Although it is easy to judge that a woman is suffering from infertility based on the definition of infertility, it is necessary to further identify the specific causes of infertility and prescribe the right medicine for clinical treatment, so that the disease can be cured. Providing evidence is still a difficult issue in infertility diagnosis. Sometimes one of the causes is found and treated symptomatically, but the effect of pregnancy still fails, and further examination reveals that a more hidden cause still exists; some infertile couples have normal examinations, but have difficulty conceiving until they give up treatment and adopt. After giving birth to an adopted son, she unknowingly became pregnant again. It turned out that mental infertility was caused by mental stress. Therefore, identifying the cause and making a clear diagnosis are key and difficult issues in the symptomatic treatment of infertility. In clinical diagnosis, in addition to the eight cardinal principles and viscera syndrome differentiation based on the four diagnostic methods and combined with women\’s physiological and pathological characteristics, it is also necessary to find and evaluate various causes of disease from multiple levels, aspects, and factors to provide the basis for treatment. Provide valid evidence.
There are many methods for predicting ovulation, but they all have certain limitations. Only when multiple methods are combined and have complementary advantages can we predict ovulation more accurately. Among them, the basal body temperature measurement and mid-luteal progesterone measurement are retrospective, that is, the basal body temperature does not rise until after ovulation, and the progesterone does not rise until after ovulation. Urine luteinizing hormone peak measurement and ultrasound follicle monitoring can predict the time of ovulation before ovulation, so they are more useful in treatment. Ovulation generally occurs 24 hours after the peak of luteinizing hormone. Ultrasound monitoring of ovulation, in addition to intuitively understanding follicle development and diagnosing ovulation, can directly observe luteinized unruptured follicle syndrome, but B-ultrasound often cannot understand the endocrine function of follicles. Cervical score can only reflect estrogen levels, but it cannot confirm whether ovulation is actually occurring. The most noteworthy thing in the diagnosis and treatment of ovulation disorders is the application of gynecological laparoscopy. Laparoscopy is the most reliable. A laparoscopy was performed 4 days after ovulation, and the typical ovulation triad was seen: ovarian ovulation spot: mostly located on the surface of the ovary in the center of the fresh blood. The shape of the ovulation spot shortly after ovulation is like a volcano or a fish mouth, with a central depression and peripheral It bulges, and blood can be seen overflowing from the hole; a little while after ovulation, the surface of the ovulation hole is covered with a translucent film, the hole shrinks and the periphery becomes flat, like a golf hole. Blood body formation: Most blood bodies are on the surface of the ovary, with a diameter of 1.0 to 1.5 cm. The ovulation spot is mostly located in the center of the blood body. Bloody peritoneal fluid: For those with ovulation spots and blood bodies, bloody peritoneal fluid can often be seen in the uterine rectal fossa and bladder side fossa. The degree of bloodiness varies with the length of ovulation. It will be bloody soon after ovulation, and it will turn into pus and blood after a while. Like, if the time is longer, it will look like light blood.. The typical triad of ovulation is a golden indicator for checking whether ovulation occurs. Gynecological laparoscopy can obtain more information for infertility diagnosis. Many hospitals list laparoscopy as a routine examination and can perform it shortly after ovulation. After ovulation, the peritoneal fluid can still be aspirated for sex hormone testing and compared with the sex hormone content in the serum to assist in diagnosing the presence or absence of ovulation. After normal ovulation, the follicular fluid containing high concentrations of sex hormones enters the peritoneal cavity, causing the content of sex hormones to increase, especially the estrogen content. The higher the concentration of estrogen in the peritoneal cavity, the better the quality of the follicles and the higher the pregnancy rate.
Both hysterosalpingography and laparoscopy are the main examination methods for infertility. According to literature reports, the compliance rate of the two methods for fallopian tube examination is 46% to 89%. The misdiagnosis of lateral fallopian tube obstruction during hysterosalpingography is related to the spasmodic contraction of multiple uterine corners, mostly due to the high viscosity of methylene blue in the fallopian tube contrast agent. Hysterosalpingography is more accurate in examining the condition of the uterine cavity, so it can be used to screen patients with uterine abnormalities. Laparoscopy can not only confirm whether the fallopian tubes are unobstructed, but can also detect other pathological conditions that affect fertility, such as endometrium. Heterotopia and adhesions, etc.
Through laparoscopy, intrauterine lesions that cannot be found by other examinations can be discovered, such as uterine submucosal fibroids, endometrial polyps, endometrial tuberculosis, intrauterine adhesions, and endometrial defects. and residual intrauterine devices, etc., which can be treated laparoscopically, which not only has diagnostic value, but also has therapeutic significance.
Before the widespread use of laparoscopy, the diagnosis of mild or moderate endometriosis could only be made through laparotomy. In recent years, due to the widespread application of laparoscopy, endometriosis lesions can be directly seen under a microscope, and tissue biopsy of endometriosis lesions can be performed. At the same time, the application of laparoscopy can more intuitively detect luteinized unruptured follicle syndrome. 20% to 40% of those previously diagnosed with unexplained infertility may be associated with endometriosis and luteinized unruptured follicle syndrome. With the development of new immunological technologies, the discovery of antibodies such as anti-endometrial antibodies, anti-lecithin antibodies, and anti-sperm antibodies has led to the discovery of immunological causes for some infertility that were previously thought to be unexplained.
This article is provided by Baidu Reading and is excerpted from \”The Clear \”Conception\” Plan\” Author: Sun Jianqiu and Xie Yingbiao