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1DISORDERS OF REPRODUCTIVE FUNCTION IN WOMEN ASSOCIATED WITH INFERTILITY OF UTERINE GENESIS
Soliyeva R.B.
Soliyeva Ranokhon Bokhodirjon kizi - PhD, Assistant, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: In the article all evidences are concerned that perinatal outcome of women with infertility and reproductive disorders and the potential mechanisms that may influence poor pregnancy outcome.
Keywords: polycystic ovary syndrome, metabolic factors, placental pathologies and hypertensive disorders, assisted reproductive technologies, pregnancy.
Reproductive disorders and infertility are associated with the risk of obstetric complications and have a negative impact on pregnancy outcome. Affected patients often require assisted reproductive technologies (ART) to conceive, and advanced maternal age is a further confounding factor. The challenge is to dissect causation, correlation and confounders in determining how infertility and reproductive disorders individually or together predispose women to poor pregnancy outcomes. Reproductive disorders (endometriosis, adenomyosis, polycystic ovary syndrome and uterine fibroids) and unexplained infertility share inflammatory pathways, hormonal aberrations, decidual senescence and vascular abnormalities that may impair pregnancy success through common mechanisms. Either in combination or alone, these disorders results in an increased risk of preterm birth, fetal growth restriction, placental pathologies and hypertensive disorders. Systemic hormonal aberrations, and inflammatory and metabolic factors acting on endometrium, myometrium, cervix and placenta are all associated with an aberrant milieu during implantation and pregnancy, thus contributing to the genesis of obstetric complications. Some of these features have been also described in placentas from ART. Reproductive disorders are common in women of childbearing age and rarely occur in isolation. Inflammatory, endocrine and metabolic mechanisms associated with these disorders are responsible for an increased incidence of obstetric complications. These patients should be recognized as 'high risk' for poor pregnancy outcomes and monitored with specialized follow-up. There is a real need for development of evidence-based recommendations about clinical management and specific obstetric care pathways for the introduction of prompt preventative care measures. A major challenge of modern women's health is to define maternal or fetal factors associated with the risk of adverse obstetric outcomes. A growing number of studies are revealing that infertility and reproductive disorders, such as endometriosis, adenomyosis, polycystic ovary syndrome (PCOS) and uterine fibroids, may have a negative impact on pregnancy, from implantation until term. In addition, many patients with reproductive disorders and/or infertility require assisted reproductive technologies (ART), which independently may affect pregnancy
outcomes. Thus, it is a difficult task to distinguish the contribution of specific reproductive disorders or infertility to poor pregnancy outcomes relative to the interventions required for pregnancy success. Therefore, women with reproductive disorders often have multiple risk factors (advanced maternal age, use of ART) contributing to negative obstetric outcomes. It is important to understand the causes of this effect and develop new care pathways to ensure adequate management of their reproductive health. Hormones and inflammatory mechanisms are implicated in the major events of female reproductive function, including ovulation, menstruation, embryo implantation and pregnancy. Increasing evidence shows that hormonal aberrations and a hyperinflammatory state may lead to derangements of the immune-endocrine cross talk among endometrium, myometrium and cervix, and between the decidua and trophoblast, predisposing to pregnancy complications. Therefore, the aim of the current review was to assess whether inflammatory mechanisms and hormonal and metabolic dysfunctions occurring in uterine (endometrium, myometrium, cervix) and placental tissues in women with uterine fibroids, endometriosis, adenomyosis, PCOS and unexplained infertility may contribute to pregnancy disorders. Since other uterine conditions associated with obstetric complications, such as uterine malformation, synechiae and Asherman syndrome, work mainly through mechanisms other than inflammatory, endocrine and metabolic pathways, they are not part of the present review.
Infertility is a medical condition that can cause psychological, physical, mental, spiritual, and medical detriments to the patient. The unique quality of this medical condition involves affecting both the patient and the patient's partner as a couple. Although male infertility is an important part of any infertility discussion, this topic reviews the evaluation, management, and treatment of female infertility. To understand infertility, one must understand normal fecundability, the probability of achieving pregnancy in one menstrual cycle. This activity reviews the evaluation, management, and treatment of female infertility and highlights the interprofessional healthcare team's role in improving care for this patient population. Infertility is a medical condition that can cause psychological, physical, mental, spiritual, and medical detriments to the patient. The unique quality of this medical condition involves affecting both the patient and the patient's partner as a couple. Although male infertility is an important part of any infertility discussion, this topic reviews the evaluation, management, and treatment of female infertility. To understand infertility, one must understand normal fecundability, the probability of achieving pregnancy in 1 menstrual cycle. This basic understanding helps the healthcare team properly counsel the patient on referrals and provide basic education and understanding of this medical condition.
The research community has established a fecundability rate multiple times, which has helped establish normal pregnancy rates to assist in diagnosing infertility. The largest study identified that 85% of women would conceive within 12 months. Based on this study's findings, fecundability is 25% in the first 3 months of unprotected intercourse and then decreased to 15% for the remaining 9 months [1]. This research has helped the American Society of Reproductive Medicine (ASRM) establish when a couple should undergo an infertility evaluation. The
ASRM recommends initiating an evaluation for infertility after failing to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35.
The World Health Organization (WHO) performed a large multinational study to determine gender distribution and infertility etiologies. In 37% of infertile couples, female infertility was the cause; in 35% of couples, both male and female causes were identified; in 8%, there was male factor infertility [3]. In the same study, the most common identifiable factors of female infertility are as follows:
• Ovulatory disorders: 25%
• Endometriosis: 15%
• Pelvic adhesions: 12%
• Tubal blockage: 11%
• Other tubal/uterine abnormalities: 11%
• Hyperprolactinemia: 7%
These causes are further investigated in later portions of this topic; male and unknown factors are outside the scope of this topic. Even though these factors are not discussed here, it is important to realize that male factor infertility represents a substantial portion of the identifiable factors causing infertility.
References
1. Guttmacher A.F. Factors affecting normal expectancy of conception. J Am Med Assoc. 1956 Jun 30;161(9):855-60.
2. Infertility Workup for the Women's Health Specialist: ACOG Committee Opinion, Number 781. Obstet Gynecol. 2019 Jun;133(6): e377-e384.
3. Recent advances in medically assisted conception. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser. 1992; 820:1-111.
4. Chandra A., Copen C.E., Stephen E.H. Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth. National Health Report. 2013 Aug 14.
