Diagnosis of infertility: Couples who have had normal sex for one year and failed to conceive Incidence: about 10-15% Causes of infertility: organic, endocrine, immunological, psychiatric, organic lesions, etc. 1. Vagina: congenital absence of vagina, vaginal longitudinal septum, scars, vaginitis. Cervix: congenital malformation, polyp, myoma, cervicitis (erosion). Uterus: congenital malformations (unicornuate, bicornuate, longitudinal uterus), fibroids, endometritis (bacterial, STD, TB, etc.), endometrial complex or atypical hyperplasia. Fallopian tubes: inflammation, obstruction, effusion, adhesions. Ovary: congenital abnormal development, tumor, after radiotherapy or chemotherapy. 2, Endocrine factors; PCOS, hyperprolactinemia, luteal deficiency, hypogonadotropic, hypergonadotropic, simple anovulation. 3, immune factors: endometriosis, anti-sperm antibodies (the relationship with infertility is not recognized and elucidated), disorders of implantation and early pregnancy (anti-placental immune response, recurrent spontaneous abortion), pre-eclampsia. 4, mental factors: mental stress leads to increased secretion of adrenaline, which affects the hypothalamic gonadotropin system affecting ovulation. The autonomic nerve endings of the ovaries surround the follicles and directly control the follicle size, hormone secretion and ovulation of the ovaries. Mental stress and autonomic excitement affect the contraction of the fallopian tubes and the transport of oocytes. Infertility examination 1, medical history: age, menstrual history, reproductive history, sexual life, past history, surgical history, etc. 2. Physical examination and gynecological examination: pay special attention to hirsutism and lactation. 3.BBT: 5 minutes of sublingual table after 6-8 hours of sleep without any disturbance. Objective: To know the presence or absence of corpus luteum and luteal function, presence or absence of ovulation and estimated ovulation date, normal luteal phase of 12 to 16 days, insufficient days of luteal phase, insufficient rise of luteal phase, fast rise of luteal phase, slow rise of luteal phase, high body temperature of luteal phase, early pregnancy. 4. Husband’s semen examination (normal value): volume of semen discharge: 2ml-7ml, sperm density: 20×106/ml, liquefaction time: <30 minutes, PH value: 7.0~8.0. Semen color: transparent grayish white, light orchid or yellowish white. Viability: >50%. Fast linear motion: >25%, fast + slow linear motion: >50%. 5. Tubal examination: lumpectomy: if there is no resistance and reflux, at least one side of the tube can be diagnosed to be patent and the presence of lesions and adhesions cannot be judged. Hysterosalpingography: to understand the situation and adhesions in the cavity of the uterus and oviducts, but cannot be resolved. Laparoscopy: observes the specific pelvic cavity and partially resolves the problem, but does not see the condition of the uterine cavity and the lumen of the oviducts. Ovulation promotion therapy: 15% of couples of childbearing age have conception disorders, and 40% of female infertility is anovulation or sporadic ovulation. Ovulation induction: Induces the development of a dominant follicle followed by ovulation for a spontaneous pregnancy. 70% of patients with simple ovulation disorders are able to have a healthy child after repeated ovulation induction treatments. Commonly used drugs for ovulation induction: 1. Sulforaphane (Clomiphene): 70-75% ovulation rate, 20-30% pregnancy rate. Dosage: 50-150mg of clomiphene daily for 5 days from the 5th day of menstruation; the dosage should be increased gradually. Each dose should be increased only if it is not effective. If it is still not effective, the clomiphene extension method can be applied, i.e. 150mg of clomiphene for 7 or 9 days from the 5th day of menstruation, monitor the follicles until the maximum follicle diameter is 1.8-2.2cm and give HCG 5000-10000IU intramuscularly, but no monitoring can be done if there are financial difficulties or no conditions. Stop the intramuscular HCG for 3-6 months and perform IUI or instruct intercourse for 36 hours. On day 16, if there is no menstruation, urine HCG can be checked to see if you are pregnant. During ovulation induction, estrogen or FSH or HMG can be added depending on the situation. 2. Gonadotropins: HMG (with FSH and LH), FSH FSH for ovulation indications: those who are ineffective with CC or those over 35 years old with simple anovulation and PCOS. Usage: Take blood for FSH, LH, E2, P, HCG, PRL and vaginal ultrasound in the morning of the second to fourth day of normal menstruation. Use FSH 37.5 to 75 IU, recheck E2 and vaginal ultrasound on the fourth day of dosing, and every 2 to 3 days thereafter. Increase or decrease the dosage of FSH according to the response of the follicles. Indications for HMG-induced ovulation: pituitary amenorrhea. FSH, LH, E2, P, and vaginal ultrasound on the morning of the second to fourth day of menstruation induced by an artificial cycle. HMG 75 IU, E2 and vaginal ultrasound are repeated on the fifth day of dosing and every 1 to 3 days thereafter. Increase or decrease the dosage of HMG according to the response of the follicles.