BackgroundPolycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders affecting women of reproductive age, with a prevalence of about 5%–10% in the general population. PCOS is characterized by menstrual disturbances due to hirsutism, chronic anovulation or oligoovulation, and acne due to excessive androgen production (hyperandrogenemia). The pathogenesis of PCOS is still unexplained. Following the main criteria of diagnosis (Rotterdam Consensus 2003), Dewailly, Welt and Pehlivanov divided the patients with PCOS into 4 phenotype groups: Oligo + HA + PCO, Oligo + HA, HA + PCO, Oligo + PCO. ObjectiveThis aim of the study was to compare gonadotropin levels in serum of reproduction age for comparative healthy women and polycystic ovary syndrome (PCOS).MethodsA cross-sectional study was performed comprising 425 comparative healthy women of reproductive age group 18-35 (<20 n=76, 21-25 n=131, 26-30 n=92, 31-35 n=126). To collect blood sample 4 times of healthy, normal menstrual cycle and body mass index (BMI) of women. To determine FSH, LH hormone in serum by ELISA (Eucardio lab kit used). To evaluate FSH, LH, LH/FSH normal menstrual phase (early follicular phase,late follicular phase, ovulation and mid-luteal phase). PCOS patients divided 2 type (oligo+ha, ha+pco).ResultsThe mean age was group A 26.33±5.28, group B 24.9±4.93, and group C 29.75±4.12, BMI a; 22.35±2.95, b; 28.88±3.85, c; 28.0±3.19. The mean level was FSH a; 4.64±1.65 mIU/ml, b; 12.07±3.85 mIU/ml, c; 5.35±7.20 mIU/ml, LH a; 6.42±3.3 mIU/ml, b; 39.43±15.89 mIU/ml, c; 10.89±2.53 mIU/ml of PCOS. To correlate FSH, LH, LH/FSH level was women was significantly (p<0.05).Conclusion: The increased level of LH, LH/FSH strongly correlates with the clinical degree of amenorrhea and hyperandrogenism.It seems that LH, LH/FSH could be a crucial diagnostic and predictive factor among women with menstrual disorders or presence of polycystic ovaries.

Background: According to the study conducted by International Diabetes Federation, total of 127,1 million pregnant women were participated in the study and 21,7million (16,8%) of them were diagnosed as Gestational diabetes mellitus.³ Maternal physical structure, figure and correlation between maternal anthropometrics and fetal measurements influence directly to fetal status, process of labor and termination of birth. During the period between 1950-1960, it was described for the very first time that gestational diabetes mellitus can lead to infant overweight.⁴ Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels after 24 weeks thus the risk to develop Diabetes mellitus type 2 increases. The average infant at right after birth weighs approximately 3200-3500 grams but sometimes infants with more than average weight are born. If infant weighs 4000-5000 grams and more than this, it is defined as overweighed. The infant’s weight depends on several factors. However, hereditary factors and blood glucose levels are the main cause of infant’s overweight. According to study conducted by Koyanagi et al, 2003, maternal obesity, diabetes mellitus type 2, post term pregnancy, subsequent pregnancy, maternal and paternal height and weight, maternal older age and previous history of giving birth to overweight infant can lead to infant being born overweight.⁷ Methods: The study is made by using cross sectional method of analytic study and total of 200 pregnant women from Khan-Uul, Bayangol, Chingeltey and Bayanzurkh districts who were attending the first admission of pregnancy follow-ups. According to WHO recommendation, we made diagnosis based on results of glucose tolerance test (blood glucose measurement 2 hours after giving 75 grams of sugar orally). The body mass index is calculated by using body weight and height as BMI. In full term birth, infant weighs less than 3999 grams is normal and more than 4000 grams is termed as overweight infant Results: Infant weight depends on maternal age and it is statistically significant (р<0.025). Pre pregnancy weight and BMI are affecting the increasing level of blood glucose by statistically significant (р<0.005) (table 3). In addition, maternal age (0.012) and Glucose tolerance test (blood glucose level after 2 hours) (0.002) have direct correlation to infant weight and it is statistically significant respectively.
96 of total (48.0%) pregnant women gave vaginal birth, 104 (52,0 %) of them have undergone caesarean section. It seems, that as fetus weight rises, frequency of caesarean section increases (table 5). Moreover, fetal weight depends on gestational physical activities rather than frequency of pregnancy and gestational weight gain (р<0.002). Conclusion Women who gave birth to overweighed infant have higher fasting blood glucose and glucose tolerance test (glucose level after 2 hours) results and higher index than mean BMI. In other words, gestational diabetes mellitus is one of the risk factors which leads to infant’s overweight.

Endometriosis is described as a chronic inflammatory disease, characterized by endometrial-like tissue, found outside the uterine cavity which cause chronic pelvic pain, infertility,dysmenorrhea. The prevalence of endometriosis is difficult to determine accurately but in asymptomatic women, the prevalence of endometriosis ranges from 2- 22 %, depending on the population studied , in infertile women 20-50 % and in those with pelvic pain, between 40-50% (Balasch, 1996; Eskenazi, 2001; Meuleman, 2009).Endometriosis is found 7-10% of reproductive agewomen and 20-90% in with chronic pelvic pain, infertility cases. Pathogenesis of endometriosis is not yet fully understood but one potential cause of the disease is retrograde menstruation which results in the deposition of endometrial tissue into the peritoneal cavity. Today a composite theory of retrograde menstruation with implantation of endometrial fragments in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted explanation for peritoneal endometriosis. Susceptibility to endometriosis is thought to depend on the complex interaction of genetic, immunologic, hormonal and environmental factors. To determine prevalence and severity of clinical symptoms, compare meta-analysis to changes the clinical value of serum CA-125 and peritoneal fluid cytology in women with endometriosis of Ulaanbaatar city. We had selected total of 60 woman with endometriosis which were registered from January to December 2014 in gynecologic clinic of First Maternity Hospital. The research group registered in questionnaire with 28 questions. During the inspection laboratory analysis of serum CA-125, ultrasound analysis and peritoneal fluid cytology were done. Assessment of pelvic pain by means of a 10-point linear analog scale / pain score/ which provided by International Pain Association. The research result was worked out by prospective method. Average age of patients 33.4±8.9. Pain location: Chronic pelvic pain 30%; Dysmenorrhea 28.3%; Dysparunea 10%; Pain during defecation 6,7%; Without pain -25%. Average level of Serum СА125 was 38.13±20.6. Location of endometriosis: adenomyosis - 8.4%, endometrioma-15% endometriotic lesion at cul de suc 68.3%, rectal involment 1.7%, tubal lesion-3.3%, combined 3,3%. 76.7% of surgery for endometriosis have done by laparoscopy and 23.3% by laparotomy. Ultrasound examination result: endometrioma d=0-2cm-1.7%, d= 3-5cm-36.2%, d=6-8cm-10.3%, d=9cm<-12.1%. Cytology result: Peritoneal fluid contains 75% of erythrocytes, mesothelial cells and it needs to further study.CONCLUSION:Most of patient /58.3%/ had chronic pelvic pain and dysmenorrhea. The severity of pain was significantly improved after operative laparoscopy. /p<0.05%/51,7% of patient had infertility problem.Value of serum CA-125 was higher in study group with large sized and not clear content ovarian endometrioma by ultrasound examination. /p<0.05%/The local environment of peritoneal fluid surrounding the endometriotic implant is immunologically dynamic and links the reproductive and immune systems. Peritoneal factors to stimulate cell growth is the most widely accepted explanation for peritoneal endometriosis. Peritoneal fluid contains a variety of free floating cells, including macrophages, mesothelial cells, lymphocytes, erythrocytes, eosinophils and mast cells. In our cytology results: peritoneal fluid contains 75% of erythrocytes, mesothelial cells.

BACKGROUND: Infertility rate among Mongolian couples was about 8.7% in 2003. According to researchers in Mongolia, the causes of infertility in male is about 25.6%, in female is about 45.8%, in both couples is 18.8% and unexplained infertility is about 9.8%. Women’s previous disease such as abdominal inflammatory diseases, disorders of pregnancy and surgical diseases of reproductive system can lead to infertility. Infertility has been setting 5th rank on list of human disability as shown as problem about quality of human life. METHODS: We surveyd about secondary infertile women, who has approved by inclusion criteria and determined infertility risks. We designed case-control study. We collected 52 data at “Post partum department” of “First Maternity Hospital” for control group, and 22 data at “Women stationary” of “First Maternity Hospital” for case group (ratio 2:1). Data analyzed by STATA for OR (logistic regression tests) and Microsoft Excel. RESULT: The most common previous disease is pelvic inflammatory disease (OR=2.2) р<0.001 before infertility situation. There was statistical reliability diseases. Including: female reproductive system surgery (OR=2.1), pelvic surgical diseases (OR=1.9) and complication of previous pregnancy (1.2). CONCLUSION: Pelvic inflammatory disease, surgical diseases of female reproductive system, complication of previous pregnancy and pelvic surgical diseases are the risk factors of female secondary infertility.

Background: Approximately, 3.2 millions of children are born with congenital anomalies in worldwide annually which is equal to one case per each 33 live births. As for Mongolia, there are 2.7 congenital anomalies cases for each 1000 live births on average between 2005 and 2007, however, this number is increased up to 5.04 or doubled up for each 1000 live births in 2012 urging us to concern more on this public health issue. Objective: To determine the prevalence and incidence of the congenital anomalies among infants’ with 0-7 days registered in Mongolia. Materials and Methods: This study is conducted through descriptive analyses. Statistical analyses were conducted by using Stata13, MS excel, and ArcGIS software. Results: Total 669,579 women who gave a birth and 2,376 children with congenital anomalies data were used in this study between 2006 and 2016 in Mongolia. In 2006, there were 3.88 cases of congenital anomalies for each 1000 live births and this increased up to 6.44 cases by 2016. Taking into account the incidence of congenital anomalies by the organ systems, abnormality of circulatory systems were 24.5%, cleft lip and palate were 18.1% of the total cases, respectively. By its geographical patterns, the incidence of congenital anomalies were mostly reported in Orkhon, Gobi-Altai, Gobisumber and Tuv provinces while the least cases reported province was Bayan-Ulgii.
Mean maternal age who gave a birth children with congenital anomalies was 28±6.3 which was statistically significant different (p=0.001) than maternal age who gave a normal birth. In addition, there was high incidence of congenital anomalies among the maternal age groups of 35-44 and above 45 years old. Conclusion
1. Between 2006 and 2016, the incidence of congenital anomalies was increased around 1.7 times it is tended to increase steadily. Particularly, cases of congenital anomalies were occurred in cardiovascular, circulatory system, cleft lip and palates, skeletomuscular system, digestive and nervous systems.
2. Orkhon province had the highest incidence of congenital anomalies in our study. There was significant association (12% more than live births with normal weight) between congenital anomalies and child live birth with less than 2500 gr in weights. By gender, congenital anomalies were reported dominantly in boys and it was statistically significant. Case of congenital anomalies increases as the age of mother increases.

Background: To investigate relapse rates after the successful treatment of patients with non-atypical endometrial hyperplasia (EH) either a levonorgestrel impregnated intrauterine system (LNG-IUS; MIRENA®) or two regimens of oral dydrogesterone (DGS) after primary histological response. Currently, the incidence of EH is indistinctly reported to be around 200,000 new EH cases per year in Western countries. Methods: Patients were at their choice assigned to one of the following three treatment arms: LNG-IUS; 10 mg of oral DGS administered for 10 days per cycle for 6 months; or 10 mg of oral DGS administered daily for 6 months. The women were followed for 6 months after ending therapy. [Figure2] Women aged 25-55 years with low or medium risk endometrial hyperplasia met the inclusion criteria, and 35 completed the therapy. Results: Histological relapse was observed in 55/ (41%) women who had an initial complete treatment response. The relapse rates were similar in the three therapy groups (P = 0.66). In our study involved 25-55 (mean 42.2±1.61) aged 35 women. Among them had reproductive aged 31.43% (n= 11) premenopausal women 42.86 % (n= 15) postmenopausal women 25.71% (n= 9). Their mean body mass index had 28.8±1.15 kg/m², and normal weight 34.29% (n=12), overweight 34.29% (n=12), obese 17.14% (n=6), extremely obese 14.29 % (n=5). [Figure3] Types of obesity had normal 37.14% (n=13), android 25.71% (n=9), gynecoid 37.14% (n=13). Mean parity had 1.8±0.19 to nulliparous 14.29% (n=5), primiparous 60% (n=21), multiparous 25.71% (n=9). Smoke 17.14% (n=6). Non combined disease had 65.7% (n=23), diabetes mellitus 17.14% (n=6), PCOS 14.29% (n=5), cardiovascular disease had 2.86% (n=1). [Table1] Mean endometrial thickness of TVUS had ( 16.0±0.91mm). Smoke (p=0.0391), types of obesity (p=0.0436) and myoma of the uterus (p=0.0187) seen affected the endometrial thickness. LNG-IUD group had after treatment’s menstrual period 11.11% heavy 80ml (n=1), 88.89% light 5ml (n=8). DGS (5-25 day) group had after treatment’s menstrual period 9.09% heavy =80ml (n=1), 90.91% light5ml (n=10), DGS (16-25 day) group after treatment menstrual period 40% heavy 80ml (n=6), 46.67% normal 5-80ml (n=7), 13.33% light 5ml (n=2) байв. Therefore between the three treatment groups had no differences. But treatment’s before and after result had statistics probability differences (P= 0.4064). [Figure4] Conclusions Finally, given the long natural history of menorrhagia, study outcomes need to be assessed over a period that is longer than 2 years. In conclusion, our study showed that both the LNG-IUD, oral progestin treatment reduced the adverse effect of menorrhagia on women’s lives over the course of two years. LNG-IUD was the more effective first choice, as assessed impact of bleeding on the women’s quality of life.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-age women, affecting an estimated 5-8% of all women in this age group. Clinically, hyperandrogenism, chronic amenorrhea, central obesity and polycystic ovary can all occur in women with PCOS and may cause of infertility. Dehydroepiandrosterone sulfate is an androgenic hormone produced inadrenal cortex and recently, there is no any data determined DHEA-S in patients with PCOS.Our study was designed to evaluate obesity, central obesity, hirsute grade and infertility and to determine serum DHEA-S hormone in women with PCOS and healthy non-PCOS women.We have used a cross-sectional study design and the study included reproductive-age 36 women, of whom 18 were diagnosed with PCOS and 18 were non-PCOS. Anthropometric components were measured and ELISA test to determine serum DHEA-S hormone was analyzed for all of these women. When we analyzed ELISA test to determine serum DHEA-S hormone, DHEA-S level was2.9±2.0 µg/ ml in non-PCOS reproductive-age women and 8.0±2.1 µg/ml in women with PCOS, respectively (р=0.01). Among the women diagnosed with PCOS had higher incidence of central obesity and grade II hirsute and infertility than healthy women (p=0.001). By the result, higher level of serum DHEA-S in women diagnosed with PCOS may cause of sign of hyperandrogenism such as central obesity, infertility and hirsute.

IntroductionPolycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-age women,affecting an estimated 5-8% of all women in this age group. Clinically, hyperandrogenism, chronicanovulation, central obesity and polycystic ovary can all occur in women with PCOS and may causeof infertility. Dehydroepiandrosterone sulfate is an androgenic hormone which produced from adrenalcortex and recently, there is no any data determined DHEA-S in patients with PCOS.GoalOur study was designed to determine serum DHEA-S and other hormones in women with PCOS.Materials and MethodWe have used a cross-sectional study design and the study included reproductive-age 18 women withPCOS. ELISA test to determine serum DHEA-S and other sexual hormones was analyzed for all of thesewomen.ResultWhen we analyzed ELISA test to determine serum DHEA-S and other sexual hormones, DHEA-S level8.0±2.1 μg/ml, LH level 9,45±4,3 mlU/ml, FSH level 5,04±1,1 mlU/ml, prolactin level 19,78±12,2 ng/ml, E2 hormone level 16,8±8,9pg/ml, testosterone level 0,25±0,1 ng/ml were in women with PCOS,respectively. And LH/FSH ratio was 2:1 in these women. (p=0.001).ConclusionBy the result, serum DHEA-S, LH,

BACKGROUND. Uterine cervical cancer is the fourth leading cause of cancer deaths in women worldwide. In our country, cervical cancer is second most common cancer in women. Uterine cervical smear (Papanicolaou test) remains an effective and widely used method for early detection of precancerous and cancerous lesions. Since 2002, the cervical smear was introduced to the clinical practice of our country. However, there is no study to performed external quality assurance of cervical smear until now. MATERIALS AND METHODS. We selected 20 glass slides of uterine cervical smear, the diagnosis was approved by histopathology. Each chosen slides were evaluated by four cytologists of A, B, C, D hospitals with hidden clinical information, independently. RESULTS. The sensitivity of A, B, C and D hospitals were 87.5%, 93.3%, 93.3%, and 93.3%, respectively. The specificity of A, B, C and D hospitals was 85.7%, 85.7%, 75%, and 66.6%, respectively. The diagnostic concordance of A, B, C and D was 70%, 75%, 50%, and 55%, respectively. The agreement of cytological diagnosis was moderate (kappa = 0.55), moderate (kappa = 0.43), fair (kappa = 0.37), and fair (kappa = 0.33) in A, B, C, and D hospitals, respectively. CONCLUSION: The external quality assurance in cytopathology is needed in Mongolia. The diagnostic concordance method would be applicable in our country to improve diagnostic agreement.

Introduction: Among women with Polycystic Ovarian Syndrome (PCOS), obesity is one of the diagnosis criteria and it is evaluated by waist circumference. We aimed to determine the measurement of waist circumference in women with PCOS. Obesity and PCOS tend to increase throughout the world. In 1994, leptin was discovered to be directly related to body mass index in obesity. Ovarian cystic syndrome has been shown to be associated with leptin levels and also that indicating the need for prevention of obesity in women. Objective: Clinical and medical determination for the waist circumference of women with PCOS and comporation study to leptin and comparative study to leptin levels. Мaterial and Methods: This research included a total of 86 women aged 18-35 in Ulaanbaatar city. We took a permission to start the research at the meeting of the Research Ethics Council of the Mongolian National University of Medical Sciences on March 22, 2019. Statistical analysis of this study results was performed using SPSS 19.0, text recording using Microsoft Office 2018 software, T-test to exclude group differences, ANOVA test for differences between more than two groups, and p<0.05 statistical probability difference. Results: The research of the 56 women tested for leptin in the serum of women with PCOS, 28 (32.5%) had a normal BMI with PCOS and 28 (32.5%) had an excess of BMI with PCOS, respectively. The mean levels of leptin was 13.86±11.40 kg/ml for people with normal BMI, PCOS and 33.78±17.63 kg/ml for people with excess BMI, PCOS. Leptin is higher in women with BMI, PCOS and this result is statistically significant (P-value 0.000). Conclusion Leptin levels are higher during PCOS, and leptin levels increase as the number of risk factors increases. Leptin secretion is affected by BMI and waist circumference.