Ovulation disorders account for approximately 25-30% of infertility roles and include conditions such as premature ovarian failure (POF), polycystic ovary syndrome (PCOS), congenital gonadal dysgenesis (GD), ovarian resistance syndrome (ROS), luteinized follicular nonrupture syndrome (LUFS) and hyperprolactinemia, with persistent anovulation being the most prevalent clinical condition. Ovulation in women is controlled by the central hypothalamic-pituitary-ovarian gonadal axis. Infertility with ovulation disorders can occur due to various pathological conditions such as insufficient follicle production in the ovaries, excessive egg consumption, failure of follicles to grow and mature, failure of eggs to be eliminated, and inadequate luteal function in any one of these links.
Etiology of ovulation disorders
The pathogenesis of ovulation disorders is very complex and there are more than a hundred different etiological categories. The causes of ovulation disorders are clinically classified according to the site of onset, and the common representative clinical disorders of each type are.
1. Central hypothalamic causes.
(1) anorexia nervosa.
(2) obesity.
(3) hypogonadotropic gonadal dysfunction.
2. Pituitary causes.
(1) idiopathic hyperprolactinemia.
(2) pituitary adenoma.
(3) Empty saddle syndrome.
3. Ovarian causes
(1) Premature ovarian failure.
(2) Turner syndrome.
(3) Congenital gonadal dysgenesis.
(4) Polycystic ovarian syndrome.
(5) Ovarian resistance syndrome.
(6) luteal insufficiency.
(7) luteinized follicle non-rupture syndrome
(8) follicular membrane proliferation disorder
(9) Functional endocrine tumors of the ovary.
4. Other endocrine gland causes.
(1) congenital adrenocortical hyperplasia.
(2) Cushing’s syndrome.
(3) hypoadrenalism (Addison’s disease).
(4) hypothyroidism (Hashimoto’s disease).
Diagnosis of ovulatory disorders
An important sign of ovulation is the periodic onset of menstruation. Regular menstruation is one of the important features of ovulation, provided there is no disease of the reproductive tract or endometrium. However, not every menstrual period is ovulatory. The special tests for ovulation are mainly the following.
1.Basal body temperature measurement
The basal body temperature (BBT) is measured every morning after waking up with an oral meter and the change curve is marked according to the cycle. The basal body temperature curve should be in biphasic form, with high temperature maintained for more than 10 days accordingly. The significance is that.
(1) To allow retrospective analysis of whether ovulation has occurred in the current cycle.
(2) To analyze whether there may be signs of short luteal phase.
2.Cervical mucus measurement
The cervical mucus is thin, clear and long drawn before ovulation, and is viscous, cloudy and white after ovulation. The significance of identifying the nature of cervical mucus is that it can identify whether ovulation is imminent or has already occurred.
3.Histological examination of the endometrium
The endometrium is taken for histological examination before or just after menstruation. If no progestational drugs are taken, the secretory endometrium is the endometrium with ovulation.
4.B ultrasound monitoring
Transvaginal ultrasound to monitor follicular development and endometrial morphology has become the most popular tool. It is very accurate, convenient, non-invasive and inexpensive to dynamically measure the diameter of the follicle, observe the rupture of the follicle and observe the thickness and morphology of the endometrium. Eggs in follicles with a general diameter of 17mm-25mm have the ability to fertilize and develop, and the thickness of the endometrium before ovulation should be between 9mm-13mm, with type A being the best.
Color ultrasound with Doppler function can also measure the flow and resistance of uterine and ovarian vessels and analyze the relationship between blood flow and ovulation.
5.Hormone measurement
On day 3 of the menstrual cycle (counting from the first day of menstruation), the levels of blood FSH, LH, E2, T, PRL and other hormones can be measured to assess the function of the ovaries. Other measurements of hormones such as insulin, glucose tolerance test, sex hormone binding globulin, and dehydroepiandrosterone sulfate can also help physicians determine the cause of ovulation disorders. The measurement of reproductive hormones emphasizes the time requirements for the measurement, with some values being repeated for verification, and the relationship between the measured values of each hormone is also analyzed.
Other endocrine indicators such as cortisol, thyroid function, endorphins, 17 hydroxyprogesterone, pituitary excitation test, dexamethasone inhibition test, etc. can be used to help diagnose the cause and extent of ovulation disorders according to the patient’s condition.
6.Laparoscopy
Laparoscopy is performed after ovulation and allows direct observation of the fresh ovulation rupture on the ovary and the corpus luteum in all periods to confirm that ovulation has occurred.