таза, проведенного в фолликулярную фазу менструального цикла, оценка экспрессии матричной РНК (мРНК) генов врожденного иммунитета в соскобе слизистой оболочки цервикального канала: проанализированы гены интерлейкинов (англ. interleukin, IL) IL-1β, IL-10, IL-18, фактора некроза опухоли альфа (англ. tumor necrosis factor-alpha, TNF-α), толл-подобного рецептора 4 (англ. toll-like receptor 4, TLR4), GATA-связывающего белка 3 (англ. GATA-binding protein 3, GATA3), кластера дифференцировки 68 (CD68), β2-микроглобулина. На основании профилей экспрессии мРНК изучаемых генов с применением метода бинарной логистической регрессии в автоматическом режиме с помощью программного обеспечения проведен расчет интегрального индекса воспаления (ИВ); при его величине более 60 % регистрировалась локальная воспалительная реакция в соскобе слизистой цервикального канала. Статистическую обработку с целью сравнения показателей в группах проводили в среде R v 4.4.3. При проверке гипотез статистически значимыми считали различия при р &lt; 0,05.</p></sec><sec><title>Результаты</title><p>Результаты. Распространенность ультразвуковых признаков хронического эндометрита (ХЭ) в группах 1, 2, 3 оказалась сопоставимой (р &gt; 0,05) – 16,7, 18,9 и 19,9 %. Частота встречаемости внутриматочных синехий по данным ультразвукового исследования (УЗИ) в группе 2 (17,0 %) оказалась выше (р = 0,022), чем в группе 1 (4,6 %) и сопоставимой (p &gt; 0,05) с группой 3 (14,9 %). В анамнезе у пациенток группы 2 чаще, чем у женщин группы 1, производилось рассечение внутриматочной перегородки (17,0 % vs. 1,9 %; р = 0,003) и чаще, чем у пациенток группы 3 регистрировался наружный генитальный эндометриоз (24,5 % vs. 7,8 %; р = 0,009). В репродуктивном анамнезе пациенток группы 2 по сравнению с женщинами группы 1 выявлено бо́льшее число беременностей (4,0 [3,0; 4,0] vs. 1,0 [0,0; 1,0]; р &lt; 0,001), более высокая частота самопроизвольных выкидышей (50,9 % vs. 5,6 %; р &lt; 0,001) и вторичного бесплодия (24,5 % vs. 11,1 %; р &lt; 0,001), а также разница в количестве попыток экстракорпорального оплодотворения (1,0 [0,0; 3,0] vs. 0,0 [0,0; 2,0]; р = 0,002). Несмотря на высокие значения показателя интегрального ИВ (более 60,0 %) в соскобе слизистой цервикального канала во всех группах (р &gt; 0,05), установлена разница в уровнях экспрессии мРНК гена IL-1β у пациенток группы 1 (4,6 [3,5; 5,3]) и группы 3 (4,9 [4,1; 5,8]; р = 0,044), что может указывать на разные механизмы реализации нарушений эндометриально-эмбрионального диалога на общем воспалительном фоне.</p></sec><sec><title>Заключение</title><p>Заключение. У пациенток с бесплодием (группа 1), привычным выкидышем (группа 3) и сочетанием данных патологий (группа 2) распространенность ультразвуковых признаков ХЭ составляет до 20 %. При подтверждении ХЭ, а также наличии сопутствующих дисбиотических нарушений с активацией локального иммунитета обсуждается необходимость коррекции микробиоценоза влагалища до наступления беременности с целью профилактики инфекционно-воспалительных осложнений. Необходимо разработать программу прегравидарной подготовки на основании данных клинико-иммунологической характеристики женщин с бесплодием и привычным выкидышем с учетом высокого риска реализации инфекционно-воспалительных осложнений беременности.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>женское бесплодие</kwd><kwd>привычный выкидыш</kwd><kwd>эндометрит</kwd><kwd>репродуктивная медицина</kwd></kwd-group><kwd-group xml:lang="en"><kwd>female infertility</kwd><kwd>recurrent pregnancy loss</kwd><kwd>endometritis</kwd><kwd>reproductive medicine</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Шешукова Н.А., Боровкова Е.И., Большакова О.В. Этиопатогенетические варианты спонтанного выкидыша. Гинекология. 2014;16(2):84–8.</mixed-citation><mixed-citation xml:lang="en">Sheshukova N.A., Borovkova E.I., Bolshakova O.V. 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