INFERTILITY CAUSED BY OVULATION DISORDERS. EXAMINATION, CLINICAL FEATURES, TREATMENT

Аннотация

Infertility is a disorder of the male or female reproductive system, defined as the inability to achieve pregnancy after regular unprotected intercourse for 12 months or more. Infertility may be caused by a condition of the male or female reproductive system or by unexplained factors. Key words: hyperprolactinemia, amenorrhea, endometrium, menstruation, oligomenorrhea, hyperthyroidism. БЕСПЛОДИЕ, ВЫЗВАННОЕ НАРУШЕНИЯМИ ОВУЛЯЦИИ. ОБСЛЕДОВАНИЕ, КЛИНИЧЕСКИЕ ПРИЗНАКИ, ЛЕЧЕНИЕ Аннотация. Бесплодие — это расстройство мужской или женской репродуктивной системы, определяемое как неспособность достичь беременности после регулярной незащищенной половой жизни в течение 12 месяцев и более. Бесплодие может быть вызвано состоянием мужской или женской репродуктивной системы или необъяснимыми факторами. Ключевые слова: гиперпролактинемия, аменорея, эндометрий, менструация, олигоменорея, гипертиреоз. Endocrine infertility is infertility caused by ovulation disorders: 1. Anovulation. Chronic anovulation may be a consequence of dysfunction of the hypothalamic-pituitary system (disruption of the rhythm and amount of secretion of gonadotropins and gonadotropic hormones of the pituitary gland). developed as a result of neuroinfection, intoxication, psychoemotional stress, cerebral trauma, etc. Anovulation is also a symptom of endocrine diseases, namely polycystic ovaries, dysfunction of the adrenal cortex, hyperprolactinemia. Postpartum obesity, hypo- and hyperthyroidism. Itsenko-Cushing's disease, nervous and mental illnesses. In addition to infertility, chronic anovulation may manifest itself in menstrual cycle disorders - dysfunctional uterine bleeding, amenorrhea, oligomenorrhea. The diagnosis of anovulation is based on functional diagnostic tests: monophasic basal temperature, monotonous karyopyknotic index (usually fluctuating within the limits characteristic of the beginning of the first phase of the cycle), absence of the "pupil" symptom, 1183 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 3 tension of the cervical mucus 2-6 cm, laparoscopy is used for diagnostic purposes, which evaluates the appearance of the ovaries, the absence of ovulatory stigma and corpora lutea, and identifies non-endocrine causes of infertility - adhesions, the presence of endometrioid ectopia in the small pelvis. Additional chromopertubation - the introduction of a dye (indigo carmine, methylene blue) through the external cervical os - allows you to establish obstruction of the fallopian tubes or the localization of their obstruction. 2. Luteinization of an unovulated follicle. It is believed that stress plays a role in the development of this pathology. Hyperprolactinemia and ovarian inflammation. The diagnosis is very difficult, since functional diagnostic tests and the content of hormones in the blood and urine do not differ from those during the ovulatory cycle. Ultrasound examination and measurement of follicle diameters reveal a slow gradual decrease in the size of the preovulatory follicle (while ovulation is characterized by the disappearance of the dominant follicle). Laparoscopy performed on the 13th-15th day of the cycle reveals a hemorrhagic corpus luteum without ovulatory stigma. 3. Insufficiency of the luteal phase of the cycle (hypofunction of the corpus luteum) - accompanied by a decrease in progesterone synthesis. The causes of infertility with luteal phase deficiency may be: incomplete secretory transformations of the endometrium, preventing implantation of the fertilized egg; decreased peristaltic activity of the fallopian tubes due to progesterone deficiency. Luteal phase deficiency may be observed as a physiological phenomenon after menarche, childbirth, abortions during several menstrual cycles. The causes of luteal phase deficiency may be adrenal hyperandrogenism, hyperprolactinemia, inflammatory diseases of the uterus and appendages, hypothyroidism. In addition to infertility, with luteal phase deficiency, scanty bloody discharge is observed on the 4th-7th day before the next menstruation. The diagnosis of luteal phase insufficiency is established based on the shortening of the hyperthermic phase of basal temperature to 4-8 days with a temperature difference in the first and second phases of the cycle of less than 0.4 ° C; a decrease in the content of pregnanediol in the urine below 3 mg / day, progesterone in the blood below 15 nmol / l on the 4th day of increasing basal temperature; an incomplete secretion phase in the endometrium 2-3 days before menstruation. All the numerous variants of endocrine disorders leading to ovulation disorders can be conditionally combined into separate clinical groups, which are characterized by a corresponding symptom complex: - Group I - hypothalamic-pituitary insufficiency (pathological conditions defined as genital underdevelopment); 1184 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 3 - Group II - hypothalamic-pituitary dysfunction (patients with menstrual cycle disor