The 34 year old has no child after ectopic pregnancy surgery, and the doctor asserts that she will menopause before she is 40 years old

Ms. Xiao, 34, has no baby yet. A year and a half ago, she underwent laparoscopic surgery for ectopic pregnancy in a local hospital. She has contraception since. A month ago, she checked the sex hormone in the local hospital, and the doctor told her that her ovarian function was not good, and asked her to go to a higher hospital for reexamination. < p > < p > after asking for medical history, I learned that Ms. Xiao’s regular menstruation is normal. She has menstruation once every 24-25 days, and her menstruation period is 4 days. There is no dysmenorrhea. One and a half years ago, she had an operation on ectopic pregnancy. < p > < p > physical examination: her vital signs were normal, height: 1.62 m, weight: 56 kg, body mass index: 21.37, no acne, no hirsutism, the rest of the physical examination showed no abnormality. Results: estradiol: 55.3pg/ml; follicle stimulating hormone: 27.38iu/l; luteinizing hormone: 9.13iu/l. A five: normal. Pelvic ultrasound findings: anterior uterus, size 5.1 × 5.0 × 4.7cm, endometrial thickness about 0.5cm, type A, homogeneous echo, sinus follicle 8.5mm, 8mm and 4mm in right ovary, 3-4mm3 sinus follicle in left ovary, no abnormal echo in bilateral adnexal area. < p > < p > to this, my answer is that the hormone levels of the six sex hormones on the 2nd to 4th day of menstruation reflect the ovarian reserve function, the hormone levels before ovulation reflect the quality of the egg, and the hormones after ovulation reflect the situation of corpus luteum. The physiological function of follicular estrogen is to promote follicular maturation and secretion of estrogen. But the follicle grows good, the girl’s menstruation will be normal. FSH was at a low level in the early follicular phase, and the specific normal value of FSH was less than 10iu / L. The ratio of FSH / LH was 1 ~ 2. E2 was 20 ~ 50pg / ml. Prolactin is lower than 25ng / ml, and it is better to be lower than 20ng / ml. Progesterone < 1ng / ml. 75 ng / ml. < p > < p > If FSH > 10 IU / L, that is, Ms. Xiao’s situation, or FSH / LH > 3, it indicates that ovarian function is decreased, FSH / LH < 1, which may lead to irregular ovulation. < / P > < p > when flowers bloom, they must be folded. We can choose the age of love, the age of marriage, but not the age of ovary. With the passing of spring and autumn, along with the aging of female students, ovarian function has also changed from “golden age” to “dusk”, because age is an important factor affecting women’s ovarian reserve function. The ovarian reserve function of girls over 35 years old has decreased, and the fertility has also decreased year by year. In particular, the number of follicles decreased sharply, the quality of oocytes decreased, and the abnormal nucleus of oocytes appeared. The proliferation rate of granulosa cells decreased, the apoptosis rate increased at the same time, and the hormone level produced by cultured luteinized granulosa cells also decreased sharply. < p > < p > the fertility of the patients with low ovarian reserve function is low, and the probability of natural pregnancy is naturally low, especially for women with FSH & gt; 20u / L, that is, Ms. Xiao, the FSH > 20 in both tests, and the chance of natural pregnancy is & lt; 2% – 5%. In view of this situation, doctors generally recommend that girls actively help pregnant women. In the diagnosis of low ovarian reserve function, sex hormone is one of the tests. In addition to six sex hormones, AMH or ultrasound detection of antral follicle development are also included. As we said before, the determination time of sex hormone is 2-4 days after menstruation. The increase of basal FSH level indicates the decrease of ovarian reserve function. FSH level < 10iu / L is normal, which may be normal ovarian response; FSH > 10-15iu / L indicates low ovarian response; FSH > 20iu / L is the latent period of premature ovarian failure, which indicates amenorrhea after one year. If the age is less than 40 years old and FSH is more than 40 U / L for two consecutive times, the diagnosis of premature ovarian failure is diagnosed. In addition, if the FSH / LH ratio exceeds 3, it indicates that the ovarian function is decreased. The increase of basal E2 level was earlier than that of basal FSH level, E2 > 80pg / ml, which indicated that the ovarian response and function decreased. With the age and ovarian failure, the state of high FSH, LH and low E2 would appear. AMH is not affected by menstrual period. Studies show that AMH < 0.5-1.1ng/ml indicates the decline of ovarian function. Compared with FSH, AFC and inhb, AMH can accurately reflect the decline of ovarian reproductive function. AMH level is relatively constant and can be measured at any stage of menstruation. B ultrasound: clinicians can evaluate the ovarian reserve function by detecting the ovarian volume, the number of basal sinus follicles, and the blood flow of ovarian artery. The decrease of ovarian volume in basic state is related to the decrease of original follicles and the number of follicles growing. Antral follicles refer to the follicles with a diameter of 2-9 mm in the early follicular phase. It is generally considered that the total number of follicles in bilateral ovarian sinuses is less than 5-7, indicating the decline of ovarian reserve function. < / P > < p > the answer is that at present, we do not have a panacea to reverse our ovaries. Follicles enter the orbit of autonomous development and atresia after embryo formation. There are about 2 million follicles left at birth, and most of them degenerate in childhood, and only 300000 follicles remain in adolescence. After puberty, the process of follicular development from autonomous development to maturation depends on the stimulation of gonadotropin. During the growth period, a number of follicles are developed every month. After recruitment and selection, only one dominant follicle can reach full maturity and excrete eggs. Follicular atresia is called follicular atresia. Generally, only 400-500 follicles mature and ovulate in female life, accounting for only 0.1% of the total. < / P > < p > when these 400-500 follicles are mature and complete? Finally, ovarian failure is caused by natural depletion of ovarian follicles or loss of response of remaining follicles to pituitary gonadotropin. The permanent cessation of menstruation is called menopause. Menopause is actually a retrospective diagnosis, normal judgment, only one year not menstruation to diagnose menopause. < / P > < p > but combined with Ms. Xiao’s FSH value, I told her that she might be menopausal before she was 40 years old. For menopause before 40 years old, it belongs to “premature ovarian failure”. < / P > < p > I suggest that Ms. Xiao can take blood for AMH test, and stop contraception immediately. She can come to the hospital to test pregnancy for 3 months under vaginal B-ultrasound monitoring. At the same time, her husband is also advised to test semen. Next month, when Ms. Xiao’s menstruation is clean, do salpingography to assess whether the fallopian tube is unobstructed. < / P > < p > if the results of the above tests are normal, and Ms. Xiao is still not pregnant after being instructed by the doctor for ovulation monitoring by B-ultrasound for three months, it is necessary for Ms. Xiao and his wife to conduct a comprehensive infertility examination process, and then the doctor will make further pregnancy assistance programs. < / P > < p > warm tips: Doctor Fu Hong met many female friends in the outpatient department. Because of ectopic pregnancy or abortion, they did not dare to have babies, so they kept contraception. However, the older the female is, the worse the ovarian function is. The older the female is, the worse the ovarian function is. The older the female is, the worse the ovarian function is. The older the female is, the easier the abortion is, the higher the rate of fetal malformation and the higher the incidence of complications and complications during pregnancy. Hope that female friends must “good flowers can fold straight must fold”, do not wait for ovarian function decline empty sad. 08/16/2020