The diagnosis of ovarian infertility
(A) of the luteal phase defect
Important cause of infertility for women, infertility accounts for 3% -14% of women. Luteal phase defect that late ovulation ovarian dysfunction as a result progesterone insufficiency insufficient progesterone, endometrial hypoplasia and damage caused by the normal fecundity implantation, luteal phase defect of the following types:
1. Luteal progesterone secretion lead to lower than normal but late ovulation (luteal phase) continuous days of normal. Endometrial morphological changes and changes in the menstrual cycle for more than a difference of 2d. Mainly due to follicle-stimulating hormone (fsh) concentration of less than the formation of corpus luteum in luteal granulosa cell layer is missing; or luteinizing hormone (lh) peak of the lower corpus luteum granule cells and development are good, but very few LH and angiogenesis.
2. Luteal phase shortened luteal phase ≤ 8d which is characterized by early follicular phase and late luteal concentration of fsh normal fsh / lh were significantly decreased follicular maturation defects, midcycle estradiol (e2) peak at low luteal phase progesterone reduced secretion of estradiol and the lack of the expected rise.
3. No luteal phase is a serious type of luteal phase defect is characterized by the normal menstrual cycle luteal function without obvious. Midcycle lh or e2 levels increased, but later in the cycle, no increase in progesterone values; basal body temperature often single-phase; premenstrual endometrial biopsy is often no obvious change in the diagnosis of secretory anovulatory menstrual cycle, But in fact had ovulation, and therefore this type can be considered a typical range of non-ovulatory menstrual cycle and luteal phase defect of the middle stage of the luteal phase progesterone in serum can be used as indicators of luteal function, in the mid-luteal serum progesterone alone time hormone levels> 15 nmo / l can say that ovulation occurred. Preferably before the next menstrual blood for 4 to 100 3 3 total value measured in 45 nlnol / l above normal luteal function can be confirmed. Endometrium (en) biopsy in the diagnosis of luteal phase defects in a more accurate and simple economical method as far as possible close to the menstrual period of the endometrium was scraped in order to be reflected in the luteal phase function of the information. If the people behind the organizational changes after the date of the corresponding zd 2 d or more suggestive of luteal phase defect may be, but it must be the same again in the next cycle, obtained biopsy confirmed the biopsy results before.
(B) luteinizing unruptured follicle syndrome
Mostly occurred in menstrual disorders, infertility in women and one of the factors is characterized by egg follicles can not be discharged from the mature, LH and follicle to produce progesterone. Patients can still a regular menstrual cycle and normal functional basis luteal phase body temperature curve type, a secretory endometrium, serum progesterone and estradiol levels in normal ovulatory cycle with no significant difference in diagnostic methods can not therefore be used not generally ruptured follicle syndrome and normal luteal ovulation cycle of distinction. Must be found by successive b ultrasound follicular diameter increased to 18 ~ 24mm, 72h contained within the still narrow and cervical fluid changes show that luteal phase serum progesterone level> 9.5nmol / l can be diagnosed luteinizing unruptured follicle syndrome.
(C) of the polycystic ovary syndrome (pcos)
The cause of the majority of people believe that the lack of ovarian enzyme aromatase system dysfunction were led to serum androgen (androstenedione plug ketone, DHEA) levels were increased, disrupting the normal function of Removal of a pituitary level in serum lh increased, hh low or normal, lh / fsh ratio of the maximum exception when> 3. Any of the following should be suspected polycystic ovary syndrome: ① primary infertility women of childbearing age have sexual menstruation and menopause thinning hair by using progesterone feasible; ② long period without ovulation; basal body temperature single-phase; ③ hit a two-joint consultation increase one or both ovaries; ④ associated with obesity, hirsutism can be confirmed.
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