Anovulation
Description:
One of the reasons of infertility is anovulation.
At this pathology there is a disturbance of process of maturing and an exit of an ovum from a follicle.
Anovulation symptoms:
Ovulation, or ovum exit from the ripened dominant follicle in an abdominal cavity on average for the 14th day of a menstrual cycle — an indispensable condition for pregnancy emergence. Lack of an ovulation is called anovulation.
There are 2 types of anovulation: physiological and pathological.
Physiological anovulation natural to pregnant women and the feeding women, and also meets in the period of a premenopauza and puberty. The anovulatory cycle caused by various pathologies — one of the frequent reasons of female infertility.
Anovulation signs:
* Atypical character of periods
During an anovulatory cycle the yellow body is not formed, the secretory phase does not replace proliferative, the functional layer of an endometria often does not exfoliate. Therefore anovulation is followed by an amenorrhea (lack of periods), an oligomenorrhea (rare periods) or plentiful uterine bleedings.
* Monophase schedule of basal temperature
Anovulation is confirmed also in the course of measurement of basal temperature which does not increase in the middle of a menstrual cycle.
* Lack of changes in allocations
One more sign of anovulation as at healthy women in the middle of a cycle vulval allocations become watery.
At an anovulatory cycle pilosis signs on men's type, an acne, a hair loss can be also observed.
Anovulation reasons:
1. Disturbance of interaction of gipatolamo-pituitary-ovarian system.
Hypothalamus — department of a cerebral cortex the setting work rhythm to reproductive system by means of the hormones influencing work of a hypophysis. A hypophysis — department of the brain producing hormones by means of which the rhythm of work of ovaries is set. Ovaries — internal gonads the producing hormones and an ovum.
These disturbances can arise:
- after a physical or psychological stress,
- injuries,
- acute or long inflammatory process in uterus appendages,
- sharp reduction of initial normal body weight,
- medical abortion,
- gynecologic diseases (hysteromyoma, endometriosis, polycystosis of ovaries),
- endocrine diseases (thyroid gland, adrenal glands, hypophysis, pancreas),
- neuroinfections (encephalitis, meningitis), brain injuries.
2. The raised products of male sex hormones (androgens) ovaries and/or adrenal glands.
3. The increased development by a prolactin hormone hypophysis (giperprolaktinemiya).
4. Pathology of work of a follicle in ovaries (yellow body), caused by biochemical changes in the environment (in an abdominal cavity).
5. A disease of a thyroid gland with the lowered or raised products of hormones (a hypothyroidism, a hyperthyroidism).
Treatment of Anovulation:
The main method of treatment of anovulation — stimulation of an ovulation which is applicable at any listed origin.
Before use of stimulation of an ovulation it is necessary to be convinced that such reasons of infertility as are excluded:
- inflammatory processes in a vagina, a neck of uterus, in a cavity of the uterus, uterine tubes,
- pathology of uterine tubes (carrying out diagnosis of passability of uterine tubes and their functioning)
- male infertility (disturbance as a part of sperm and pathology of the genital status).
Stimulation of an ovulation is carried out by drugs:
1 group.
Clomifene citrate (klostilbegit, Clamidum) are drugs of direct stimulation, the productions of hormones leading to strengthening in a hypothalamus and a hypophysis which in turn stimulate work of ovaries (growth and maturing of a follicle with an ovum).
Frequency of approach of pregnancy at stimulation of an ovulation clomifene — about 30-40%.
Stimulation begins from 2-5 in the afternoon a menstrual cycle within 5 days, the tableted drug form 1-2 times a day is appointed.
Ultrasonic control of growth of the leading follicle and reaction of an endometria (mucous membrane of a cavity of the uterus) is carried out for 7-11, 14-16 days of a menstrual cycle, for 14-16 day (at 28-30 day cycle) sufficient maturing of a follicle is fixed.
Administration of drug of Chorionic Gonadotropin — pregnyl, for the fixed ovulation is appointed (the hormone promoting an ovulation — to an ovum exit from the leading follicle). The sexual contact this day and on following is recommended. Ultrasonography is conducted for 17 - 19 day of a menstrual cycle for confirmation of the taken place ovulation.
From 16 in the afternoon a menstrual cycle drugs for support of functioning of the yellow body producing the progesterone necessary for preparation of an endometria for an oospore attachment are appointed. Progesterone drugs (Duphaston, утрожестан, progesterone) within 10-14 days are used.
The test for pregnancy (uric) is carried out in 1-2 days prior to periods and in case of a periods delay for 7-10 day blood test on HG (a chorionic gonadotrophin which is developed at pregnancy) joins, also ultrasonography for pregnancy establishment is carried out.
Clomifene possesses anti-oestrogenic action which can adversely affect a condition of slime of a neck of uterus in the form of disturbance of advance of spermatozoa and a condition not of readiness of an endometria to an oospore attachment. For elimination of this action drugs of an oestrogenic orientation (Microfollinum, a proginova) are used in a stimulation cycle.
Absence or insufficiency of efficiency in 1 cycle of stimulation (there is no leading and growing follicle within 10-15 days after cancellation of a klostilbegit) serves as the indication to increase in a dose of drug in the following cycle.
If the effect of stimulation of an ovulation is absent, then it is regarded as decrease in sensitivity to drug. In this case carrying out stimulation by drugs of other row — gonadotrophins is shown.
In a cycle of stimulation of an ovulation klostilbegity the special attention is deserved by patients with disturbance of a lipometabolism, excess body weight, increase in the ABP, puffiness at which stimulation by this drug is often inefficient.
Along with patients with reduced sensitivity to a klostilbegit, there are women with the increased reaction to drug which is shown in hyper stimulation at which, the sizes of ovaries increase there are small pains in the bottom of a stomach, abdominal distention, a meteorism, there can be cysts of ovaries. These manifestations demand treatment on an outpatient basis or in the conditions of a hospital within 7-21 days, depending on severity of manifestation of a symptom of hyper stimulation.
2 group:
Puregon, меногон, gonat — drugs of a gonadotropic row (gonadotrophins — the hormones which are produced in a brain hypophysis share lobby stimulating growth and maturing of follicles in ovaries).
Stimulation begins about 2-3 days of a menstrual cycle under ultrasonography control since it is necessary to create the necessary rhythm of impact on follicles since the beginning of a menstrual cycle, imitating a natural cycle of their growth and maturing.
Usually it is a daily intramuscular injection in one and too time.
Control on 6-7 is necessary for efficiency assessment (formation of the leading follicle and its growth) of influence of these drugs and their possible correction OUSE; 9-11; 13-16 days of a menstrual cycle (at 28-30 day menstrual cycle). Sometimes in need of ultrasonography it can be appointed in addition for more exact orientation in a clinical picture, it allows to reveal some possible difficulties at stimulation. For example, the bad growth of an endometria against the background of good follicles, formation of cysts, or uneven growth of follicles — all these problems are solved, the main thing will be defined in time.
With an adequate growth of follicles and an endometria, to the middle of a menstrual cycle 13-16 to day of a menstrual cycle the ovulatory dose of HG (pregnyl) for a controlled ovulation is appointed (an ovum exit from the leading follicle).
The sexual contact approximately by this time is appointed (in day of administration of pregnyl and next day). Control of the taken place ovulation is carried out for 17-19 day — ultrasonography.
Further for maintenance of functioning of the yellow body formed in a sovulirovanny follicle progesterone drug (утрожестан Duphaston, progesterone) from the 16th bottom of a menstrual cycle within 10-14 days is appointed.
The test for pregnancy uric is carried out in 1-2 days prior to periods and at a periods delay for 7-10 days, blood test on HG the reflecting term and a condition of pregnancy joins.
When carrying out stimulation of an ovulation gonadotrophins under individual control and correction achieve good results of approach of pregnancy.
But there can sometimes be an increased, inadequate reaction to use these drugs, shown in hyper stimulation. Timely correction and use of auxiliary medicines in out-patient conditions or a hospital levels these manifestations within 7-20 days.
3 group:
The combined use of a klostilbegit and gonadotrophins.
Frequency of approach of pregnancy of 30-70%.
The beginning of stimulation of an ovulation from 2-5 in the afternoon of a menstrual cycle from use of a klostilbegit within 5 days, then gonadotrophins within 5-7 days, under OUSE are entered by control, the drug HG for the fixed day of an ovulation and carrying out sexual contact in ovulatory day further is administered, and from 16 in the afternoon a menstrual cycle progesterone drugs are appointed. Tests for pregnancy are carried out to the same terms, in the same volume.
