ANATOMIC-FUNCTIONAL STATE OF PELVIC ORGANS IN WOMEN WITH INFERTILITY AND OVARICOVARICOCELE

Abstract

Introduction. High informativeness and accessibility of ultrasound examination in infertile patients provides for the exclusion or confirmation of morphological changes in genitals, the degree of damage to the organ and the involvement structures, in particular, varicose veins of the gonadal veins, which can be explained by the emergence of ovarian dysfunction. In addition, the polymorphism of semiotics of echographic signs of pathological changes in pelvic organs in the examined patients confirms the complexity of determining the main and concomitant etiological factors of the emergence of functional infertility in women, the development of disorders of reproductive function and causes the need to involve other methods. The aim of the work was to study the anatomical and functional characteristics of the pelvic organs by ultrasound, medical diagnostic laparoscopy and hysteroscopy to determine the degree of morphological changes of the genitals in women with infertility and ovaricovaricocele. Materials and methods. To solve the goals and objectives, 117 pregnant women of reproductive age (21-44 years old) with functional infertility were prospectively examined and divided into 2 groups for the comparative analysis: the main group was 62 women with infertility and varicose veins in the ovaries; a comparison group was 55 women with infertility without varicose veins. The study of the anatomical and functional state of the uterus, ovaries and fallopian tubes in women of the studied groups was performed by standard ultrasound examination on the PHILIPS ATL-HDI 4000, PHILIPS HD 11-XE with the analysis of folliculogenesis. Laparoscopic intervention was performed by the patients of the main group on the apparatus "Karl Storz" (Germany) in the first phase of the menstrual cycle. Diagnostic hysteroscopy in order to clarify the state of the uterus and endometrium was performed simultaneously with laparoscopy in the 1st or 2nd phase of the menstrual cycle using the equipment "Karl Storz" (Germany).
Results. In women of the main group with a combination of functional infertility and ovaricoaricocele, there is a statistically significant increase in the percentage of incorrect position of the uterus - 36 (58.1%) in normal form and size of the uterus, both in the main group of women and in the comparison group - 53 (85,5%) and 48 (87.3%) cases respectively. Analyzing the indicators of ovarian size and the number of antral follicles, a statistically significant difference was found in the direction of its reduction in women with functional infertility and ovaricovaricocele women without varicose dilatation of ovarian veins - 4.1 ± 0.1 cm3 vs. 5.8 ± 1 , 4 cm3 and 3.9 ± 1.1 versus 5.6 ± 1.4, respectively, in two groups. In addition, there is a tendency to reduce the size of the ovary of the protradiental age in women of all the studied groups with statistically significant rates in the patients of the main group. Also, there is a difference in the right ovary volume relative to the left in women with infertility and ovaricovaricocele in the direction of decreasing the size of the latter, which may be due to the predominant localization of the enlarged gonadal vein, and this difference is statistically significant. In determining the functional state of the ovaries in the overwhelming number of women in all of the studied groups ovulation was noted, however, when studying the characteristics of the functional state of the yellow body according to echographic signs, decrease in the thickness of the endometrium in the middle of the luteal phase of the menstrual cycle in patients of the main group, as well as the absence in the overwhelming majority cases of its adequate secretory changes, which is statistically significant against the women of the comparison group. In patients, both the main group and the comparison groups, there is a decrease in the ratio of the volume of the yellow body and ovarian volume and the decrease in the thickness of the wall of the yellow body, respectively, against the control group women, which is an ultrasound sign of inferiority of the yellow body and lack of luteal phase of the menstrual cycle. In addition, women in the main group have a statistically significant reduction in the rates against the women in the comparison group. In women of the main group, a large percentage of varicose veins of the small pelvis are found in the absence of organic changes in the uterus and adnexies (73.3%) in the presence of infertility of obscure genesis.
Conclusions. Ultrasound study in combination with color Doppler of patients with ovaricovaricocele is a highly informative method of research, because it allows to perform topical diagnosis, to determine the morphological character of the lesion, to differentiate the type of pathological process and to identify the concomitant pathology of the pelvic organs. The conducted study suggests that ovaricovaricocele should be considered not only as an accompanying symptomatic changes in diseases of the female genitals, but also as one of the causes of ovarian dysfunction with delay or termination of growth of the follicles, change in their size, degenerative-dystrophic changes in the ovaries, which leads to a violation hormonal homeostasis and manifested by reproductive disorders. In the perspective of further research it is necessary to consider a complex analysis of the morphological and functional characteristics of the internal genital organs, which will establish the presence of a certain functional and organic gynecological pathology and will enable to diagnose the initial and minimal course of the pathological process of the pelvic organs, finally verify the final diagnosis and appoint pathogenetic treatment.