Polymorbidity as a factor affecting reproductive function in women with benign cystic-degenerative changes in the ovaries

Abstract

The aim. To determine the factors affecting reproductive function in women with cystic-degenerative changes in the ovaries.
 Materials and Methods. The study involved 398 women who were divided into groups: main (I) – 177 patients with cystic-degenerative changes of the ovaries and infertility; comparison group (II) – 121 women with cystic-degenerative changes of the ovaries and realized reproductive function; control group (K) – 100 healthy fertile patients of reproductive age. Clinical, instrumental, laboratory research methods and methods of statistical analysis were used.
 Results. In the course of the study, it was found that cystic-degenerative changes of the ovaries in women of reproductive age are formed against the background of dyshormonal disorders associated with the pathological influence of benign thyroid pathology, and are also combined with at least one other risk factor for the development of infertility. Among the patients of the 1st group, 71 had primary infertility (40.1%, the duration varied from two to five years and was, on average, 3.6±0.9 years), secondary infertility was 106 (59.8% ) women (the duration was, on average, 5.6±0.7 years). The highest percentage of endocrine pathology was also observed in the 1st group, autoimmune thyroiditis (AIT) with subclinical hypothyroidism (55%), hyperprolactinemia syndrome - (21.4%), mixed type of hyperandrogenism - (7.2%) were most often observed. The leading place among the various causes of infertility in women with cystic-degenerative changes of the ovaries was occupied by endocrine disorders, namely AIT - 44.5%, glandular endometrial hyperplasia (20.1%) and uterine factor (13.7%).
 The most common gynecological pathology in the examined women of the three research groups were: abnormal uterine bleeding - 136 (29.9%), 130 (28.5%) and hyperplastic processes of the endometrium - in 136 (29.9%). According to the obtained results, the following were registered: laparoscopy - 110 (27.0%), laparohysteroscopy with laparoscopy - 140 (34.3%), hysteroscopy - 87 (21.3%), laparotomy - 71 (17.3%). Anamnestic data on the frequency of gynecological surgical interventions in women with cystic-degenerative changes of the ovaries and infertility indicate that the examined women represent a complex contingent from the point of view of implementation of reproductive function, since 61.9% of patients underwent from one to three gynecological operations, which in general contributes to the spread of the adhesion process (15-69%, respectively), which leads to a violation of the fallopian tube function, as a concomitant tubo-peritoneal factor of infertility.
 Conclusions. The results of the conducted studies indicate the presence of disorders of the reproductive function of women with cystic-degenerative changes of the ovaries, the factors of which are somatic morbidity, including endocrine pathology; accompanying gynecological pathology - chronic inflammatory processes, hyperplastic processes of the endometrium, disorders of menstrual function, ovarian cysts, endometriosis of various localization; as well as their combination. Women with infertility and cystic-degenerative changes of the ovaries are a high-risk group with regard to a burdened reproductive history, namely, a high specific gravity of endocrine pathology plays a significant role in the pathogenesis of infertility in patients with cystic-degenerative changes of the ovaries, as autoimmune benign thyroid pathology is one of the predictors of decreased ovarian function and development in these patients with PR and ER endometrial resistance. Therefore, in such women, a mandatory examination of the functional state of the thyroid gland, endocrinological and immunological status, ovarian reserve (anti-Mullerian hormone level), regardless of age, is necessary.