Prevalence and Characteristics of Pelvic Congestion Syndrome in Infertile Women: A Cross-Sectional Study

valves.This results in retrograde blood flow and accumulation.PCS may also result from venous obstruction. 1,2The etiology of PCS is multifactorial, involving a combination of predisposing factors.Hormonal influences, such as elevated estrogen levels, are thought to contribute by weakening the walls of pelvic veins, making them more susceptible to dilation. 3Purpose: Pelvic congestion syndrome (PCS) is a complex condition characterized by chronic pelvic pain (CPP) resulting from engorgement and dilatation of pelvic veins.Although PCS is primarily associated with CPP , recent research suggests a potential link between PCS and fertility problems.The aim of this cross-sectional study was to determine the prevalence of PCS in a large cohort of infertile women, and to identify and analyze associated demographic, clinical and ultrasound characteristics. Methods:The study included 1,343 women presenting to a single infertility clinic.Participants underwent demographic interviews, gynecological examination, endocrinological workup, and transvaginal examination.Color Doppler identified veins, arteries and flow velocity during the val-salva maneuver.Patients with any ovarian vein with a diameter >5 mm, retrograde ovarian flow, >4 pelvic veins >4 mm diameter, or dilated arcuate veins communicating between bilateral pelvic varicose veins were diagnosed as PCS.Results: Ultrasonographic evaluation identified a 5% prevalence (n=67) of PCS in this cohort.Women with PCS exhibited significantly lower rates of prior pregnancies (4.5% vs. 21.2%;p=0.001) and lower mean total antral follicle count (9.3+/-4.4 vs. 12.9+/-5.8;p<0.001) compared to infertile women without PCS.None of the women with PCS had polycystic ovary syndrome (PCOS) (0% vs. 17.3%;p<0.001).Symptoms such as CPP (p<0.001),hemorrhoids (p<0.001),dyspareunia (p<0.001),dysmenorrhea (p<0.001),lower extremity varices (p=0.009 for left; p<0.001 for right), vulvar varices (p=0.002) and hematuria (p=0.01) were significantly more prevalent in PCS group. Conclusion:This large prospective cohort of 1,343 infertile women revealed a 5% prevalence of PCS using strict sonographic criteria.This finding is clinically significant, suggesting PCS as a previously omitted factor in 1 of 20 infertility cases.The findings found no evidence of PCS co-existence with PCOS and significant differences between groups in terms of frequency of a range of symptoms including CPP , dyspareunia, dysmenorrhea, and varices.These results suggest PCS may have a role in primary infertility and altered ovarian function.