Hypoplasia of ovaries
Hypoplasia of ovaries – an anatomic and functional underdevelopment of female gonads – ovaries. At a hypoplasia of ovaries the hypomenstrual syndrome or , decrease a libido, infertility is noted. The hypoplasia of ovaries is diagnosed by the general and gynecologic survey, results of ultrasonography of bodies of a small pelvis, hormonal researches, a laparoscopic biopsy of ovaries, definition of a karyotype (set of chromosomes). Treatment of a hypoplasia of ovaries demands performing cyclic hormonal therapy.
Hypoplasia of ovaries
The hypoplasia of ovaries is more often noted against the background of the general or sexual infantility; it can be combined with a hypoplasia of a uterus, aplaziy uterus and vagina (Rokitansky-Kyustnera's syndrome), a hypoplasia of kidneys, an underdevelopment of other bodies. Besides, the hypoplasia of ovaries meets at a disgeneziya of gonads – the genetic diseases caused by qualitative and (or) quantitative pathology of sexual chromosomes (Shereshevsky's syndrome – Turner, etc.). In these cases the parenchyma of ovaries is presented mainly or exclusively connecting fabric.
The acquired hypoplasia of ovaries is a consequence of adverse effects on an organism during ontogenesis, especially at children's age or during the pubertatny period. Development of a hypoplasia of ovaries can be promoted by inflammations of gonads (an ooforita, an adneksita), termination of pregnancy, violations of food (hypovitaminosis, anorexia), chronic intoxications, children's infections (parotitis, a rubella, measles, scarlet fever, etc.), quinsies, to an endokrinopatiya (inflammatory damages of a hypophysis and hypothalamus, adenoma of a hypophysis, a prolaktinom, a hypothyroidism, etc.), radiation by radioactive materials. More rare the hypoplasia of ovaries happens is caused by pre-natal defeat of the follicular device owing to pregnancy pathology at mother.
According to an etiology and level of defeat the gynecology allocates a hypoplasia of ovaries of the central (gipotalamo-hypophysial) genesis; peripheral (yaichnikovy) genesis and idiopathic (not clear) origin. At a hypoplasia in ovaries reduction of expressiveness of a follicular layer is noted. In hypoplastic ovaries of primary egg cages and primordialny follicles can not be absolutely or be noted the termination of their maturing and growth that defines a picture of clinical manifestations.
Symptoms of a hypoplasia of ovaries
At patients with a hypoplasia of ovaries various disorders of menstrual function – primary, sometimes secondary , or a hypomenstrual syndrome, an anovulyatorny cycle can be observed. The listed violations at a hypoplasia of ovaries are followed by infertility.
Patients are put on female type, but have slightly expressed evnukhoidny signs. At a hypoplasia of ovaries secondary sexual characteristics are usually expressed poorly – poor pilosis on a pubis and in axillary hollows, flattening of mammary glands, not expressiveness of an areola and nipples is noted. Lack of the first periods (menarche) by 15-16 years is characteristic. Sexual desire at women is lowered, frigidity is quite often observed. Other signs of a hypoplasia of ovaries come to light when carrying out comprehensive gynecologic examination.
Diagnostics of a hypoplasia of ovaries
At gynecologic survey the hypoplastic structure of external genitals, the tonyoky not pigmented small vulvar lips, existence of a narrow inextensible and short vagina, infantilism of a uterus pays attention. When performing ultrasonography, OUSE-gisterosalpingoskopii or and gisterosalpingografiya is confirmed reduction of the sizes of ovaries and a uterus, the twisting, thin, extended uterine tubes are defined.
Basal temperature has monophase character. The research of cervical slime at a hypoplasia of ovaries allows to reveal gipoestrogeniya signs – the negative or poorly expressed symptom of "pupil". Low level of estrogen (in certain cases - gonadotropny hormones) is confirmed at laboratory blood test. Conducting test with progesterone at a hypoplasia of ovaries usually yields negative result, testifying to the expressed estrogenic insufficiency. The test combined estrogen-gestagennaya positive that testifies to functional safety of endometrium.
For identification of the central form of a hypoplasia of ovaries resort to conducting pharmacological tests with a menopauzny human gonadotrophin, a horionichesky gonadotrophin, clomifene, lyuliberiny; to performance of a X-ray analysis of the Turkish saddle, brain MRT. If necessary the diagnostic laparoscopy and a biopsy of ovaries is carried out.
Treatment and forecast of a hypoplasia of ovaries
At a hypoplasia of ovaries treatment pursues the aims of restoration of hormonal and reproductive functions. A therapy basis at a hypoplasia of ovaries is cyclic hormonal therapy. At the first stage hormonal therapy is directed to creation of an estrogenovy background, and after emergence of menstrualnopodobny reaction - to normalization cyclic - hypophysial yaichnikovo-uterine processes. Hormonal therapy is carried out under control of a follikulometriya. At the same time at a hypoplasia of ovaries vitamin therapy, physical therapy (magnetotherapy, magnetolaser therapy, laser therapy, , etc.), gynecologic massage, balneoprotsedura are appointed.
Under the influence of hormonal therapy characteristic female sexual characters develop. Women with a hypoplasia of ovaries have to be observed at the gynecologist-endocrinologist for timely detection of gipotalamo-hypophysial tumoral processes and hyper plastic violations in the sexual device under the influence of hormonal therapy.
At induction of a two-phase menstrual cycle at patients with a hypoplasia of ovaries chances of pregnancy make from 30 to 60%; at the same time the probability of development of polycarpous pregnancy is not excluded. At a deep hypoplasia of ovaries motherhood is possible thanks to to auxiliary reproductive technologies - EKO with use of a donor ovum. The embryos received by artificial insemination (way IKSI, PIKSI or IMSI) freeze (a cryopreservation of embryos), and then carry out cryotransfer and replanting of embryos in a uterus. If necessary the donor embryo can be used. Course and conducting pregnancy at patients with a hypoplasia of ovaries is accompanied by risks of not incubation. In such cases resort to the surrogacy help.