uterine infertility
Introduction
Introduction to uterine infertility Uterine dysplasia, also known as the naive uterus, refers to the normal structure and shape of the uterus, but the volume is small, the cervix is relatively long, and may be accompanied by dysmenorrhea, rare menstruation, or even primary or secondary amenorrhea. Uterine dysplasia is often an important cause of infertility, and it has been reported to account for 16.2% of infertile patients. Uterine infertility, including uterine dysplasia, uterine malformation, endometritis, uterine fibroids, abnormal uterine position and intrauterine adhesions, can cause female infertility. basic knowledge The proportion of illness: 0.002% Susceptible people: women Mode of infection: non-infectious Complications: infertility
Cause
Cause of uterine infertility
Cervical canal atresia (15%):
Cervical atresia and stenosis are often caused by abortion, mainly in the abortion of the cervix during aspiration surgery, or the use of negative pressure to remove the straw, or the doctor's improper operation, etc., to the female uterus The membrane causes damage and the end result is the occurrence of infertility. Women who have this condition often feel periodic pain in the lower abdomen. During the examination, the vagina is purple-blue, the cervix is painful, and the palace is slightly full, active, and tender.
Cervical tube position difference (10%):
Chronic pelvic inflammatory disease or endometriosis can cause the uterus to be extremely backward, hindered or flexed, which is not conducive to the ascending sperm. In addition, prolongation of the cervix, too short or cervical prolapse may also change the normal positional relationship between the external cervix and the posterior iliac crest, preventing sperm from ascending.
Intrauterine adhesions (10%):
Due to surgery, curettage, electrocautery and drug corrosion, endometrial damage and infection caused by cervical and uterine adhesions, uterine cavity deformation, menstrual disorders and infertility syndrome.
Dysplasia (5%):
Uterine dysplasia, also known as naive uterus, generally refers to the uterus still less than normal after puberty. Simple small uterus is not necessarily the direct cause of infertility. If ovarian dysplasia is at the same time, it is the direct cause of uterine infertility.
Uterine malformation (5%):
Whether uterine malformation affects fertility depends on the type and extent of deformity. Most of these patients have no obvious symptoms, but some manifest as primary amenorrhea and irregular menstruation, such as menstrual thinning, menorrhagia, dysmenorrhea or dysfunctional uterine bleeding; and some manifestations of genital and breast development Poor, such as sexual naive, breast and secondary sexual dysplasia, ovarian dysfunction, no ovulation. Some patients, even if they can conceive, can not expand due to the uterine cavity, prone to miscarriage, premature delivery, abnormal fetal position, abnormal placenta or stillbirth.
Uterine fibroids (10%):
Uterine fibroids are sex hormone-dependent tumors, and smaller uterine fibroids rarely affect pregnancy, but larger volumes and submucosal fibroids can cause infertility and miscarriage.
Endometritis (5%):
Endometrial inflammation can lead to menstruation, reproduction, barrier function, excretion and endocrine dysfunction, and win infertility.
Intimal insufficiency (10%):
Endometrial insufficiency can be divided into endometrial atrophy, abnormal proliferation of endometrium, and three major types of membrane function during luteal phase.
Endometrial polyps (5%):
Endometrial polyps fill the uterine cavity, preventing sperm and pregnant eggs from persisting and implanting, causing infertility.
Prevention
Uterine infertility prevention
Maintain a specificity to prevent sexually transmitted diseases. Women should follow the doctor's advice during pregnancy, and do regular antenatal check-ups, especially to be alert to vaginal bleeding and abnormal fetal position. During pregnancy, you should pay attention to restrictive life, especially during the first trimester and the third trimester of pregnancy, to prevent intrauterine infection. Postpartum confinement should also be scientific, pay attention to daily living, ensure adequate rest, avoid premature dry work, prevent uterine prolapse.
Complication
Uterine infertility complications Complications infertility
Infertility, generally no other complications.
Symptom
Uterine infertility symptoms common symptoms vaginal discharge increased uterus small uterus tenderness endometriosis uterine contraction uterine prolapse uterine bleeding leukocytosis
Mainly manifested as infertility.
1. Female uterus malformation, poor development and female endometritis, uterine fibroids, intrauterine adhesions, abnormal uterine position and intimal dysfunction, etc., will affect sperm operation, implantation of fertilized eggs and fetal development , growth, causing infertility or miscarriage.
2. Uterine infertility is based on kidney deficiency. The clinical manifestations of uterine infertility are biased to kidney yang deficiency, kidney yin deficiency, liver and kidney deficiency or combined liver stagnation, spleen deficiency, blood stasis, and dampness.
3. Most patients with uterine malformations have no obvious symptoms, but they often cause infertility due to the implantation of fertilized eggs. Even if pregnant, because the uterine cavity can not be expanded, prone to miscarriage, premature birth.
Examine
Uterine infertility check
(1) Diagnostic curettage: Applicable to married women to understand the depth and width of the uterine cavity, whether there is adhesion in the cervical canal or uterine cavity. Scraping the endometrium for pathological examination can understand the response of the endometrium to ovarian hormones, and also determine the diagnosis of endometrial tuberculosis, and the scrapings are also used for tuberculosis culture.
(2) uterine tubal lipiodol angiography: to understand the shape, size and fallopian tube of the uterine cavity, to diagnose reproductive system dysplasia, malformations, tuberculosis and intrauterine adhesions and other diseases.
(3) hysteroscopy: observation of the uterine cavity and endometrium under direct vision, diagnosis of intrauterine adhesions, suspected tuberculosis lesions, should be routinely taken for pathological examination.
(4) Drug withdrawal test: 1 progesterone test (progesterone test). In order to evaluate the simple and rapid method of endogenous estrogen levels, if the progesterone test has no withdrawal bleeding, the patient's estrogen level is low. 2 estrogen test. The estrogen test should be repeated once without withdrawal bleeding. If there is still no bleeding, suggesting that the endometrium is defective or damaged, it can be diagnosed as uterine amenorrhea.
(5) B-ultrasound: 1 Check the shape, position and size of the uterus, measure the length, width and thickness of the uterus, and observe the degree of uterine dysplasia and whether it is a naive uterus. 2 can check for the presence of tumors, such as uterine fibroids, ovarian tumors, cystic teratoma and so on. 3 uterine malformations, such as no uterus, trace uterus, double-horned uterus, single-horned uterus, residual uterus, etc. can be examined by B-ultrasound. 4 can find endometrial polyps.
(6) X-ray film is mainly used for uterine fibroids. When the fibroids are calcified, they appear as scattered spots, or shell-like calcified envelopes, or honeycombs with rough edges and wavy edges.
Diagnosis
Diagnosis and diagnosis of uterine infertility
diagnosis
Diagnosis based on the history of infertility and examination results:
(1) Diagnostic curettage: Applicable to married women to understand the depth and width of the uterine cavity, whether there is adhesion in the cervical canal or uterine cavity. Scraping the endometrium for pathological examination can understand the response of the endometrium to ovarian hormones, and also determine the diagnosis of endometrial tuberculosis, and the scrapings are also used for tuberculosis culture.
(2) uterine tubal lipiodol angiography: to understand the shape, size and fallopian tube of the uterine cavity, to diagnose reproductive system dysplasia, malformations, tuberculosis and intrauterine adhesions and other diseases.
(3) hysteroscopy: observation of the uterine cavity and endometrium under direct vision, diagnosis of intrauterine adhesions, suspected tuberculosis lesions, should be routinely taken for pathological examination.
(4) Drug withdrawal test: 1 progesterone test (progesterone test). In order to evaluate the simple and rapid method of endogenous estrogen levels, if the progesterone test has no withdrawal bleeding, the patient's estrogen level is low. 2 estrogen test. The estrogen test should be repeated once without withdrawal bleeding. If there is still no bleeding, suggesting that the endometrium is defective or damaged, it can be diagnosed as uterine amenorrhea.
(5) B-ultrasound: 1 Check the shape, position and size of the uterus, measure the length, width and thickness of the uterus, and observe the degree of uterine dysplasia and whether it is a naive uterus. 2 can check for the presence of tumors, such as uterine fibroids, ovarian tumors, cystic teratoma and so on. 3 uterine malformations, such as no uterus, trace uterus, double-horned uterus, single-horned uterus, residual uterus, etc. can be examined by B-ultrasound. 4 can find endometrial polyps.
(6) X-ray film is mainly used for uterine fibroids. When the fibroids are calcified, they appear as scattered spots, or shell-like calcified envelopes, or honeycombs with rough edges and wavy edges.
Differential diagnosis
Need to be differentiated from infertility caused by other causes.
