REPRODUCTIVE-AGED WOMEN WITH ANOVULATORY MENSTRUAL CYCLE AND INFERTILITY

Аннотация

Anovulatory menstrual cycle is one of the common hormonal disorders in reproductive-aged women. In this condition, ovulation does not occur, which leads to the inability to conceive. This article discusses the causes of anovulatory cycles, diagnostic criteria, itsassociation with infertility, and modern treatment approaches. Keywords: anovulation, menstrual disorder, infertility, ovulatory dysfunction, hormonal balance, luteal phase Ovulation in reproductive-aged women is an integral component of a normal menstrual cycle. The absence of ovulation (anovulation) leads to infertility as well as menstrual cycle disturbances. Worldwide, 30–40% of female infertility cases are associated with ovulatory dysfunction. Anovulatory cycles often clinically manifest as absence of menstruation (amenorrhea), scanty menstruation (oligomenorrhea), or irregular menstruation. The most common causes include polycystic ovary syndrome (PCOS), hypothalamic-pituitary disorders, thyroid diseases, and factors such as stress and weight loss. The purpose of this article is to analyze the mechanisms by which anovulatory menstrual cycles cause infertility and to review modern treatment strategies. This study has an analytical-observational nature, based on clinical observations and a review of existing scientific literature. The research was conducted during 2023–2024 in specialized obstetrics and gynecology centers of the Republic of Uzbekistan, utilizing patient dataand recent international publications. Theanalysis included 40women aged 20–35years who sought medical help for infertility andwere diagnosed with ovulatory dysfunction. Inclusion criteria for thestudy were: •Inclusion criteria: oNo pregnancy in thelast 12months; oMenstrual cycle disturbances lastingmore than 3months (oligomenorrhea, amenorrhea); oAbsence ofovulation confirmed bylaboratory orinstrumental examinations. •Exclusioncriteria: oWomen olderthan 35years; oCases with anatomical defects of theuterus or ovaries; oWomen with severe endocrineor chronic systemicdiseases. Thestudy employed thefollowing clinical, laboratory, and instrumentalmethods: •Medical history collection: menstrual cycles, ovulation history, duration ofinfertility; •Physical examination: bodymass index (BMI), identification of hirsutismsigns; •Hormonal tests: oFSH, LH, LH/FSH ratio; 98,7:ROTCAFTCAPMI .SECNEICSLACIDEM ,5202, enuJ,5emuloV gro.srehsilbupcimedaca.www oEstradiol, progesterone (on day 21); oProlactin, TSH,AMH (anti-Müllerian hormone); •Ultrasound examination(USG): assessment ofdominant follicledevelopment and signs of ovulationin theovaries; •Basal bodytemperature monitoring(in somecases); •Ovulationdetection tests (ifpatients were under regular observation). The obtained results were analyzed, and the etiological structure of anovulation, clinical presentations, and its association with infertility were statistically described. Results were analyzed based onpercentages and relativeindicators. Cause(Etiology) Percentage (%) PolycysticOvary Syndrome (PCOS) 47.5% Hypothalamic-pituitary dysfunction 20% Thyroid gland disorders 12.5% Hyperprolactinemia 10% Weight lossand anorexia 5% Idiopathicanovulation 5% Someclinical observation results:  Among women with anovulation, 65% had irregular menstruation, while 30% had amenorrhea.  Serum progesterone levels <3 ng/ml confirmed absence ofovulationin patients.  Ultrasound results showed nodevelopment ofa dominantfollicle.  Theaverage duration ofinfertility ranged from 1.5to3years. Anovulatory cycle is a menstrual cycle without ovulation. It is a major cause of infertility, especially common in cases related to PCOS.Luteal phasedeficiency, imbalance ofestrogen andprogesterone, and disruptionofthe ovulatory cycle all makeconception impossible. Causes ofanovulation should becomprehensively assessed:  Endocrine etiology is identified byhormonal tests (TSH, LH/FSH ratio, prolactin);  Ultrasound monitoringshows presence orabsence ofovulation;  Sometimes diagnosticlaparoscopy is necessary. Modern treatment approaches:  ForPCOS:ovulation stimulation (Letrozole, Clomiphenecitrate);  In hypothyroidism: restoration of hormonal balance with levothyroxine;  In hyperprolactinemia: Dostinex (cabergoline) is used;  Forweight loss-related conditions: normalizationof nutritionand bodyweight. Lifestyle changes such as exercise, stress reduction, and BMIcontrol are also very important. 98,7:ROTCAFTCAPMI .SECNEICSLACIDEM ,5202, enuJ,5emuloV gro.srehsilbupcimedaca.www Anovulatory menstrual cycle is widespread among reproductive-aged women and is considered a primary cause of infertility. Because its etiology is multifactorial, individual approach, accurate diagnosis, and treatment strategies are essential. Recommendations:  Every woman presenting with infertility shouldbe evaluated for ovulation;  Ovulationstimulation can be effectivein cases ofPCOS;  Supporting treatment with lifestyle improvement, weight reduction, and stress management isimportant;  Horm