Endocrine infertility yog ib qho nyuaj ntawm hormonal ntshawv siab uas tuaj yeem ua rau tsis xwm yeem lossis tsis muaj ovulation hauv cov poj niam. Hauv cov txiv neej, nws tuaj yeem ua rau cov phev tsis zoo. Qhov kev kuaj mob no yog nyob ntawm ntau yam kev ua haujlwm ntawm cov thyroid caj pas, thiab ntxiv rau, cov qog nqaij hlav. Kev kho mob rau kev kuaj mob ntawm "endocrine infertility" yog txhawm rau tshem tawm nws qhov laj thawj tseem ceeb, nrog rau kev kho cov kev ua txhaum cai thiab tswj kev noj qab haus huv hormonal keeb kwm yav dhau. Normalization ntawm kev ua haujlwm ua rau cev xeeb tub hauv 70% ntawm cov neeg mob. Peb yuav qhia koj ntxiv txog qhov ua rau, cov tsos mob thiab cov yam ntxwv ntawm kev kho mob hauv cov khoom no.
Diagnosis
Nws yuav tsum tau hais qhia tias tam sim no txhua tus poj niam thib peb muaj kev xeeb tub vim yog pathology ntawm nws cov kab mob endocrine. Yog li ntawd, qhov kev kuaj mob yog ib qho kev txhais lus uas suav nrog kev ua txhaum ntawm cov txheej txheem ntawm kev tswj hwm hormonal.lub voj voog. Txawm hais tias qhov ua rau endocrine infertility nyob rau hauv cov txiv neej thiab cov poj niam, lub hauv paus ntawm nws tsim yog ib tug ua txhaum ntawm kev loj hlob functions.
Ua rau muaj menyuam tsis taus: hypothalamic-pituitary dysfunction
Qhov tsis muaj ovulation, uas ua rau endocrine infertility, yuav tshwm sim los ntawm hypothalamic-pituitary dysfunction. Feem ntau, xws li kev ua haujlwm tsis zoo tuaj yeem pom tawm tsam keeb kwm ntawm kev raug mob craniocerebral, nrog cov qog ntawm thaj tsam hypothalamic-pituitary, uas yog nrog los ntawm hyperprolactinemia. Kev nce hauv prolactin secretion ua rau inhibition ntawm LH thiab FSH los ntawm lub caj pas pituitary, thiab tseem ua rau inhibition ntawm zes qe menyuam muaj nuj nqi, provoking tsis tshua muaj poj niam txiv neej thiab kev loj hlob ntawm tsis tu ncua anovulation nrog rau endocrine infertility..
YHyperandrogenism
Lub xub ntiag nyob rau hauv poj niam lub cev ntawm ib qho me me ntawm androgens, uas yog txiv neej cov tshuaj hormones, yog qhov tsim nyog rau kev puberty thiab noj qab haus huv ntawm zes qe menyuam. Kev tso zis ntau ntxiv ntawm androgens tuaj yeem tsim los ntawm zes qe menyuam thiab qog adrenal.
Feem ntau, hyperandrogenism hauv cov poj niam yog nrog los ntawm polycystic zes qe menyuam syndrome, uas ua rau endocrine infertility nrog rau kev rog, hirsutism, los ntshav thiab amenorrhea. Adrenal hyperandrogenism feem ntau tshwm sim vim hyperplasia ntawm adrenal cortex.
Yog vim li cas lwm yam tuaj yeem ua rau poj niam muaj menyuam tsis muaj menyuam?
Impaired thyroid activation as infertility
Cov kev kawm ntawm hypothyroidism nrog diffuse toxic goiter feem ntau tuaj yeem nroganovulation, thiab nyob rau hauv tas li ntawd, nyob rau hauv cov ntaub ntawv no, theem nrab hyperprolactinemia, infertility, impossibility ntawm kev xeeb tub thiab fetal anomalies yog yam ntxwv. Feem ntau muaj qhov tsis txaus ntawm estrogen lossis progesterone. Qhov tsis muaj cov tshuaj hormones no tuaj yeem ua rau tsis txaus secretory transformation ntawm endometrium thiab kev hloov hauv kev ua haujlwm ntawm cov hlab ntsha fallopian, tiv thaiv kev sib txuas ntawm lub qe fetal. Qhov no ua rau lub cev tsis muaj peev xwm dais tus menyuam hauv plab lossis txawm ua rau endocrine infertility.
Kev rog dhau, uas ua rau tsis muaj kev xav
Adipose cov ntaub so ntswg hauv poj niam lub cev kuj ua haujlwm ntawm endocrine thiab cuam tshuam rau cov txheej txheem metabolic ntawm lub cev xeeb tub. Ntau lub cev rog ua rau hormonal tsis txaus nrog rau kev ua cev qhev thiab kev loj hlob ntawm endocrine infertility. Nyob rau tib lub sijhawm, txwv tsis pub noj cov rog nrog kev poob qis ntawm lub cev hnyav kuj tuaj yeem cuam tshuam kev ua haujlwm ntawm zes qe menyuam.
Kev muaj menyuam tsis taus ntawm endocrine keeb kwm tuaj yeem tshwm sim rau lwm yam laj thawj.
Resistant ovary syndrome
Tus mob no yog ua raws li kev ua txhaum ntawm kev sib txuas ntawm pituitary thiab zes qe menyuam, nyob rau hauv uas tsis muaj kev nkag siab ntawm lub receptor apparatus rau gonadotropin, uas ua rau ovulation, uas tshwm sim nws tus kheej hauv daim ntawv ntawm amenorrhea thiab infertility nrog tsim. yam ntxwv ntawm kev sib deev. Kev puas tsuaj rau zes qe menyuam tuaj yeem ua rau kis tus kabmob rubella, mob khaub thuas, thiab lwm yam.
mob ntshav qab zib ua ntej, kev hloov pauv ntawm kev sib deev chromosomes ua rau muaj menyuam tsis taus
Secondary amenorrhea, uas tshwm sim hauv cov poj niam hluas hnub nyoog qis dua peb caug-tsib, tuaj yeem ua rau lub cev hloov pauv hauv lub cev thiab ua rau muaj menyuam tsis taus.
Nyob rau hauv cov kab mob uas tshwm sim los ntawm chromosomal abnormalities, tej zaum yuav muaj ib tug tsis muaj peev xwm ntawm poj niam txiv neej cov tshuaj hormones, uas yuav muaj nrog kev sib deev infantilism, thawj amenorrhea thiab endocrine infertility.
Symptoms of infertility
Qhov tshwm sim tseem ceeb ntawm qhov kev xeeb tub yog qhov tsis muaj peev xwm xeeb tub. Lwm cov tsos mob tuaj yeem suav hais tias muaj ntau yam sib txawv ntawm kev coj khaub ncaws. Nyob rau tib lub sijhawm, kev coj khaub ncaws tuaj yeem tuaj yeem ncua sijhawm los ntawm ib lub lis piam mus rau rau lub hlis, nrog rau kev mob, tso zis ntau dhau, lossis amenorrhea. Feem ntau tej zaum yuav pom thaum lub sij hawm intermenstrual.
Nyob rau hauv cov poj niam uas muaj cov tsos mob ntawm endocrine infertility, lub cev ntas yog anovulatory nyob rau hauv cov xwm, thiab ncaj qha nyob rau hauv nws lub sij hawm sib raug mus rau ib txwm coj khaub ncaws - los ntawm nees nkaum-ib mus rau peb caug-rau hnub. Yog li ntawd, lawv hais txog kev los ntshav.
mob plab nrog daim ntawv no tsis muaj menyuam
Tus neeg mob yuav hnov mob hauv plab plab lossis sab nraub qaum, nrog kev tawm ntawm qhov chaw mos nrog rau dyspareunia thiab cystitis. Tej zaum kuj yuav muaj kev ntxhov siab nrog hnyav hauv cov qog mammary thiab galactorrhea cuam tshuam nrog kev nce hauv prolactin. Lub syndrome ntawm premenstrual nro kuj yog ib yam, uas yog qhia nyob rau hauv ib tug deterioration nyob rau hauv tus mob nyob rau hauv lub ua ntej ntawm feem ntau.menses. Nrog hyperandrogenism, uas nrog endocrine infertility, pob txuv yuav tshwm sim nrog hirsutism, hypertrichosis thiab alopecia. Ntawm lwm yam, tej zaum yuav muaj kev hloov pauv hauv siab nrog kev loj hlob ntawm kev rog lossis poob phaus.
Qhov no yog cuam tshuam los ntawm endocrine yam ntawm infertility. Nws yog dab tsi, tam sim no peb paub.
YKev kuaj mob ntawm pathology
Raws li ib feem ntawm keeb kwm noj cov neeg mob uas muaj tus kab mob no tsis muaj menyuam, lub sijhawm pib ntawm lawv kev coj khaub ncaws tau teev tseg nrog rau kev mob hnyav thiab mob. Tej zaum yuav muaj cov lus nug txog keeb kwm (xws li leej niam ntawm tus neeg mob) ntawm kev coj khaub ncaws tsis zoo nrog rau lub sijhawm tsis muaj cev xeeb tub. Tsis tas li ntawd, nws tseem ceeb heev kom paub qhov tshwm sim thiab teeb meem yog tias kev xav tau tshwm sim. Ntawm lwm yam, nws yuav tsum paub seb puas muaj kev ua haujlwm gynecological tau ua ua ntej. Qhov tseem ceeb sib npaug yog cov ntaub ntawv hais txog hom thiab lub sijhawm ntawm kev siv tshuaj tiv thaiv kab mob.
Kev kuaj mob dav dav ntawm tus neeg mob suav nrog kev ntsuas ntawm nws qhov siab nrog rau qhov muaj kev rog, kab mob, kev loj hlob ntawm cov qog mammary, cov yam ntxwv ntawm kev sib deev theem nrab. Kev ntsuam xyuas los ntawm gynecologist yog qhov yuav tsum tau ua, thaum lub sij hawm lub cev thiab qhov ntev ntawm qhov chaw mos raug txiav txim siab nrog rau qhov mob ntawm lub ncauj tsev menyuam thiab cov appendages. Raws li cov ntaub ntawv ntawm kev kuaj gynecological, qhov ua rau endocrine infertility hauv cov poj niam tau pom. Lawv tuaj yeem yog kev sib deev infantilism nrog polycystic zes qe menyuam thiab lwm yam. Kev soj ntsuam ntawm kev ua haujlwm hormonal ntawm zes qe menyuam nrog lub xub ntiag ntawm ovulation hauv endocrine infertility yog txiav txim siab los ntawm kev siv cov hauv qab no. Kev xeem ua haujlwm:
- Ib qho kev sim tsom rau kev ntsuas qhov ntsuas kub.
- Kev kuaj zis los txiav txim qhov muaj peev xwm ntawm ovulation.
- Ultrasound xyuas ntawm follicle maturation.
Daim Ntawv Kub Kub
Qhov muaj lossis tsis muaj ovulation yog txiav txim siab los ntawm daim ntawv ntsuas kub basal. Qhov ntsuas kub nkhaus qhia txog qib ntawm kev tsim tawm tom qab ovulatory ntawm progesterone los ntawm zes qe menyuam, uas npaj cov endometrium ntawm lub tsev menyuam rau kev cog qe tom ntej. Lub basal nkhaus yog tsim los ntawm qhov ntsuas kub thaum sawv ntxov, uas yuav tsum tau ntsuas txhua hnub hauv qhov quav. Nrog rau ovulatory cycles, lub sij hawm yog ob-theem: nyob rau hauv lub hnub ntawm ovulation, kub poob los ntawm 0.3 ° C, thiab nyob rau hauv lub thib ob theem, uas kav txog kaum plaub hnub, nws nce los ntawm 0.6 ° C piv rau ib txwm tus nqi. Lub voj voog anovulatory yog tus yam ntxwv los ntawm qhov kub thiab txias ntawm monophasic tsis tu ncua hauv qab 37 ° C.
Koj tuaj yeem lees paub lossis, qhov sib txawv, tsis lees paub qhov muaj ovulation los ntawm kev txiav txim siab qib ntawm progesterone. Thaum lub sij hawm anovulatory voj voog, qhov ntsuas no nyob rau theem thib ob yog qhov qis heev, thiab thaum lub sij hawm luteal theem nws raug txo qis piv rau lub voj voog ovulatory. Kev kuaj ovulation ua rau nws muaj peev xwm txiav txim siab qhov nce hauv LH nees nkaum plaub teev ua ntej nws tshwm sim. Thiab kev saib xyuas ultrasound pab tswj kev loj hlob ntawm cov follicle tseem ceeb hauv zes qe menyuam.
Kev xav txog kev ua haujlwm ntawm zes qe menyuam yog lub xeev ntawm endometrium ntawm lub tsev menyuam. Nyob rau hauv ib tug endometrial scraping uas yognoj ob hnub ua ntej kev coj khaub ncaws, nrog endocrine infertility, hyperplasia ntawm txawv qhov hnyav los yog secretory insufficiency pom.
Txhawm rau tsim kom muaj qhov ua rau muaj menyuam tsis taus, theem ntawm FSH raug txiav txim siab nrog rau estradiol, prolactin, testosterone thiab lwm yam. Kev tshuaj xyuas rau cov tshuaj hormones yog muab rau hnub thib tsib rau ntau lub voj voog. Kev kuaj hormonal ua rau nws muaj peev xwm ua kom paub meej txog lub xeev ntawm kev ua me nyuam tiv thaiv keeb kwm ntawm endocrine infertility. Lub tshuab ntsuas ntsuas yog ntsuas tus neeg mob cov tshuaj hormones tom qab kho nrog qee yam tshuaj stimulant.
Yog tias xav tau kom paub meej qhov ua rau muaj menyuam tsis taus endocrine, x-ray ntawm pob txha taub hau, kuaj ultrasound ntawm cov thyroid caj pas thiab zes qe menyuam, qog adrenal ua haujlwm. Lawv kuj tau kuaj mob laparoscopy. Kev kuaj mob ntawm qhov muaj endocrine tsis muaj peev xwm xeeb tub yog tsim rau cov poj niam tsuas yog tom qab tus txiv neej qhov tseem ceeb ntawm kev xeeb tub tsis suav nrog. Tsis tas li ntawd, yuav tsum tsis muaj pathology ntawm lub tsev menyuam thiab tubal infertility.
Kev kho mob ntawm endocrine infertility hauv cov poj niam
Txoj kev kho yog dab tsi? Nws yuav siv tau li cas?
Thawj theem ntawm kev kho mob suav nrog kev ua haujlwm tsis zoo ntawm cov qog endocrine. Hauv qhov no, kev kho mob ntshav qab zib mellitus yog xav tau nrog rau kev rog rog, kev ua haujlwm ntawm adrenal, tshem tawm cov qog, thiab lwm yam. Nyob rau hauv lub neej yav tom ntej, hormonal stimulation ntawm maturation ntawm lub follicle thiab qhov pib ntawm ovulation yog nqa tawm. Yuav kom induce ovulation, Clomiphene yog tshuaj. Cov tshuaj no ua rau muaj kev nce hauv follicle-stimulatingtshuaj hormone. Ntawm cov cev xeeb tub uas tau los tom qab qhov kev txhawb nqa no, cov menyuam ntxaib thiab peb tus menyuam yug hauv kaum feem pua ntawm cov neeg mob.
Nyob rau hauv cov xwm txheej uas cev xeeb tub tseem tsis tshwm sim thaum lub sij hawm rau ovulatory cycles tiv thaiv keeb kwm ntawm stimulation nrog Clomiphene, lawv tig mus rau kev kho mob nrog gonadotropins. Tab sis kev kho mob nrog cov tshuaj no tuaj yeem ua rau muaj qhov tshwm sim ntawm ntau lub cev xeeb tub nrog rau qhov tshwm sim thiab kev loj hlob ntawm ntau yam kev mob tshwm sim.
Kev kho mob ntawm endocrine infertility yuav tsum tau ua tiav. Nws yog ib qho tseem ceeb kom ua raws li txhua tus kws kho mob cov lus pom zoo kom ua tiav.
Hauv ntau lub sijhawm, kev xeeb tub tuaj yeem kho hormonally, thaum lwm tus, yuav tsum tau phais. Piv txwv li, tawm tsam keeb kwm ntawm polycystic zes qe menyuam syndrome, cov kws kho mob mus rau laparoscopic thermocauterization. Tom qab cov txheej txheem no, cov poj niam muaj qhov feem pua ntawm cev xeeb tub: los ntawm 70 mus rau 80% ntawm cov neeg mob, uas tshwm sim vim tsis suav nrog kev tsim cov adhesions hauv lub plab mog. Tawm tsam keeb kwm ntawm endocrine daim ntawv ntawm infertility, uas yog aggravated los ntawm tubal-peritoneal ua rau, nyob rau hauv vitro fertilization nrog transplantation ntawm npaj txhij-ua embryos rau hauv lub uterine kab noj hniav yog qhia. Qhov tseem ceeb uas yuav tsum nco ntsoov yog tsis txhob tso tseg.
