It is an indisputable fact that the incidence of infertility has increased significantly, and infertility is often the result of a variety of factors affecting both partners, and the key to treating infertility is to identify the cause through a comprehensive and careful examination of both partners. After excluding the factors of male infertility, the main content of the observation of women with infertility is the ovulation situation and the function of the fallopian tubes of the female partner. Ovulation disorders account for about 33% of female infertility? The monitoring of ovulatory function is mainly from the following aspects: 1. Determination of blood progesterone (P) The ovulation is understood from the women’s menstrual cycle. Most of them will ovulate with regular menstruation (21~35), but a few will not. Clinically, it can be indirectly formalized by the determination of blood P in the mid-luteal phase whether ovulation occurs or not. The WHO criteria for ovulation are: P>18 nmol/L and the European Society of Human Reproduction and Embryology (ESHRE) proposes ovulation criteria of at least >5 days P>16
nmol/L or a single >32
Since the variation of blood P level is related to the pulsatile secretion of gonadotropins (Gn), the presence or absence of ovulation or luteal insufficiency cannot be determined exclusively from a single blood P value. 2.Basal body temperature (BBT) is a convenient and commonly used non-invasive self-monitoring method, which measures the body temperature at rest and requires more than 6 hours of adequate sleep before waking up and doing any activity. In normal women, the blood P value rises after ovulation, and its degradation products stimulate the hypothalamic thermoregulatory center, causing the BBT to rise, and the body temperature in the luteal phase is 0.3~0.5 degrees higher than that in the follicular phase, which is called biphasic temperature. There is usually a significant drop before the temperature rises, called the nadir. 2~3 days before and after the BBT rise is the ovulation period, which is the easiest time to get pregnant and is called the fertile period. BBT measurement is subject to interference from sleep, medication, diet, disease and other factors, so BBT alone cannot accurately determine ovulation, but needs to be combined with other methods to make a comprehensive judgment. In the diagnosis and treatment of infertility, BBT has an important reference value in guiding the specific time of infertility examination, medication and sexual intercourse. Continuous ultrasound monitoring of the follicles Starting from the 8th day of menstruation in the natural cycle and the 6th day of the stimulation cycle, ultrasound monitoring of follicle development can reveal the development of a dominant follicle with a diameter of 12,mm or larger on 8-12 days, after which the dominant follicle increases at a rate of 2-3 mm per day and develops into a mature follicle. continuous ultrasound observation can reveal the whole process of follicle gradual enlargement, maturation and ovulation. 4.Dynamic measurement of E2 levels in body fluids (blood, urine, saliva and cervical secretions) Dynamic measurement of E2 can directly monitor follicular development and functional status and presume the presence or absence of ovulation, with high accuracy. In the natural cycle, the blood E2 level is 110-280 pmol/l in the early follicular phase and starts to rise significantly 3 days before ovulation, up to 740 pmol/l, and reaches 1460 pmol/l 24 hours before the LH peak, which is called the E2 peak. Ovulation occurs 24-48 hours after the peak of blood E2, and the compliance rate with ultrasound reaches more than 80%. 5. LH peak monitoring In the ovulatory cycle, the blood LH level is low in the early follicular phase, about 2~3 U/L, and reaches a peak of 40~200 U/L before ovulation, which is called LH peak. About 97% of ovulation occurs within 24 hours after the peak blood LH and is therefore a reliable method to predict ovulation. Urinary LH monitoring is of clinical significance for monitoring ovulation and determining the presence or absence of ovulation. It mainly determines the changes in the luteinizing hormone content in women’s urine, and the continuous use of this test strip can dynamically determine the changes in women’s urinary LH. 6.Endometrial biopsy Endometrial biopsy is used to determine ovarian function, to understand the development of endometrium and to diagnose endometrial lesions. It is usually performed 1 to 3 days before and 6 to 12 hours after the expected menstrual flow. The secretory endometrium suggests ovulation. The proliferative endometrium suggests anovulation. To understand luteal function it is best performed on day 21-24 of the luteal phase, which is still judged by Noyes’ criteria. A change in the secretory phase 2 days or more behind the normal menstrual cycle is diagnosed as luteal insufficiency (LPD), but results vary with the observer and are occasionally observed in normal fertile women. Endometrial biopsy is an invasive test and is not currently performed as a routine test.