secondary infertility
Introduction
Introduction The couple of childbearing age live together for one year, have a normal sex life, and have been pregnant before. No contraceptive measures have been taken now, and those who fail to conceive are called secondary infertility. Crops rely on soil, seeds, sunlight, water, and the gestation of the fetus depends on the uterus, fertilized eggs, estrogen and progesterone, and the corpus luteum. The flow of people may cause damage to the endometrium, resulting in amenorrhea or less menstrual flow, may also cause endometritis, so that fertilized eggs can not be implanted, causing secondary infertility. The flow of people can also cause attachment inflammation, causing the fallopian tubes to become unobstructed, unobstructed, and accumulating water, causing secondary infertility.
Cause
Cause
(1) induced abortion, medical abortion: human flow, drug flow is the main culprit leading to secondary infertility, and flow has become one of the main causes of secondary infertility. The flow of people may cause damage to the endometrium, resulting in amenorrhea or less menstrual flow, may also cause endometritis, so that fertilized eggs can not be implanted, causing secondary infertility. The flow of people can also cause attachment inflammation to cause the fallopian tubes to become unreasonable, accumulating water, etc., thereby causing secondary infertility.
(2) Immune infertility: People with a history of pregnancy and a history of human flow are prone to produce anti-sperm antibodies and anti-endometrial antibodies, resulting in immune infertility.
(3) ovarian dysfunction: some patients with secondary infertility are older, ovarian function is not good, there will be irregular menstruation, follicular dysplasia and ovulation disorders. Abortion can also affect ovarian function.
(4) Sexually transmitted diseases: Many sexually transmitted diseases such as gonorrhea, Chlamydia trachomatis, Mycoplasma, etc., cervical erosion, retrograde infection of the cervicitis, endometritis, pelvic inflammatory disease, salpingitis, these inflammations will change the pelvic cavity The environment and function thus affect the delivery and implantation of fertilized eggs.
(5) Amenorrhea: When excessively inhaling the palace or curettage, the endometrial basal layer is damaged, or the curette is excessively scraped, the endometrial basal layer is scraped off, so that the endometrium can not be regenerated, resulting in long-term amenorrhea, or surgery. Aseptic operation is not strict, intrauterine infection after abortion causes intrauterine adhesions and amenorrhea.
Examine
an examination
Related inspection
Hysterosalpingography gynecological ultrasound cervix gynecological routine examination vaginal gynecological routine examination vaginal secretion examination
Clinical examination:
First, physical examination: pay attention to the presence or absence of systemic diseases, such as tuberculosis, inflammation, tumors and deformities, with or without endocrine disorders, such as hairy, obese, hair loss, weight, blood pressure, secondary sexual development.
Second, ovarian function test: commonly used: basic body temperature measurement. Cervical mucus crystallization examination. Vaginal exfoliated cells are periodically smeared. Diagnostic curettage or menstrual endometrium. Pituitary or ovarian hormone assay.
Third, the fallopian tube patency test: tubal fluid, fallopian tube ventilation or uterine tubal iodine angiography.
Auxiliary inspection:
1, routine gynecological inflammation check. Gynecological examination can rule out genital tract inflammation, because genital tract inflammation is also a factor that causes women to have secondary infertility. In addition, patients need to do a fallopian tube angiography to diagnose the presence of blockage of the fallopian tube. If the fallopian tube is blocked or unreasonable, then effective dredge therapy is needed.
2, B-ultrasound. B-ultrasound can understand the condition of the uterus attachment. If there is irregular menstruation, it is necessary to test the endocrine hormone.
In order to be more certain about the diagnosis, secondary infertility also requires a medical history check to specifically ask if the patient has a history of infertility.
In addition to the general history of sexual history and infertility, special attention should be paid to the following situations:
1. Marriage history. Age of marriage, measures of contraception, health status of the spouse, occupations, etc.
2. History of infertility. At what time and in what place, after the infertility, have been examined and treated, and how effective the treatment is.
3. History of sexual life. In the sexual life of couples, there are frequent times, and there is no physical discomfort during sexual life. In addition, a detailed understanding of the history of abortion.
Diagnosis
Differential diagnosis
Female infertility: Infertility, refers to women of childbearing age who are not contraceptive after marriage and are unable to conceive. Traditionally, those who have not been pregnant for more than 3 years have been diagnosed as infertility. After the 1970s, the International Federation of Obstetrics and Gynecology shortened the definition of infertility to one year. According to the survey, the pregnancy rate is the highest in one year after marriage, up to 95%. The American Infertility Society recommends that couples living together for one year after marriage, regular sex, no contraceptive measures and no pregnancy, can diagnose primary infertility disease. More than one or abortion, and one year without re-conception, diagnosed as secondary infertility.
In view of the different causes of secondary infertility, TVS examination is performed on the patients to exclude uterus and ovarian factors. The uterus and bilateral ovaries can be clearly displayed by TVS, such as observing uterus and ovarian space occupying lesions and pelvic effusion. Etc., for the inflammatory blocking adhesion of the fallopian tube, because of its curved bending and located in the upper edge of the broad ligament of the uterus, the positive rate of TVS examination is not high. Therefore, if there is no abnormality after TVS examination, HSG examination can be performed in a targeted manner to improve the diagnosis rate of secondary infertility. HSG can not only clearly show the obstruction and obstruction of the fallopian tube, but also clearly show the conduction of the tubal fluid therapy under TV monitoring. In summary, the combination of TVS and HSG, to promote strengths and circumvent weaknesses, to take advantage of it, has important diagnostic and differential diagnostic value for secondary infertility, and at the same time has a certain therapeutic effect, can be used as a preferred diagnostic method.
