Structural and Functional Parameters of the Endometrium and Ovarian Tissue in Patients With Impaired Reproductive Potential and Obesity

Abstract

According to the WHO, every second woman has a problem with excess weight, while about 23% of women indicate a pathological body mass index, and excess weight (the so-called “pre-obesity”) is noted in 25% of women.
 The aim of the research was to evaluate the structural and functional parameters of the endometrium and ovarian tissue and to optimize the diagnostic algorithm and monitoring of the endometrium in women with obesity and impaired reproductive function.
 Materials and methods. 110 patients of reproductive age with impaired reproductive health underwent a comprehensive clinical and laboratory examination within the framework of this research. The main group included 64 patients with overweight and class 1 obesity, and the comparison group consisted of 46 women with a normal body mass index. The proposed diagnostic algorithm included a sonographic study of the structural parameters of the endometrium and ovaries, as well as an assessment of the features of the blood supply to the pelvic organs and statistical processing of the results.
 Research results and their discussion. The presented results allow us to note a significant percentage of comorbidity of somatic and gynecological pathology in overweight and obese patients. Pregnancy is accompanied by a higher percentage of early reproductive losses (14.0%), preterm birth (10.9%), preeclampsia (42.2%), placental dysfunction (46.4%) and low birth weight (17.2%). The main clinical forms of endometrial pathology in the main group were polyposis (32.8%), endometrial hyperplasia (23.4%) and dyschronosis of morphological changes of the endometrium (28.1%). The combination of endometrial hyperplasia with/or uterine leiomyoma, adenomyosis, benign ovarian tumors and retention formations was noted in 53.6% of observations in both groups; in 46.4% of women the isolated form was noted. The morphological characteristics of endometrial polyposis allowed us to note the dominance of glandular-fibrous polyps (45.2%) and in the case of a combination with myoma or ovarian retention cysts - glandular forms (32.3%). The most frequent sonographic marker of dysfunction of the endometrial potential (inconsistency of the ultrasound image of the endometrium with the phase of the menstrual cycle) was revealed in more than half of the cases (62.5%). Sonographic evaluation of the structural parameters of the endometrium and ovarian tissue showed an increase in the anterior-posterior size of the uterus and the thickness of the endometrium by 2.8 times, the volume of the ovary – by 2.0 times. It should be noted that the patients of the main group had a greater proportion of cysts and endometriomas. According to dopplerometry data, significantly lower parameters of the vascular resistance index were confirmed in the ovarian arteries and in the arteries of the stroma; in almost half of the observations, varicose veins of the parametrium were noted.
 Conclusions. Changes in steroidogenesis against the background of lipid metabolism disorders are accompanied by an increase in the volume of the endometrium and ovarian tissue, growing proportion of cystic formations in the appendages, an increase in the hemodynamic imbalance of blood flow in pelvic organs, which requires optimization of the monitoring program at the stage of preconception preparation and elimination of risk factors for placental dysfunction.