not ovulating
Introduction
Introduction Women of normal reproductive age have ovulation once a month, and ovulation usually takes about two weeks before the next menstruation. The main organs that dominate ovulation are the hypothalamus, pituitary, and ovarian axes. The reasons for women not ovulating include pituitary anovulation, hypothalamic anovulation, central nervous system anovulation, intracerebral lesions, immune or mental factors. Women who do not ovulate have a high chance of normal ovulation and pregnancy. But first identify the cause, and then develop a treatment plan for your specific situation.
Cause
Cause
The reasons for women not ovulating include pituitary anovulation, hypothalamic anovulation, central nervous anovulation, intracerebral lesions, immune or mental factors.
1. Pituitary dysfunction. Pituitary adenoma, Xihan syndrome, tuberculosis or syphilis granuloma.
2. Hypothalamic disorders. Divided into two categories: functional and organic. The former includes idiopathic interbrain without menstruation, psychogenic menstruation, functional hyperprolactinemia, anorexia nervosa; the latter includes inter-brain tumors, encephalitis, and head trauma.
3. Ovarian dysfunction. Includes primary ovarian amenorrhea and secondary amenorrhea. The former includes Turner syndrome and the like. The latter includes premature ovarian failure, organic damage to the ovaries, such as loss of function after radiation exposure, destruction by tumors and inflammation.
Examine
an examination
Related inspection
Determination of basal body temperature of infertility in ovulation pretest paper by tubal fluid examination
In addition to suffering from infertility, often manifested as menstrual disorders, such as less menstruation, menstrual thinning or amenorrhea, heavy hair, obesity and so on. Due to long-term non-ovulation, endometrial hyperplasia, and no antiproliferative effects of periodic progesterone, the risk of developing endometrial cancer or breast cancer is relatively increased.
(1) Basal body temperature (BBT)
Anovulatory BBT is single-phase and ovulation is biphasic. Generally, BBT rises more than 2-3 days after ovulation, and a few rise on ovulation day, with an increase of >0.3 degrees. BBT monitoring ovulation method is simple and economical, but predicting ovulation is not accurate, the error is ±4 days. In addition, only 80-90% of ovulators BBT is biphasic, and another 10-20% of ovulatory normal BBT is single-phase; and individual BBT is biphasic but no ovulation, such as LUFS.
(B), vaginal exfoliated cells:
One third of the vaginal epithelial cells are sensitive to changes in sex hormones and also periodically during the menstrual cycle. If the vaginal exfoliated cells in the second half of the menstrual period are still affected by estrogen, there are many keratinocytes without periodic changes, indicating no ovulation. The method is cumbersome and has poor accuracy, and is currently rarely used.
(C), cervical mucus
Cervical mucus in the second half of menstruation is still fern-like plant crystal, no ellipsoid, no anovulation.
(four), endometrial examination
Affected by ovarian estrogen and progesterone, there is a significant metaphase change in the endometrium in the mid-menstrual period: the late 5-7 days are the late secretion changes. If the endometrial examination is performed within 12 hours before menstruation or during menstruation, the proliferative phase changes, indicating no ovulation. In recent years, a special case has been discovered, that is, pseudo-luteal dysfunction: in order to have ovulation, the function of the corpus luteum is normal, because the endometrium lacks the P receptor, there is no change in the secretory phase, and the endometrial examination changes in the proliferative phase. The diagnosis of pseudo-luteal dysfunction is endometrial histology + endometrial P receptor determination. Treatment is the administration of hMG and E2 during the follicular phase to synergistically promote the production of intimal P receptors.
(5) Determination of blood sex hormones
At different stages of the mid-menstrual period, the levels of sex hormones in the blood are different. To analyze whether the sex hormone levels are normal, it is necessary to consider the time of blood draw. Observe whether ovulation is generally measured at two time: 1 month menstruation (ovulation period), mainly to see whether there is LH peak (>40U / L), and E2 peak (400pg / ml); 2 menstrual day 21 (or 7 days before menstruation, mainly observe progesterone and estrogen levels, P>5ng/ml indicates ovulation, P is 6-10ng/ml, although there is ovulation, but there is insufficient luteal function, P>15ng/ml is normal . On the 9th day of March, if FSH, LH3, etc. (non-ovulation period).
(6) Self-monitoring of urinary ovulation test strips
(7) Ultrasound follicle monitoring
Ultrasound can resolve 2-4 mm follicles (vaginal ultrasound is clearer). Generally, it starts from the 9th day of the menstrual cycle and is observed once every 1-3 days. Through continuous observation, it can be seen that the follicles gradually grow up and migrate to the surface of the ovary. On the 9th to 12th, the dominant follicles (>14mm) can be identified and ovulated. The anterior follicles are 2-3 mm long. Mature follicles 18-24mm (natural cycle 17mm, hMG ovulation > 18mm, clomiphene ovulation > 20mm), located on the surface of the ovary.
1. Ovulation signs:
1 Follicle rupture: follicular collapse, volume reduction, and no echo zone disappeared.
2 blood, irregular cysts with strong echo spots.
3 pelvic effusion: 20% visible effusion (discharge 4-6ml follicular fluid, B super can detect > 5ml liquid).
2. No ovulation:
1 no follicular development.
2 dominant follicles.
3LUFS: The follicle does not rupture, persists, and there is no fluid in the pelvic cavity.
(eight), laparoscopy
Such as ovulation, can be seen ovulation plaque, blood body - corpus luteum.
Diagnosis
Differential diagnosis
1, amenorrhea (no menstruation).
2. Irregular menstrual cycles.
3, rare menstruation (reduced menstrual times).
4. Obesity.
5. Serious weight loss.
6, galactorrhea (breast lactation).
7, hirsutism (abnormal or excessive hair growth in the body and face).
8, acne acne.
In addition to suffering from infertility, often manifested as menstrual disorders, such as less menstruation, menstrual thinning or amenorrhea, heavy hair, obesity and so on. Due to long-term non-ovulation, endometrial hyperplasia, and no antiproliferative effects of periodic progesterone, the risk of developing endometrial cancer or breast cancer is relatively increased.
