{"paper_id":"524b4324-e561-43ac-a736-5fe751072d1b","body_text":"DOI: https://doi.org/10.53350/pjmhs211581773 \nSYSTEMIC REVIEW \n \n1773   P J M H S  Vol. 15, NO.8, AUG  2021 \nCauses of Ovarian Dysfunction and its Sonographic Findings With \nRespect to Infertility: A Systematic Review \n \nNIMRA AFZAL1, SAYYEDA KHADIJA TUL SUGHRA MURRIUM1, FUROZAN BAIG1,2, IRUM RAHEEM1,3 \n1Department of Radiology, University of Lahore Pakistan \n2Department of Medical Imaging and Ultrasonography, School of Health Sciences, University Of Management & Technology, Lahore  \n3Department of Medical Imaging and Radiology, Northwest Institute of Health Sciences affiliated with Khyber Medical University Peshawar  \nCorrespondence to Namra Afzal, Email: namraadnan4@gmail.com, Cell: 92-0321-4852591 \n \nABSTRACT \n \nBackground: Ovarian dysfunction is a condition in which ovaries stop working and menstrual periods stops before  \nage 40. This can cause fertility problems. There are several causes of ovarian dysfunction causing infertility such \nas endometriosis, ovarian torsion etc. \nAim: To revise the current literature about causes of ovarian dysfunction and its sonographic findin gs in infertile \nwomen. \nMethods: Electronic data base search was performed (PubMed, Science direct, Google Scholar) with data range \nfrom 2000 to 2019. All the data is available online in English.  \nResults: Seventeen articles were found regarding different causes of ovarian dysfunction and their sonographic \nappearance. Also our results show that ultrasound can be used as a reliable tool for detection of ovarian \npathologies. \nConclusion: This study supports a temporal association between various causes of ovarian dysfunction and \ninfertility risk. Gray -scale in addition to color Doppler ultrasound serves an important role in detection of different \ncauses of ovarian dysfunction and their sonographic appearances. \nKeywords: Ultrasound exam, ovarian dysfunction, ovarian volume, ovarian masses \n \nINTRODUCTION \n \nOvarian dysfunction’s subclass is primary ovarian \ninsufficiency. Ovarian dysfunction is classified by the trio of \namenorrhea for minimum 4 months 1. Ovarian dysfunction is \ntermination of menstruation afore the predictable age of \nmenopause due to diverse diseases in ovaries 2. Infertility is \nthe failure of a couple to get pregnancy within 12 months of \nunguarded intercourse. This problem is disturbing people of \nall communities 3. For evaluating ovarian follicular \nmaturation and ovulation in women n atural menstrual \ncycles ultrasound is considered an important tool 4,5. It is \nalso used in treatment of infertility and essentially used in \nmanagement of ovarian pathologies and diseases6. \nOvarian cyst is commonly diagnosed in women of \nreproductive age as w ell as in those undergoing follow up \nfor infertility 7. The typical features of polycystic ovaries are \ngrowth in the size (volume) of the ovary because of larger \nnumber of follicles and volume of stroma associated \nthrough normal ovaries8. There are evidence proposing that \ndiabetes may accelerate menopausal onset. Type 1 \ndiabetes causes early decay of anti -Müllerian hormone \nlevels, that’s indicates premature ovarian ageing. Also, \nwomen with T1D have been stated to move in menopause \n5 years prior than  non-diabetic women 9. Infertility can be \ncaused by ovarian masses for example dermoids, \nendometriomas, or functional cysts. Ovarian cyst is often \nseen with endometriosis associated with typical low -level \nechoes in infertile patients 10. Bone disorders as we ll as \ncardiovascular disease can be caused in patients with \ndiabetes11. Endometriosis was seen in 20 to 50% of women \nhaving infertility12. \n------------------------------------------------------------------------------- \nReceived on 26-02-2021 \nAccepted on 21-07-2021 \n \nRESULTS AND DISCUSSIONS  \n \nE. J. Pavlik performed a study (2000) according to which \namount of yearly screened patients was 13963.Which \nshows women with age less than thirty years having m ean \novarian volume 6.6±0.19 cm 3. Drop  in mean ovarian \nvolume was seen as age of females increased6.1± 0.06 \ncm3 in females 30to39 of age; 4.8± 0.3 cm 3 in females \n40to49; 2.6± 0.01 cm 3 in females 50to59; 2.1±0.01 cm 3 in \nfemales 60to 69; and 1.8 ±0.08 cm 3 in females ≥70.There \nwas note  worthy reduction in ovarian volume by every \ndecade of life span from age 30to70. Mean ovarian volume \nlessened on or after  4.9± 0.03 cm 3 in “P remenopausal \nfemales” to 2.2±.01 cm3 in “Postmenopausal females”13. \nJoseph E. Pena performed a study (2000), 25 \npatients was diagnosed with ovarian torsion. 21 patients \nundergoing surgery and ovarian torsion wereconfirmed in \nthem. Out of 21 patients, Doppler ultrasound was \nperformed in 10 patients who were undergoing the s urgery. \n60% patient’s  shows normal Doppler findings, while 20% \nshows reduced Doppler flow, and 20% shows absent \nDoppler flow. When nonstandard flow was identi fied on \nDoppler, diagnosis  time (mean= 5.3 hours) &  discharge \ntime (mean= 2 days) were reduced when linked thru cases \nwhere standard flow of  “Doppler” was identified, by fifty \nnine hours and fifty five  hours. No association  was found \namong the “size”, “pathology”, or side of “torsed ovary” or \n“tubal ligation ”&“Doppler results of ovary also  reviews the \nfrequency of possibly influencing circumstances in females \nhaving “adnexal torsion ”. “Torsion” includes right ovary in \n70% patients. “Ovulation induction ” was linked in 19% \npatients; 75% were recognized properly with nonstandard \nDoppler results. Pregnancy was linked in twenty four \npercent patients. Prior tubal ligation was linked in twenty \nnine percent patients14. \n \n\nN. Afzal, S K. S. Murrium, F. Baig et al \n \n \nP J M H S  Vol. 15, NO.8, AUG  2021   1774 \nJuan Luis Alca´zar performed research (2012) in which 69 \nwomen undertook surgical removal of the mass.  Cysts \nvanished afterwards one continuation examination and \nwere acknowledge  functional in 16 women. Cases having \nbenign masses 1simple cyst, 2 hydrosalpinges, 5 \nendometriomata, 5 dermoid cysts then 1 pedunculated \nuterine leiomyoma. 14 women having benign  masses \nselected conserv ative management. Overall, 41% M asses \nwere “Malignant” and 59% were “Benign”. Affording to the \nassessor carrying out  assessment of “3D-Volumes”, the \nassessment could be performed in wholly cases. \nArrangement among “Real-Time Ultrasound” and“3D-\nVolume”investigation was worthy for both assessors \n(Kappa Index: 0.82, 95% CI: 0.70 –0.93 and 0.78, 95% CI: \n0.65–0.90).  No arithmetical differences in sensitivity &  \nspecificity amongst the 2 methods15. \nAkmal El-Mazny conducted a study (2016) according \nto which total of 120 women met standards. Study \nconsisted on group of women diagnosed with hydrosalpinx \nwith U/L 46(76.7%) or B/L 14(23%). “Hydrosalpinx” \narranged for “laparoscopic tubal ” discontinuation or \n“Salpingectomy” afore In vitro fertilization . Non -\nhydrosalpinx set contained of sixty  women with men \n38(63.3%) and inexplicable 22(36.7%) childlessness \nprepared aimed at  In Vitro Fertilization. Not essential \nvariances in  age (p=0.947), equality (p=0.605), \nchildlessness kind (p=0.566), childlessness period \n(p=0.646), intermission of menses (p=0.304),& BMI \n(p=0.453) amongst the 2 groups. O varian V elocity Index \nand V elocity Flow Index were lesser in  “hydrosalpinx \ngroup” as compare to the “non-hydrosalpinx grou p”. \nThough, “Ovarian A rtery” Pulsatility Index (p=0.246) &  \nResistive Index (p=0.179), &volume of ovaries (p=0.157) & \nFI were not suggestively dissimilar amongst 2 groups. No \nimportant variances were detected in “Endometrial” and \n“Ovarian” Velocity Index, FI, and V elocity Flow Index \namongst females with U/L &B/L hydrosalpinx16. \nJuan Luis Alca´zar conducted a study (2013) \naccording to which 320 women were qualified for this \nstudy. 76 were omitted as ultrasound was not done  in 32 \npatients, operation was not done at our hospital in twenty \neight patients &patients lacking records were sixteen. 244 \nwomen were eventually counted in. Patients age stretching \nfrom 19 to 84 years old. 67 patients have type I Epithelial \novarian cancer, and 177 patients have  type II Epithelial \novarian cancer. Females having type I Epithelial ovarian \ncancer were young in age , showing no symptoms  at \nidentification more  often, & had lesser “CA-125” levels &  \nlesser cancer stage than female shaving type II Epithelial \novarian cancer. Type II Epithelial ovarian cancer was  \ncommonly recognized as solid mass and minor lesions as \ncompare to  type I  Epithelial ovarian cancer . Quantity of \nFlow inside cancer was not dissimilar amongst groups. \nUnusually, “High-Grade S erous carcinomas” & \n“undistinguishable Carcinomas” appears more regularly \nsuch as  greatly vascularized minor solid cancers as \nparalleled to  all further histotypes and contribute to \ninfertiity17. \n \n \n \n \nCONCLUSION \n \nIn conclusion, we witnessed that a 2 -fold augmented \nhazard of consequent infertility amongst women with the \nage >35 years and/or with >BMI,  25kg/m2, progression of \nPCOS in potential to insulin resistance (IR), upper genital \ntract infection in diabetic patients and its association to  \ninfertility, endometriosis results to lower live birth rate ; \npotential management of this can improve the quality of \nfertility outcomes. Ultrasonography in  corelation with the \nother diagnostic tools can diagnose timely and  overcome \nthe persistence of this problem.  \nAcknowledgment: I am very thankful to Dr. Sayyeda \nKhadija, Assistant Professor, Department (UIRSMIT) \nFAHS, University of Lahore, and my classmate Irum  \nRaheem (Student of MS Diagnostic Ultrasound, University \nof Lahore) for their unforgettable kind help and encouraging \nsupport. \nFinancial sources & competing interests disclosure: I \ndeclare that I have no related associations or economic \ncontribution with any institute or entity with a n economic \nattention in or economic clash with the subject material or \nresource is coursed in the script. It is a learning based \nstudy and I have no competing interests.  \n \nFigure 1 a normal ovary   b ovary having cyst1 \n \n(Srivastava S, Kumar P, Chaudhry V, Singh A. Detection of Ovarian Cyst in \nUltrasound Images Using Fine -Tuned VGG-16 Deep Learning Network. SN \nComputer Science. 2020 Mar;1(2):1-8) \n \nFigure 2: Serous cyst adeno carcinoma of the ovary in  38-year-old \nwoman. TVS color Doppler Ultrasound scan shows a complex \novarian cyst with septum and a solid nodule (arrow). There is flow \nwithin the solid nodule, typical of malignancy.2 \n \n(Brown DL, Dudiak KM, Laing FC. Adnexal masses: US characterization and \nreporting. Radiology. 2010 Feb;254(2):342-54) \n \n \n \n\n\nOvarian Dysfunction and its Sonographic findings \n \n \n1775   P J M H S  Vol. 15, NO.8, AUG  2021 \nFigure 3: Left hydrosalpinx on gynecological ultrasound3 \n \n(Hydrosalpinx–Wikipedia https://en.wikipedia.org › wiki › Hydrosalpinx) \n \nREFRENCES \n \n1. De Vos M, Devroey P, Fauser BC. Primary ovarian \ninsufficiency.The Lancet. 2010 Sep 11;376(9744):911-21. \n2. Laven JS.Primary ovarian insufficiency.InSeminars in \nreproductive medicine 2016 Jul (Vol. 34, No. 04, pp. 230 -\n234).Thieme Medical Publishers. \n3. Sudha G, Reddy KS. 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