2? Hymen abnormality: Hymen atresia is a common abnormality in the development of female reproductive organs. When vaginal mucus is retained by blood, the hymen will swell out. It is best to cut before menarche.
3? Vaginal diaphragm: Vaginal diaphragm can completely or partially block vagina. Can lead to a large number of vaginal mucus retention in childhood and recessive menstruation in adolescence.
4? Vaginal atresia: The clitoris, labia and urethra of patients with vaginal atresia are often normal. Hymen ring slightly invaginated.
5? Abnormal ovarian development: including abnormal ovarian downward movement, gonadal hypoplasia and congenital ovarian hypoplasia.
6? True hermaphroditism: There are two gonadal tissues: ovary and testis. Tortoise is the most common gonad in true hermaphroditism. The diagnosis must be made by laparotomy or laparoscopy, and the ovary and testis should be distinguished from each other in appearance, and the gonad should be biopsied. Send pathological examination to confirm the existence of two kinds of tissues. It can't be judged only by external genitalia and sex chromosomes.
Acute and chronic inflammation of various parts of vulva, congenital malformation of vagina, cicatricial stenosis of vaginal orifice or too tight perineal repair and suture, short vagina after cervical cancer operation, trichomonal vaginitis, fungal vaginitis, vaginal atrophy, cervical hypertrophy, cervical overlong, pelvic inflammatory disease, endometriosis and other lesions. , due to narrow or blocked channels, sexual pain, reflex vaginal spasm, insufficient vaginal wetting, etc. After the inflammation is cured, some people can get pregnant soon.
Common diseases leading to infertility 1? Luteal insufficiency: Luteal insufficiency leads to infertility and repeated abortion. It is the most common and mild ovarian dysfunction.
2? Luteinized unruptured follicle syndrome: a disease with inconspicuous clinical manifestations. The incidence of unexplained infertility is high.
3? Polycystic ovary syndrome: Polycystic ovary syndrome involves many factors such as hypothalamus, pituitary, ovary, adrenal gland, pancreas and heredity.
Symptoms: sparse menstruation, amenorrhea, infertility, hirsutism, obesity, occasional ovulation, but mostly anovulation, basal body temperature is monophasic, and the endometrium changes in proliferative phase on the first day of menstruation. Only half of patients have typical clinical manifestations, while 25% patients have no other symptoms except infertility.
4? Hyperprolactinemia: Abnormal increase of prolactin concentration in peripheral blood caused by various reasons is hyperprolactinemia. Breast-feeding, emergency treatment, medication, chest wall stimulation and other factors can all cause hyperprolactinemia.
General treatment 1? Strengthening exercise, strengthening physique and paying attention to nutrition are beneficial to the recovery of fertility of infertile patients; Master sexual knowledge, learn to predict ovulation and other pregnancy knowledge, and improve the probability of pregnancy; Avoid alcohol and tobacco, eliminate bad mental factors, adjust mentality and maintain mental health.
2? Etiology and treatment: organic diseases, such as tumor, hymen atresia, scar adhesion, vaginal septum, etc. Trichomonas, mold infection or other inflammation should be actively treated; Those with cervical canal stenosis and adhesion can simply dilate the cervix and play a therapeutic role; Uterine dysplasia. According to the etiology, taking hormones or placing intrauterine devices for 2 ~ 3 months; For intrauterine adhesions, we can dilate the uterine cavity and separate the adhesions.
3? Ovulation promotion: Ovulation promotion drugs include clomiphene citrate, menopausal gonadotropin, luteinizing hormone releasing hormone, bromocriptine and chorionic gonadotropin. Clomiphene citrate is the first choice. During the use of ovulation induction drugs, cervical mucus and blood estrogen levels should be observed, and follicular development should be monitored by B-ultrasound.
4? Promote or supplement luteal secretion function: those with insufficient luteal secretion function should be supplemented with progesterone.
5? Improvement of cervical mucus: estrogen was given on the fifth day of menstrual cycle, for a total of 10 days.
6? Treatment of tubal obstruction: proximal tubal obstruction can be treated by injecting liquid medicine into fallopian tube, and the effect of injecting medicine into fallopian tube under endoscope is better. Tubostomy is feasible for distal tubal obstruction, and salpingoplasty, salpingectomy and anastomosis, salpinghorn anastomosis and tubal intraluminal transplantation can be selected according to different conditions.
7? Treatment of immune infertility: avoiding contact with antigens, artificial insemination in the official cavity, immunosuppressants.
After about three years of marriage, artificial insemination has not yet given birth, but after detailed examination and various treatments in the hospital, it is still invalid. When it is proved that it is really impossible to conceive through sexual intercourse, the scientific method of artificial insemination can be used to achieve the purpose of conception and delivery. Artificial insemination is not through sexual intercourse, but through artificial means (syringe injection). Sperm is injected into the reproductive organs of women, so that sperm can be combined with eggs, thus becoming pregnant and giving birth.
Semen can be her husband's or a voluntary donor's. The former is called artificial insemination between spouses, and the latter is called artificial insemination by donors. The sperm of the donor and her husband are mixed for artificial insemination, which is called mixed insemination.
The semen of artificial insemination can be fresh or frozen at low temperature. The pregnancy rate of fresh semen and frozen semen is above 65%. Frozen semen can be stored in the sperm bank and can be taken out at any time. Waiting for fertilization during ovulation, no need to take semen repeatedly. The semen of the donor can be refrigerated, and if necessary, it can be provided to one or several women for multiple artificial inseminations. This is also conducive to the confidentiality of the recipient. Sperm can still survive when frozen to-196℃.
The indication of husband's artificial insemination is that the woman thinks that she is really pregnant and fertile after examination, and the man's semen meets the standard after laboratory tests. However, due to the malformation of male and female reproductive organs, such as male hypospadias, severe penile flexion deformity, cavernous sclerosis, impotence, premature ejaculation, retrograde ejaculation, etc. The woman's vaginal stenosis, vaginal spasm, scar adhesion in the vagina, deformity outside the vaginal orifice, excessive relaxation of the vagina, inability to store semen, cervical stenosis, obvious flexion or posterior position of the uterus, etc. , thus affecting sexual intercourse or normal injection of semen into the vagina.
The indication of donor artificial insemination is that the man is absolutely infertile after examination. Such as azoospermia and severe oligozoospermia (5 million sperm per milliliter of semen). Semen has the following abnormalities, such as sperm count below 20 million per milliliter; The amount of semen is reduced to 0? Oligospermia below 5 ml; Infertility can be caused by low sperm motility, high abnormal sperm, continuous coagulation of semen after discharge and incomplete liquefaction, so donor artificial insemination can be used. The man suffers from mental illness or other serious genetic diseases. Although the man has fertility, it is forbidden to conceive with the sperm of such patients, and it is also possible to give birth by artificial insemination by donors. In addition, if the husband and wife are infertile due to immune incompatibility, close relatives with genetic diseases in the family get married. Donor artificial insemination can also be used. Accepting the donor's semen to conceive and give birth involves some complicated issues, even legal issues. Therefore, it should be carefully considered and discussed with the relevant medical and judicial units, and all the prescribed procedures should be completed in advance.
For couples who are suitable for donor artificial insemination, the hospital should be responsible for strictly selecting sperm donors for them:
(1) Investigate whether the family of the sperm donor has hereditary diseases and a history of marriage of close relatives.
(2) Individuals should have no addiction to alcohol and tobacco, have no important medical history at birth, be between 25 and 35 years old, have a medium education level or above, have normal intellectual and personality development, and have correct facial features. Moderate figure, healthy and disease-free.
(3) Married, lover has no smoking hobby, family harmony, normal sex life and children with normal development. Neither husband nor wife is exposed to harmful rays and toxic substances in the workplace.
(4) The donor should have the same nationality as the husband of the recipient (fertilized person). It is best to be as close as possible to the husband of the fertilized person in figure, skin color and appearance. The donor's blood type is suitable for the fertilized person, and it is best to have the same blood type as the husband.
(5) The sperm of the donor should exceed the normal level in sperm quantity and quality.
(6) Medical personnel must keep it strictly confidential, and there is no connection between the donor and the fertilized couple. It is absolutely forbidden to disseminate any information in this regard.
Semen collected by sperm donors is collected by masturbation. Sexual intercourse interruption and vaginal ejaculation are not as convenient as masturbation. In order to ensure that the semen of the donor can meet the semen standard of artificial insemination, sexual intercourse, masturbation, nocturnal emission and other behaviors are not allowed one week before sperm collection. The semen standard of artificial insemination is: the amount of semen is 4 ~ 6 ml, the number of sperm is more than 60 million/ml, the motility rate is more than 80%, and the abnormal sperm is obviously less than 20%. The recipient of artificial insemination should undergo basic body temperature measurement for more than three months, and cooperate with continuous cervical mucus crystallization and vaginal cell examination to determine the ovulation period. The most suitable time for artificial insemination is before ovulation when cervical mucus is secreted the most. Because the survival time of an egg after it is discharged from the ovary is only 8-24 hours, and sperm can survive for up to 48 hours in the female reproductive tract, it takes an average of about 12 hour for sperm to swim from the female vagina to the fallopian tube and meet the egg. Therefore, it is very important to determine the ovulation date accurately. The average number of days in the last three menstrual cycles minus 14 days is also acceptable as the ovulation day. The method of measuring basal body temperature at home is to infer that the day with the lowest body temperature or the last day of the "low temperature period" is the ovulation day before the transition date from "low temperature period" to "high temperature period". Artificial insemination is performed three times per menstrual cycle, that is, three days before ovulation, once every other day. If the menstrual cycle is 28 days, it will be in 1 1, 13, 15. People with a menstrual cycle of 30 days do it on 13, 15 and 17 days respectively. If calculated by hours, it is 72 hours before ovulation, 24 hours after ovulation, and 24 hours. If it is not successful, you can repeatedly determine the ovulation date and continue artificial insemination for several menstrual cycles. If necessary, drugs can be used to induce and adjust ovulation period to improve pregnancy rate. When taking semen by masturbation, wash and dry hands and penis with warm water and soap, and shoot semen into a beaker that is sterilized by drying or boiling, and keep it below 37℃ for artificial insemination within 65438 0 hours. The fertilized person will lie on his back on the gynecological examination table, take the cystolithotomy position, and routinely disinfect the vulva, fully expose the cervix with a sterile speculum, and routinely disinfect the vagina and around the cervix. Suck 1 ~ 2 ml semen into a sterile dry syringe with a thin plastic tube, and insert the plastic tube into the cervical canal. 5 ~ 1 cm, slowly inject semen 0? 5 ~ 1 ml, inject excess semen into the posterior fornix of vagina. You can also inject semen directly into the cervix to form a semen pool, so that semen can overflow the cervix. If the vaginal acidity is high, you can first rinse the vagina with alkaline liquid such as sodium bicarbonate or glucose physiological saline, which is beneficial to sperm activity. You can also use a diaphragm or a small plastic cup. After semen injection, put the uterine cap on the cervix, or put a small plastic cup with semen at the outer mouth of the cervix to make it close to the cervix. These methods can avoid sperm contact with acidic secretions in vagina. The main purpose of the above method is to make semen directly contact with the external cervix, which is beneficial for sperm to enter the uterine cavity. In the past, injecting semen directly into uterine cavity easily caused spasmodic pain, bleeding or infection.
After artificial insemination, raising hips and lying on your back for 30 ~ 60 minutes is beneficial for sperm to enter official language. In order to prevent infection, antibiotics should be taken two days after artificial insemination, and sexual life should be forbidden for 2 ~ 3 days. Fertilizers can move and work normally after returning to China. After artificial insemination, the fertilized person should continuously measure the basal body temperature and go to the hospital to check the changes of cervical mucus crystallization and vaginal cytology. If the "high temperature period" of basal body temperature lasts for more than 20 days, it means that pregnancy is possible. Although there is a "high temperature period" and vaginal bleeding or abdominal discomfort, attention should be paid to preventing abortion.
The pregnancy rate after artificial insemination can reach more than 65%. Due to the continuous improvement of artificial insemination technology of frozen semen, the pregnancy rate of frozen semen is close to that of fresh semen. The incidence of spontaneous abortion after artificial insemination is the same as that of normal pregnancy, or even lower. Children born by artificial insemination have fewer birth defects than children born by normal sexual intercourse. After artificial insemination, donors gave birth to more boys than girls. However, the development of donor artificial insemination technology requires strict medical system and legal procedures.
"test-tube baby"
The full name of "IVF" is in vitro fertilization and embryo transfer. The main indications are tubal nowhere disease, cervical mucus blocking sperm penetration, endometriosis and low sperm count and motility. This method is not suitable for every kind of infertility. Women undergoing IVF surgery must have normal ovarian and uterine functions, and the endometrium is suitable for implantation of fertilized eggs. Generally speaking, women should not be over 40.
The main process of "IVF" is:
1? Promote egg maturation: At present, drugs are commonly used to stimulate follicular development and artificially control ovulation time. Commonly used ovulation induction drugs include clomiphene citrate, human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG). This drug stimulation method can obtain multiple eggs.
2? Taking eggs under ultrasonic monitoring: There are many ways to take eggs, and the most common way to take eggs at present is to take eggs through vagina. Put the vaginal ultrasound probe into the vagina, measure the exact position of the follicle, and suck out the egg with a negative pressure device. This method of egg retrieval only needs local anesthesia. The patient has little pain and accurate puncture. On average, five eggs can be removed from each patient at a time.
3? In vitro fertilization: After collecting eggs for 4-8 hours, each egg is incubated with 500,000-500,000 highly active sperm 12-24 hours. If fertilized, continue to culture for 24 ~ 48 hours.
4? Embryo transfer: 30 ~ 50 hours after the egg is taken out, the embryo divided into 2 ~ 6 cells is implanted into the uterus through the cervix, and generally 3 embryos are implanted. A fertilized egg usually cannot be implanted into the endometrium. The abortion rate after pregnancy is high, and women over 40 years old are more likely to have an abortion. Multiple pregnancies are prone to perinatal death.
Gamete fallopian tube transplantation gamete fallopian tube transplantation, referred to as GIFT, gamete is the general term for sperm and eggs. It is to inject eggs and sperm directly into fallopian tubes for natural fertilization, division, transfer to uterus and implantation, rather than artificial transplantation into uterus after in vitro fertilization. GIFT is only applicable to those women whose fallopian tubes are unobstructed and cannot ovulate naturally due to mechanical obstruction or fallopian tube disease.
Laparoscopic technique is generally used to inject sperm and eggs into fallopian tubes. After the surgical incision was closed, the gift was delivered. Let the lying-in woman lie still in the hospital bed for 8 hours, and then she can move freely.
The success rate of IVF is high, and the success rate of embryo transfer is low. GIFT avoids the process of embryo treatment and transplantation in in vitro fertilization. The fertilization process of sperm and eggs is carried out in the fallopian tube, and the subsequent transfer, division and implantation of fertilized eggs are the same as natural conception, so the success rate of GIFT is higher than IVF.
Chinese medicine treatment Chinese medicine treatment of infertility, first of all, to regulate menstruation, dialectical treatment of kidney-yang deficiency, kidney-yin deficiency, liver depression, phlegm-dampness, blood stasis caused by irregular menstruation and other syndromes.
1? Acupuncture:
(1) Kidney deficiency type: tubal disease and endometrial disease.
Body acupuncture: Taixi, Shiguan, Dahe, Shuiquan, Guanyuan and Uterus are all supplements, and the needle is kept for 30-60 minutes once a day or every other day. At the same time, warm acupuncture or moxibustion, 10 times is a course of treatment, lasting for 3 courses.
Ear acupuncture: adrenal gland, uterus, sympathetic nerve, endocrine.
(2) Qi stagnation and blood stasis type: endometrial lesions and tubal atresia or adhesion.
Body acupuncture: Guo Li, Daimai, Yanglingquan, Zhongji, Uterus and Qihai all adopt the method of flat reinforcing and purging, and Taichong point adopts the method of purging, and the needle is kept for 30 minutes every day or every other day, with 1 0 as a course of treatment, and acupuncture is continued for three courses.
(3) Phlegm-dampness blocking collateral type: endometrial hyperplasia, proliferation tendency, tubal obstruction or adhesion.
Body acupuncture: Shu Tian, Shuidao, Huilai, Qichong, Guanyuan, Uterus and Sanyinjiao are all supplemented, once a day/kloc-0. Keep the needle for 30 minutes, 10 times is a course of treatment, and keep the needle for 3 courses.
2? Diet therapy:
Eggs and caviar: high protein, you should eat more. Eggs per day 1 ~ 2, eggs hot duck eggs cold. Infertility due to palace cold can eat more eggs, and those with yellow and red belts can eat more duck eggs. Caviar should not be eaten too much.
Game, aquatic products, such as pheasants, ducks, rabbits, pigeons, black-bone chickens, broilers, cattle, sheep, pork, all kinds of fish, shrimp, turtles and so on. Venison is aphrodisiac; Soak raw shrimp in wine to nourish yin and tonify kidney.
Eels are sweet and flat. Yan Hui in Materia Medica says "tonify kidney, strength wins", and Rihuazi Materia Medica says "tonify yang".
Wash bullwhip with testicles, chop them up, boil them in clear water, and remove fishy water. Then carefully remove the hair and sundries, and clean up the "urine" in the urethra with chopsticks. Add 500 ~ 1000 ml of yellow rice wine, 250 ml of white wine and minced onion and ginger. Add a spoonful of brown sugar and half a cup of beer, without water, and simmer until it is rotten to a paste. Bullwhip can tonify kidney yang and yang qi, and can be used alone or mixed with traditional Chinese medicine, 50 ml per day, and taken on an empty stomach. It is suitable for kidney yang deficiency, kidney qi deficiency, impotence and nocturnal emission, soreness of waist and knees, and chills of limbs.
Pork, beef soup bone or small sparerib soup: break the soup bone before cooking, and add a small amount of rice vinegar when cooking, so that the effective components of bone marrow can be more dissolved in the soup. Bone marrow contributes to hematopoiesis, spermatogenesis and improvement of sexual function.
Black fungus rock sugar soup White fungus moistens the lungs, Black fungus tonifies the kidney, Black fungus and White fungus are used together, which has a miraculous effect of golden water. Determine the proportion of auricularia auricula and tremella, and take appropriate amount. First, cook the auricularia auricula and simmer for 3 hours. Add tremella, boil, and simmer 1 hour until it is rotten like fine mud. Add appropriate amount of rock sugar for later use. Take it 250m 1 on an empty stomach every day. Jujube can be added appropriately in winter.
50 grams of mussel porridge, soaked in warm water for half a day, boiled, removed the heart, added glutinous rice 100 grams, boiled into porridge, put a little salt, and took it once in the morning and evening while it was hot to treat infertility caused by liver and kidney deficiency.
Meat cistanche mutton porridge cistanche deserticola 15g, the amount of mutton is not limited, add water 100ml, add 300ml of water after the meat is rotten, and cook until the rice is thick, add a little onion and ginger, cook for a while, and take it warm in the morning and evening. Treat infertility caused by kidney deficiency, palace cold and liver and kidney deficiency.
Raw Coix seed porridge Wash raw Coix seed, add water, cook until it is crisp and rotten like porridge, and take 250 ml on an empty stomach every day, which has the effect of strengthening the spleen and infiltrating dampness. Slight cold does not hurt the stomach, benefits the spleen and is not greasy, and clears away dampness.
Su Bu Gao is made of black sesame, walnut kernel, jujube and lotus seed meat, and made of donkey-hide gelatin. It is taken on an empty stomach at a dose of 50 ~ 100 ml per day. Supplementing qi and nourishing blood is suitable for women. Can be used for treating deficiency of both qi and blood, dizziness, insomnia, palpitation, and anorexia.
3? External therapy:
(1) Rhizoma homalomenae 30g, Notopterygii Rhizoma 20g, Herba speranskiae tuberculatae 60g, Radix Angelicae Pubescentis 20g, Sanguis Draxonis 15g, Rhizoma Osmundae 30g, Carthami Flos 30g, Myrrha 30g, angelica tail 30g, Radix Paeoniae Rubra 30g, Folium Artemisiae Argyi 60g, Radix Angelicae Dahuricae 30g, Cortex Acanthopanacis 30g, and Zanthoxylum bungeanum 30g. After steaming, apply hot compress to the lower abdomen or both sides of abdomen, once a day 1 ~ 2 times, each time for about 20 minutes, and each pack of medicine can generally be used continuously 10 ~ 12 days.
(2) Steaming 30g of Caulis et Folium Gaultheriae Yunnanensis, Rhizoma Cyperi15g, Radix Salviae Miltiorrhizae15g, Folium Artemisiae Argyi 9g, Caulis Spatholobi 30g, and Fructus Gleditsiae Abnormalis15g in a cloth bag, and then hot pressing on the lower abdomen or both sides of the lower abdomen; Or add vinegar to the medicine and fry it in an iron pan, and hot compress the lower abdomen or both sides of the abdomen; Or apply the residue of oral Chinese medicine to abdomen with cloth. After the residue becomes cold, put a hot water bag on the navel or the affected part to keep the residue warm and make the medicine penetrate into the affected part through the skin. 30 grams of vinegar is added to the residue, which is fried in an iron pan and then applied to the lower abdomen or the affected area.
This external application method is mostly used for abdominal pain and infertility caused by endometriosis, pelvic inflammatory disease and tubal obstruction. Pay attention to the temperature when applying externally to avoid burning the skin.