A. Dysmenorrhea and infertility should be alerted to endometriosis Endometriosis occurs mostly in women of reproductive age and is characterized by dysmenorrhea and infertility. About 30-50% of infertile patients have combined endometriosis, and about 20-30% of endometriosis patients have combined infertility. There is a close correlation between endometriosis and infertility. II. What is endometriosis? Endometriosis is a gynecological condition in which the endometrium, which has a growth function, grows and multiplies outside the uterine surface and the myometrium. What are the conditions that indicate possible endometriosis? Dysmenorrhea: It is a common and prominent symptom, mostly secondary, i.e. since the occurrence of endometriosis, the patient complains that there was no pain during menstruation in the past, but dysmenorrhea started to appear from a certain period. It can occur before, during and after menstruation. In some cases, the dysmenorrhea is more severe and unbearable, requiring bed rest or medication for pain relief. The pain often worsens with the menstrual cycle. The pain often starts 1-2 days before menstruation and reaches its peak at the beginning of menstruation. Most patients can have their pain relieved during menstruation. 2.Unpleasant sexual intercourse or painful sexual intercourse: Endometriosis occurring in the rectal fossa of the uterus and the vaginal rectal septum, causing swelling of the surrounding tissues and affecting sexual life, and aggravating the sexual unpleasantness in the premenstrual period. Infertility: About 20-30% of patients with endometriosis are combined with infertility. 4.Menstrual disorders: Patients with endometriosis often have shortened menstrual cycles, increased menstrual flow or prolonged periods, which are caused by ovarian dysfunction. 4. How to detect endometriosis? 1. History of dysmenorrhea or infertility. 2.Gynecological examination: 1-2 or more hard small nodules, such as the size of mung bean or soybean, can often be palpated in the rectal fossa, uterosacral ligament or the posterior wall of the cervix, and there is mostly obvious tenderness, which is more obvious on anal examination, which is important. 3, ultrasound examination: ultrasound imaging is currently an effective method to assist in the diagnosis of endometriosis, mainly to observe ovarian endometriosis cysts, commonly known as “chocolate cysts” 4, blood test: some patients with endometriosis have elevated peripheral blood CA125, CA199 5, laparoscopy: laparoscopy is the current The gold standard for diagnosing endometriosis is that laparoscopy allows direct visualization of the pelvic cavity and a clear diagnosis can be made when ectopic lesions are seen, and the severity of the lesions can be assessed to determine the treatment plan. V. Does endometriosis affect fertility? Endometriosis can lead to infertility and pregnancy is one of the best treatments for endometriosis. If it is clear that you have endometriosis, you can consider getting pregnant as soon as possible. However, you are reminded that about 30 – 50% of infertility patients will have combined endometriosis. The disease causes adhesions in the pelvic cavity, fallopian tubes, uterus and ovaries, resulting in complete adhesion of most of the organs in the pelvis and affecting conception. VI. How is endometriosis combined with infertility treated? Before treatment, a clear diagnosis is made as far as possible, and comprehensive consideration is given according to the patient’s age, requirements for fertility, severity of the disease, symptoms and extent of the lesion. 1.Expectant therapy: Expectant therapy can be adopted for young mild or mild endometriosis, and about 50% of patients can conceive naturally. However, it must be noted that endometriosis is a progressive disease, and if it is not removed in time, it will inevitably affect patients’ chances of conceiving in the future, so active treatment is currently advocated. 2.Medication: gonadotropin-releasing hormone agonist (GnRHa), endometrium, danazol, triamcinolone and synthetic progesterone (ethinyl isonolone or amnestic progesterone), etc. However, drug treatment plays a role in the improvement of self-conscious symptoms and the shrinkage and disappearance of ectopic lesions, but does not significantly improve the pregnancy rate. 3.Surgical treatment: It is the main method for endometriosis because the scope and nature of the lesion can be clarified under direct vision, which is more effective in relieving pain and promoting reproductive function. In recent years, microsurgery (laparoscopic surgery) is applied to remove the ectopic lesion, carefully suture the wound, reconstruct the pelvic peritoneum, carefully stop the bleeding and thoroughly flush it, so as to perfect the surgical effect, improve the success rate of pregnancy after surgery and reduce the recurrence rate. Through laparoscopy, a clear diagnosis can be made and tubal lavage can also be performed under laparoscopy. One of the important objectives of this conservative surgery is to achieve a full-term delivery, so both partners should be thoroughly examined for infertility before surgery. Those who recur after surgery can still use conservative surgery again and still obtain the efficacy. 4.Assisted reproductive technology: Endometriosis affects several aspects leading to infertility. If you are still infertile after medication, surgery and ovulation treatment, you need to consider assisted reproduction technology to help you conceive. This technique has increased the pregnancy rate of patients with endometriosis by multiple margins. VII. Irregular menstruation and breast overflow should be alerted to hyperprolactinemia Hyperprolactinemia is a syndrome caused by internal and external environmental factors and characterized by elevated peripheral blood prolactin, menstrual disorders, breast overflow, anovulation and infertility. How to treat hyperprolactinemia? 1.Treatment of the cause and primary disease: remove adverse mental stimuli, stop using drugs that elevate prolactin, and actively treat primary diseases such as pituitary tumors, hypothyroidism, and Cushing’s disease. Preferred drug therapy, currently bromocriptine is the main drug for treating various types of hyperprolactinemia. 2.Ovulation promotion therapy: Patients with anovulatory infertility and unsuccessful ovulation and pregnancy with bromocriptine alone can be treated with a combination of ovulation promotion drugs, such as clomiphene, letrozole and urotropin (HMG). This combination therapy can shorten the treatment cycle and improve the ovulation and pregnancy rates. 3.Surgical treatment: It is only suitable for those who have symptoms of compression of macroadenoma, and those who have failed to receive tumor anti-drugs, bromocriptine treatment and those who have multiple pituitary hormone secretion of suspicious cell tumor. The disadvantages of surgery are: if pituitary tumor has no obvious envelope and unclear boundary, the surgery is not easy to be complete or damaged, resulting in cerebrospinal fluid nasal fistula and secondary hypopituitarism. Can minimally invasive surgery treat infertility? The combined hysteroscopic and laparoscopic technology is a new technology applied in infertility treatment, in which high-tech hysteroscopic examination and treatment are carried out simultaneously, and the two mirrors complement each other. The combined hysteroscopy and laparoscopy technology can simultaneously examine and treat the uterus and abdomen visually, and if abnormalities are found, surgical treatment can be done at the same time, saving time and money. It brings the gospel of conceiving new life for women who have been infertile for many years. Under what circumstances should hysteroscopy and laparoscopy be considered for infertility patients? 1.Tubal imaging suggests fallopian tube pathology: for example, hydrosalpinx or poor patency; 2.Suspected endometriosis; 3.Recurrent spontaneous miscarriage without other abnormalities after comprehensive examination; 4.Suspected endometrial polyp, adhesion or uterine malformation by ultrasound.