Relevance. Miscarriage is one of the most common obstetric pathologies that determine the spontaneous death of the fetus. The role of changes in the microbiome of various biotopes is considered as a risk factor of this disease.Aim of the research is to assess the microbiocenoses structure of the reproductive system and the intestine associated with the development of spontaneous miscarriages in early pregnancy.Materials and methods. A case-control study was conducted and organized. The group of «cases» included 23 women with spontaneous miscarriage at 5–14 weeks of pregnancy and the control group included 23 women with normal pregnancies Based on the data of metagenomic sequencing of V3–V4 regions of the 16S rRNA gene, a comparative assessment of the structure of the vaginal and intestinal microbiome in these groups was carried out.Results. As a result of the study, a number of taxonomic groups of microorganisms in the vagina and intestines associated with miscarriage. It was found that the decrease in the proportion of Lactobacillus spp. in the structure of the vaginal microbiome, less than 90% of the total number of identified taxa is associated with this pathology (OR = 5.28 (95% CI = 1.2-23.2)). The gut microbiocenoses of women with spontaneous miscarriage are characterized by less taxonomic diversity than the gut microbiome of women with advanced pregnancy. At the same time, some representatives of the intestinal microbiome (Akkermansia sp., Faecalibacterium sp., Bifidobacterium sp., Methanobrevibacter sp., Lactococcus sp.) predominate in women with a normal pregnancy.Conclusion. The study demonstrated a significant role of changes in microbiocinosis of the reproductive tract and intestines in miscarriage. There is a potentially protective function of lactobacilli. The obtained data substantiates the need for active use of molecular genetic methods focused on the assessing the structure of the vaginal and intestinal microbiota in assessing the risks of reproductive failures.

Aim. Comprehensive epidemiological assessment of factors affecting the effectiveness of the infertility treatment in medical organizations of St. Petersburg. Materials and Methods. The effectiveness of assisted reproductive technology programs in St. Petersburg reproductive centers was evaluated by analyzing the respective database for infertility treatment in 2013-2017. We retrospectively examined 843 patient records that were submitted to one of the St. Petersburg reproductive centers in 2014-2017 with the following survey and in-depth clinical examination of 129 couples before in vitro fertilisation. Results. Risk factors of infertility included vaginal dysbiosis (OR = 7.5 (95% CI 1.04-54.1)), Trichomonas vaginalis infection (OR= 2.6 (95% CI 1.12 - 6.4)), and smoking (OR = 2.6 (95% CI 1.0 - 6.5)). Conclusion. Optimised screening of couples before in vitro fertilisation may increase the effectiveness of assisted reproductive technology programs. Stimulation of the population's commitment to a healthy lifestyle including non-smoking policy should be one of the main directions to prevent infertility.

High incidence of endocrine and uroandrologic disorders among children and adolescents results in negative reproductive potential in the future. These disorders include obesity, diabetes, thyroid disease (autoimmune thyroiditis, hypothyroidism), delayed puberty, cryptorchidism and varicocele. Despite a wide variety of studies on the problem of infertility, information about risk factors of reproductively significant pathology is currently of limited. Purpose. The aim of the present study was to evaluate the risk factors for reproductively significant endocrine and uroandrologic diseases in children and adolescents in St. Petersburg. Materials and methods. A questionnaire survey of 1 456 parents of children and adolescents was conducted during the period from 2015 to 2017. Results and discussion. It was found that a history of rubella was associated with diabetes mellitus in girls (OR 2.7, CI 1.3–5.5). Risk factors related to the parents’ health were thyroid pathology (2.7; 1.3-5.5), obesity (8.4; 2.5–27.7), varicose veins of mother (5.0; 1.8–14.0), cardiovascular diseases of father (28.7; 3.4–237.6). Insulin-independent diabetes mellitus of close relatives (grandparents) was associated with obesity (3.5; 1.8–6.8) and type 1 diabetes mellitus (6.8; 3.8–12.7) in boys. Toxicosis (2.5; 1.4–4.6), risk of pregnancy termination (2.8; 1.4–5.8), bleeding (5.1; 3.2–1.9), miscarriages (3.3; 1.2–8.9), birth of children less than 2 years apart (2.7; 1.1–6.9), birth weight less than 2 kg (5.7; 1.2–26.5) or more than 4 kg (5.1; 2.1–12.4) were found to be risk factors for reproductive significant diseases. There was a relationship between artificial nutrition and obesity in the group of boys (6.5; 2.2–19.0). The study also revealed that smoking (3.4; 1.6–7.3) and alcohol (2.1; 1.2-3.8) were risk factors. The use of diapers older than 1 year was a risk factor for cryptorchidism and varicocele (2.8; 1.4–5.6).

The article deals with terminology and modern views relating to vaginal dysbiosis and urogenital endogenous infection. Endogenous and exogenous trigger factors leading to disturbance of the vaginal microbiocenosis are characterized. Mechanisms of development of some obstetrical pathology in this infectious process are considered. Diagnostic and therapeutic approaches to correct dysbisosis with determination of the place of the system enzymotherapy in a complex therapy of this pathology are provided.