Minimally Invasive Surgery in Restoring Reproductive Function of Female Infertility Caused by Benign Ovarian Structural Changes

Abstract

The aim of the study: to assess the effectiveness of advanced minimally invasive laparoscopic surgical interventions in the treatment of women with infertility due to a benign structural changes of the ovaries. Material and methods: A survey of 270 patients with infertility who underwent in operation in gynecology department of obstetric complex № 9 in Tashkent in 2014-2016. The average age of patients was 25.8±098 years. Primary infertility suffered 160 (59.2%), the secondary - 110 (40.7%) patients. The duration of infertility was from 2 to 9 years. To clarify the causes of infertility all patients were conducted a comprehensive survey that included clinical, laboratory, hormonal, bimanual, microbiological examination, transvaginal ultrasound scan, hysterosalpingography, laparoscopy and hysteroscopy. Endosurgical treatment of patients with infertility was carried out by two methods: laparoscopic and hysteroscopic. Results: As a result of investigation of 120 women (44.4%) identified infertility due to follicular ovarian cysts and 120 (44.4%) of infertility associated with impaired ovulation - polycystic ovary syndrome (PCOS). It should be noted that 80 infertile women (30.0%) mentioned a combination of 2 to 3 factors that violate the reproductive function. During laparoscopy the patients with infertility due to a benign structural changes of the ovaries, revealed various pathological changes in the fallopian tubes: 24 (10%) had adhesions in the fimbria tract, 6 (2.5%) was determined by the obstruction of the fallopian tube in the proximal. 3 patients (1.25%) had determined adhesion process 2 - 3 degrees of severity. When hysteroscopic study, 30 women with benign structural changes of the ovaries 26 (10.8%) of women detected intrauterine pathology: chronic endometritis - 11 (4.6%), synechia in the uterus - 5 (2.1%), endometrial hyperplasia - in 4 (1.6%), foreign bodies of the uterus in the form of silk sutures after cesarean section 6 (2.5%). Conclusions: The effectiveness of resection of the ovaries in PCOS is increased 1.5 times compared to electrocauterisation. The restoration of women fertility in with benign structural changes of the ovaries amounted to 87.5%, undergoing endosurgical operation in PCOS and cystectomy. A differentiated approach to the choice of method of surgical intervention depending on the kind of benign structural changes of the ovaries. Combined laparoscopy hysteroscopic study allows to identify and eliminate the causes of uterine infertility.