Clinical and statistical characteristics of patients with infertility on the background of chronic pelvic inflammatory diseases of the genital organs

Abstract

Reproductive health and the formation of an adequate attitude to motherhood depend significantly on the social status of a woman. An increased number of people of fertile age with burdened somatic and obstetric and gynecological pathologies, a long-term stress load caused by the social and economic crisis and military actions in the country, a high specific weight of obstetric and perinatal complications - all these factors lead to a rapid decrease in the birth rate.Pathological changes in the hormonal status of female patients, sexual health disorders, and the progressive spread of inflammatory diseases of the reproductive system lead to an increased frequency of infertility. The etiological factor is most often a microbial association, which can be represented by both absolute pathogens with a predominantly sexual transmission route, and endogenous anaerobes and aerobes.Microbial associations contribute to better adaptation of the causative agent and its parasitism, increase the pathogenicity of each causative agent, their resistance to the antibiotics, which complicates the treatment of the disease as a whole. The prevalence of papillomavirus, herpes, cytomegalovirus infection in the structure of sexually transmitted inflammatory diseases negatively affects reproductive function.The objective: to analyze the risk factors for infertility in patients with inflammatory diseases of the genital organs which are determined by urogenital mixed infection.Materials and methods. A comprehensive clinical and laboratory examination of 154 married couples with infertility was carried out. The main group included 92 women who were examined for infertility and had chronic pelvic inflammatory disease (PID) caused by urogenital mixed infection.Depending on the detected pathogens, the women of the main group were divided into groups. During the In Pouch™ test in 30 (32.6%) patients who were included in the I observation group, Trichomonas vaginalis was found in biomaterial from the vagina in association with other conditionally pathogenic factors.Chlamydia trachomatis was diagnosed in polycomponent associations with other opportunistic flora in 34 (37.0%) women using polymerase chain reaction (PCR) in scrapings from the cervical canal - the II observation group.In 28 (30.4%) examined women, the human papillomavirus (HPV) was identified in the biological material from the cervix by PCR in Real time. Women with papillomavirus infection associated with opportunistic flora were included in the III observation group.To evaluate the results of the cytological examination, the Papanicolaou classification (CIN classification) and the Bethesda terminological system (The Bethesda system, TBS, 2014) were used.Results. As a result of a complex clinical and laboratory examination of women of reproductive age from 154 married couples who were observed for infertility, 60% (92 cases) of patients were diagnosed with PID due to urogenital mixed infection.Among the specific etiological factors, Trichomonas vaginalis was found in 32.6% (30 cases), Chlamydia trachomatis in 37.0% (34 cases), and HPV in 30.4% (28 cases) in multicomponent associations with representatives of opportunistic flora. It was established that, in addition to pathogenic agents of sexually transmitted infections, representatives of opportunistic flora negatively affect the reproductive function of women, among which the leading positions are occupied by mollicutes (Mycoplasma hominis, Ureaplasma urealyticum) - 67.4%; Enterococcus faecalis – 44.6%; Esherichia coli – 38.0%; Gardnerella vaginalis – 26.0%, with a maximum decrease in the vaginal content of the number or even absence of Lactobacillus spp.In the majority of women - 78.0% (64 cases), the inflammatory process had no pronounced clinical signs, in 22.0% it was almost asymptomatic, but was accompanied by frequent (up to 3-6 per year) relapses. Among the examined women of the III group, an association of two highly oncogenic HPV genotypes was found - 11 (39.5%) cases, three or more - 7 (25.0%) cases.A tendency to an earlier onset of sexual life was determined in women with sexually transmitted diseases, especially in the group with papillomavirus infection. Risk factors for infertility include the pathological course of childbirth and the postpartum period, surgical interventions, and infectious diseases. Among the diseases of the hepatic and biliary system, chronic cholecystitis prevailed.Conclusions. On the basis of the anamnestic assessment of reproductive health in the examined women with infertility on the background of chronic PID, it is possible to single out the most important factors that negatively affect the realization of the reproductive function: the age of a woman is less than 20 and more than 30 years, social maladaptation, working conditions and harmful habits, in particular smoking, as one of the cofactors of HPV-associated diseases of the cervix, as well as early sexual debut (up to 16 years), promiscuity, ignoring barrier contraception.In the genesis of pathological changes occurring in the urogenital tract, there are mixed infections, which potentially complicates diagnosis and negatively affects the results of treatment of associated forms of diseases.