Analysis of menstrual and reproductive function in women with infertility and varicose gonadic veins

Abstract

The problem of reproductive health in Ukraine over the last decade has become very important. The greatest clinical interest is infertility, which is accompanied by a violation of the ovulatory function of the ovaries due to hypothalamic-pituitary-ovarian failure. Sustained anovulation for a long time, as well as the lack of adequate correction of menstrual disorders, lead to the development of endocrine-dependent gynecological diseases, the manifestation of which is primary or secondary infertility. Increased flow of venous blood through the ovarian veins is accompanied by phlebostasis and phlebohypertension in the venous sector of the internal genital organs. Increasing the viscosity and rheological properties of blood that occurs at the same time leads to a deterioration of transcapillary metabolism and transport of oxygen to tissues. In the ischemic ovary, degenerative changes in the follicular apparatus, yellow bodies, followed by spreading to all the ovarian structural elements, which leads to its atrophy and reduced functional properties. Considering the importance of venous blood flow in the development of hormonal imbalance as a result of a violation of the endocrine function of the ovaries, the purpose of our study was to assess the menstrual and reproductive function of infertile women against the background of varicose veins. The reproductive function of women with infertility and varicose changes in ovarian veins is represented by a significant percentage of unauthorized miscarriages (41.9%) in the period of pregnancy after 6 weeks (30.6%). In patients with varicose veins in the ovaries, there was a tendency to increase the duration of infertility compared with patients without varicose dilatation of ovarian veins, which may indirectly indicate more significant functional and structural changes in the reproductive organs. In women, both the primary and the comparator groups are predominantly the late and early menarche, but the rates in groups differ slightly in their direction in women with infertility and varicose veins in the ovaries, although they do not reach statistically significant values. The menstrual function of women in the main group is characterized by a regular menstrual cycle (77.5%), regular duration (43.6%) with excessive blood loss during menstruation (54.8%) and a duration of more than 6 days (50.1%) with acyclic uterine bleeding (37.1%), dysmenorrhea (56.4%) and premenstrual disorders (51.6%), which significantly impairs the quality of life of women. At the same time, the violation of the menstrual cycle in the form of its shortening of 16,1% and acyclic uterine bleeding — 6,5%, was gradually increasing with age and was statistically significant against women from the comparison group. Conclusion in the analysis of clinical characteristics, the more significant percentage of changes in the menstrual cycle, reproductive function in women with functional infertility and varicose veins of the ovary compared with patients with infertility without structural changes in ovarian veins indicates the significant importance of venous hemodynamics in the functional properties of the ovary.