Role of endothelial dysfunction in reducing ovarian reserve in women with chronic salpingophoritis

Abstract

Chronic salpingophoritis is a critical inflammatory disease of the pelvic organs and is a risk factor of diminished ovarian reserve. Notably, chronic salpingophoritis is accompanied by decreased blood supply in the uterus. Circulation in the peripheral bloodstream of pathological inflammatory factors and immune complexes in the blood contributes to the development of oxidant stress, which damages the endothelium vessels and leads to impairment of its functions. Against the background of long-term pathological reactions in the inflammation center forms a vicious circle, wherein endothelial dysfunction plays a crucial role in the development of sclerotic processes in the ovarian tissues and endocrine function of the organ. These persistent morphofunctional disorders contribute to the delay of follicle maturation, which leads to decreased ovarian reserve. The result of the study reveals that, in women, during the peak of reproductive function, having chronic salpingophoritis and reduced ovarian reserve, blood flow in the ovarian arteries deteriorates. Pronounced changes in the dopplerometric blood flow parameters in the ovarian arteries are caused by damage to the vascular wall such as distortion of its tone and disorders in the production of vasoconstrictors and vasodilators (NO and ET-1). This is exacerbated by blood vessel endothelial thrombogenicity and results in long-term endothelial dysfunction, which contributes to impaired hormonal function of the ovaries. Notably, a persistent disorder of vasodimotor and thrombogenic endothelial function leads to a decrease in recruitment of follicles in the ovaries and reduction in ovarian reserve in the selected patient population.

Keywords

pelvic inflammatory disease / chronic salpingo-oophoritis / endothelial dysfunction / ovarian reserve / flow-mediated dilation

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