Influence of menstrual disorders of endocrine genesis on tactics ovulation stimulation in women with breast pathology

Abstract

The objective: тo analyze the results of ovulation stimulation and restoration of reproductive function in women with breast pathology with endocrine infertility. Materials and methods. For the study, a group of 130 patients (n=130) of reproductive age (mean age 27±2,3 years) was selected, who were divided into 2 subgroups by the nature of menstrual dysfunction: 1 subgroup (n=57) – women with a regular rhythm of the menstrual cycle and insufficiency of the luteal phase, 2 subgroup (n=73) – women with secondary amenorrhea and oligomenorrhea against the background of chronic anovulation. All patients complained about the absence of pregnancy for an average of 4±1,2 years. After a comprehensive assessment of the state of the reproductive system and hormone-dependent organs, women received therapy with an estrogenprogestin drug, bromocriptine and stimulation of ovulation with clostilbegit.

Results. The study found that menstrual irregularities in all patients were due to endocrine pathology: a regular rhythm in combination with luteal phase insufficiency – 43,8%, secondary amenorrhea and oligomenorrhea against the background of chronic anovulation – 56,2%. Examination of the mammary glands in 66,9% of patients revealed various variants of fibrocystic disease. Primary infertility was diagnosed in 87 patients (66,9%), secondary – in 43 (33,1%). In 1 subgroup 89,5% of cases had concomitant diseases of the pelvic organs, endocrine disorders of the type of luteal phase insufficiency in 10,5%. In patients of 2 subgroup, the incidence of combined pathology was 23,3%, and endocrine disorders – 76,7%. These results confirmed the need for endoscopic examination of all patients with infertility when deciding whether to stimulate ovulation. After gradual therapy with the inclusion in the program of laparoscopy, hysteroscopy, COCs, bromocriptine and stimulation of ovulation with clostilbegit, it was possible to restore reproductive function in 1 subgroup in 33,3%, in 2 subgroup – in 40%. In patients with hyperprolactinemia on the background of bromocriptine, ovulation was restored in 73,7%.

Conclusion. Analysis of the reproductive function of women with breast pathology with endocrine infertility proves that in almost every 2nd patient, menstrual-reproductive dysfunction arose under the influence of various factors after the establishment of a regular rhythm of menstruation, which indicates the initial imperfect level of neuroendocrine structures involved in regulation these processes in this contingent of patients. An increase in the incidence of primary infertility by 1,5 –2 times compared with secondary is characteristic for the group of patients with endocrine forms of infertility. With clostilbegit stimulation, almost a third of the surveyed contingent managed to restore the biphasic ovulatory cycle, improve reproductive function and reduce pain in the mammary glands, which allows us to conclude that complete hormonal screening and clarification of the causes of menstrual irregularities before prescribing hormonal therapy are necessary.