female infertility
Introduction
Introduction Infertility means that women of childbearing age 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. One or more withdrawals or abortions were made, and those who were not re-conceived for one year were diagnosed as secondary infertility.
Cause
Cause
First, ovarian infertility: ovarian infertility is seen in the following diseases.
(1) Defects in the luteal phase: 1. Luteal dysfunction; 2. Shortening of the luteal phase; 3. No luteal phase. (B) unruptured follicular luteinization syndrome (LuF). (3) Polycystic ovary syndrome (PCO).
Second, vaginal infertility.
Third, cervical infertility.
Fourth, uterine infertility.
5. Tubal infertility: (1) genital tract infection; (2) endometriosis (FMS).
Sixth, chromosomal abnormalities.
Seven, immune factors.
Eight other factors: mainly age, lack of nutrition, alcohol and tobacco anesthesia drugs, mental factors, environmental factors.
Examine
an examination
Related inspection
Follicular detection of urinary progesterone (P) progesterone test estrogen test gynecological ultrasound examination
Including asking about marriage history, menstrual history, maternal history, living habits and work experience, past history, family history and infertility seeking medical treatment and treatment, as far as possible to obtain the relevant test results and treatment records, fallopian tube angiography X, Endometrial histopathological sections, etc., should be reviewed to verify whether the report is accurate.
Physical examination
In addition to careful systemic examination, attention should be paid to the abnormal signs of the endocrine system, especially body shape, systemic development, nutrition, hair distribution, fat deposition and breast development. Observe the signs of hairy, masculine, hyperthyroidism or hypothyroidism. Check for galactorrhea. Routine gynaecological examination for genital malformations, infections, pelvic masses, suspected adhesions or endometriosis.
Laboratory inspection
(1) Regular inspection:
Includes blood, urine routine and syphilis serum tests. The leucorrhea test removes trichomoniasis, mold or bacterial vaginosis. It is found that cervical infection or cervical spleen is purulent, and gonococcal culture should be checked. Conditions should be checked for mycoplasma and chlamydia. Prolactin (PRL) should be measured as galactorrhea. Hormone determination in patients with irregular menstruation. If there are signs such as hairy, hemorrhoids and masculinity, it is necessary to determine androgen, excessive androgen secretion, which can damage follicular development and lead to non-ovulation.
(two) ovulation prediction
1. Basal body temperature measurement
The biphasic body temperature curve indicates that normal ovulation occurs. The single-phase body temperature curve can be 10%-20% through other indicators suggesting ovulation, which may be related to the lack of heat production in the body. The biphasic body temperature curve also has a small number of ovulations, such as unruptured follicular luteinization syndrome.
2. Palace neck fluid examination:
Clinically, ovulation was predicted based on the amount of fluid, the degree of drawing, the degree of fibrosis, and the degree of cervical cervix.
(1) Determination of the amount of cervix fluid: Connect a plastic tube with a tuberculin syringe, extend 1cm inside the cervical canal, and absorb the liquid, the amount of absorption is 0.4-0.6ml, suggesting that the follicle is mature and will ovulate.
(2) Drawing test: the aspirate part of the liquid is placed on the slide, and the long scorpion is extracted and pulled, and the length of the liquid lead is observed, and the length of the liquid is 6-10 cm or more, indicating that the egg is about to be taken.
(3) Fern-shaped crystal: Apply the cervical liquid to the glass slide, and then check it under low magnification. If it is a typical complicated fern-like crystal (3+), it will prompt ovulation.
(4) The cervix is slightly expanded in foreign countries, and the liquid is filled into the cervical canal.
3. Monitoring of LH in the mid-menstrual period: It is known that the serum estradiol level of women reaches 730 pmol/L for about 50 h, which can promote the peak of LH secretion, and mature follicles must be ovulated by the peak of LH. Therefore, the appearance of the LH peak means that ovulation is about to be ovulated, which is the most reliable sign for judging ovulation.
4. B-ultrasound monitoring of ovulation: ovarian B-ultrasound scan is a very reliable method for clearing and tracking the growth of follicles. B-ultrasound can be started on the eighth day of the menstrual cycle, once every other day, and the dominant follicle diameter is 14 mm. When you are on the left or right, you should observe it once a day. When the diameter reaches 20 mm, it indicates that the follicle will rupture and ovulate within 1.41±1.2d.
Device inspection
(1) B-ultrasound inspection
1. Continuous B-ultrasound examination: observe the growth of follicles. When the follicles increase to a diameter of 18-24 mm, they still do not shrink within 72 hours, and the unruptured follicular luteinization syndrome should be considered.
2. B-ultrasound shows that the bilateral ovary symmetry is increased, the contour is smooth, the capsule is thickened, and there are often more than 10 tiny sacs (2-6 mm in diameter) with a translucent dark area inside, arranged around the ovarian parenchyma under the capsule, suggesting Polycystic Ovary Syndrome.
(two) laparoscopy
Laparoscopy was performed laparoscopically before the 20th day of the menstrual cycle. No ovarian plaques and vascularization were found on the surface of the ovary. Unruptured follicular luteinization syndrome should be considered. Laparoscopy can also directly observe the uterus, fallopian tube nest lesions and adhesions, surgical use of methylene blue dilution through the cervical cannula into the uterine cavity, under direct vision to determine whether the fallopian tube is smooth. Mild endometriosis, adhesion around the fallopian tube and ovary, mostly diagnosed by laparoscopy.
(three) hysterosalpingography
Uterine malformations or intrauterine adhesions can be identified. You can also see if the fallopian tube is clear.
(four) hysteroscopy
It can also identify uterine malformations or intrauterine adhesions and intrauterine lesions, such as small fibroids under the diaphragm, endometrial polyps.
Diagnosis
Differential diagnosis
It should be differentiated from the following symptoms:
Endometriosis
Endometriosis is a gynecological disease caused by the growth of the endometrium anywhere outside the uterine cavity. Such as in the ovary, uterine fibular ligament, posterior wall serosa, uterine rectal sulcus and pelvic peritoneum of the sigmoid colon, etc., can also occur in the myometrium, so clinically endometriosis is divided into external Endometriosis and endometriosis. Patients often complain of infertility, dysmenorrhea and pelvic pain. Domestic and foreign reports of endometriosis patients with infertility rate of about 40%. The relationship between this disease and infertility has been the focus of clinical care, and endometriosis is one of the main causes of infertility. Therefore, in the clinical, women with complaints of infertility, if the fallopian tube is patency, the basal body temperature is biphasic, the endometrial response is good, and the post-trial test is normal, the possibility of endometriosis should be considered.
2. Secondary infertility
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.
3. Tubal enlargement
Tubal enlargement is generally caused by inflammation of the fallopian tube, which is an important factor in female infertility. Salpingitis is more common in infertile women. The cause is caused by pathogen infection. The pathogens mainly include staphylococcus, streptococcus, and large intestine. Caused by Bacillus, Neisseria gonorrhoeae, Proteus, Pneumococcal, Chlamydia, etc. The most common time for infection is postpartum, post-abortion or post-menstrual. Injury of the birth canal and placental stripping surface during labor or abortion or wounds of the endometrial exfoliation during menstruation are all ways in which the pathogen infects the internal genitalia. Sometimes infections are associated with less stringent aseptic surgical procedures, such as the placement of intrauterine devices, curettage, tubal fluid, and lipiodol. Sexual life is too frequent, sexual intercourse during menstruation, can also cause infection and fallopian tube inflammation. A small number of patients are caused by the direct spread of inflammation of adjacent organs. For example, appendicitis or other parts of the body are transmitted through the bloodstream to the fallopian tubes to cause infection.
