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哪些卵巢的因素會造成不孕不育？

出處：網(wǎng)絡(luò)收集 日期：2024-07-04 09:45:09 編輯：秩名

哪些卵巢因素會造成不孕？

 
(1)先天性異常：有先天性卵巢發(fā)育不全、47XXX綜合征、真性兩性畸形、睪丸女性化等，均不屬于不孕癥治療的范疇。先天性卵巢發(fā)育不全，是指婦女出生時就沒有卵巢或卵巢很小，很難分泌足夠的雌激素、孕激素。如遺傳性疾病特納綜合征是由于受精時，丟失了夫婦雙方中1條必需的X染色體，因而患有特納綜合征的女性只有1條X染色體，而具有正常生育功能的女性，必須具備兩條X染色體。特納綜合征患者，在出生時就具備了診斷的基礎(chǔ)，但患者往往到發(fā)身期才被確診，因?yàn)榇藭r女性仍沒有第二性征，也無月經(jīng)初潮，因而受到重視，前去就診。對于特納綜合征的患者，在給予雌激素、孕激素聯(lián)合治療后，女性的乳房、陰毛、生殖器及其第二性征可得到進(jìn)一步發(fā)育，但純合子(45XO)特納綜合征患者是不會排卵的，因而沒有生育能力，屬于絕對不孕者。適應(yīng)社會、適應(yīng)環(huán)境是這些患者最好的選擇。有一種特納綜合征(嵌合型45XO/46XX)婦女是可以妊娠的，但妊娠后習(xí)慣性流產(chǎn)的發(fā)生率很高，即使足月分娩，生出的孩子也常常伴有染色體異常，如Down’‘s綜合征?；加刑丶{綜合征婦女的治療，最好請教遺傳學(xué)家和不孕癥治療專家。還有一些能引起不孕的，是較為罕見的先天性卵巢發(fā)育不良、卵巢不敏感綜合征、卵巢早衰及性腺發(fā)育不全，至今其發(fā)病原因尚不清楚。在一些病例中，母體早孕期間的病毒感染或代謝紊亂可能是腹腔中胎兒的致病因素。有些時候，這些病變呈一過性，但過后卵巢對促排卵藥物又有反應(yīng)。因而，這類不孕癥患者應(yīng)與不孕癥治療專家取得聯(lián)系，切莫錯過治療機(jī)會。
 
(2)多囊卵巢綜合征：又稱Stein-Leventhal綜合征，是30歲以下婦女的常見病。正常情況下，卵泡發(fā)育成熟后，要突破卵巢包膜，釋放出卵子。而多囊卵巢綜合征患者，卵巢包膜增厚，多個小卵泡發(fā)育，并停留在卵巢包膜下，因而排不了卵。多囊卵巢綜合征的病因可能是：下丘腦或垂體功能紊亂，或卵巢、腎上腺之間的內(nèi)分泌失調(diào)。臨床表現(xiàn)為卵巢增大、月經(jīng)不規(guī)則、不孕、多毛及肥胖(體重過度增加)。由多囊卵巢綜合征所致的不孕，可用氯米芬誘發(fā)排卵；如果激素治療失敗，建議可行卵巢楔形切除術(shù)。其目的是使卵巢變小，卵巢內(nèi)卵泡減少，以恢復(fù)正常的排卵功能。
 
(3)卵巢炎：可分結(jié)核性與非實(shí)質(zhì)性的卵巢實(shí)質(zhì)炎、周圍炎。對于炎癥，應(yīng)以抗炎治療為主；對于周圍有纖維粘連者，可考慮剖腹手術(shù)或腹腔鏡下行粘連分解術(shù)；患結(jié)核者可行抗結(jié)核治療。
 
(4)卵巢位置異常：卵巢下垂，使輸卵管傘端與卵巢解剖位置改變，于是影響卵子進(jìn)入輸卵管。可通過做卵巢固有韌帶縮短術(shù)，將卵巢系膜縮短或固定于子宮后壁。粘連性的子宮位置異常多由炎癥、子宮內(nèi)膜異位所致，而這些均可引起不孕?？煽紤]手術(shù)或行腹腔鏡下分解粘連術(shù)。
 
(5)卵巢腫瘤：卵巢囊腫有時與不孕有關(guān)，分泌雌激素過多的多發(fā)性卵泡囊腫，可引起持續(xù)性無排卵。卵巢的實(shí)質(zhì)腫瘤，如各種分泌激素的腫瘤、分泌女性激素的顆粒細(xì)胞瘤、卵囊膜細(xì)胞瘤。大多數(shù)卵巢腫瘤并非是惡性的，但只要卵巢持續(xù)增大就必須作進(jìn)一步檢查，以明確診斷。卵巢活檢是對增大卵巢最準(zhǔn)確的診斷方法。卵巢囊腫不同于卵巢腫瘤，卵巢囊腫可以是功能性的，功能性的卵巢囊腫常會自行消失。在正常情況下，卵泡成熟后要釋放出卵子。若卵子沒有排出，卵泡持續(xù)增大，且伴有液體潴留，便形成囊腫。黃體囊腫也是這樣形成的。排卵后，若未受孕，黃體即迅速萎縮，若卵子釋出后，液體潴留其中或伴有出血(又稱血體)，便形成了黃體囊腫。若病因不復(fù)存在，卵泡囊腫和黃體囊腫也會隨即消失。卵巢腫瘤常無伴隨癥狀，但一些婦女會感到性交疼痛，或腫瘤增大明顯時，感到腹脹，出現(xiàn)膀胱、直腸壓迫癥狀，或壓迫周圍血管、淋巴管引起靜脈曲張，痔瘡及會陰、大腿的腫脹；若腫瘤進(jìn)一步增大，可使子宮移位。卵巢腫瘤可因月經(jīng)紊亂導(dǎo)致不孕。有些腫瘤會分泌異常的男性或女性激素，破壞機(jī)體的激素平衡。分泌女性激素的腫瘤患者可出現(xiàn)假孕、性早熟、不規(guī)則出血、子宮肥大和內(nèi)膜增生等癥狀。分泌雄性激素的腫瘤較為罕見，患者可出現(xiàn)閉經(jīng)、面部及胸部毛發(fā)生長、聲音低沉、女性第二性征改變，如乳房變小、陰蒂增大。腫瘤切除后，病變即逆轉(zhuǎn)，癥狀消失。惡性腫瘤的預(yù)后與組織分型、分期有關(guān)。通常，惡性腫瘤一經(jīng)診斷，多為晚期?；熡謺沟没颊咛幱诓辉谢蛳鄬Σ辉袪顟B(tài)。無論什么情況下，腫瘤專家都反對患者妊娠，因?yàn)槿焉锇殡S的高激素水平可能會增加腫瘤的復(fù)發(fā)。但也不是所有的腫瘤專家都反對患者妊娠，應(yīng)根據(jù)治療情況再決定能否妊娠。持續(xù)增大的卵巢腫瘤必須要進(jìn)行手術(shù)治療。如果盼望生育，醫(yī)師會盡可能保留女性的卵巢，但有其一定的危險性。至今，這個問題尚有爭議。一側(cè)卵巢切除，并不影響受孕。只要對側(cè)卵巢功能正常，仍可以懷孕。許多人認(rèn)為，一側(cè)卵巢切除會減少一半的受孕機(jī)會。事實(shí)并非如此，只要月經(jīng)正常，保留的另一側(cè)卵巢照例會每月排卵。
 
(6)卵巢子宮內(nèi)膜異位：在子宮內(nèi)膜異位所致的不孕中，以病灶侵犯卵巢者為最多?？捎?7-乙炔睪丸酮的衍生物藥物進(jìn)行治療；可行保守手術(shù)，應(yīng)在保留正常的卵巢組織下，盡量切除可見的病灶；也可在腹腔鏡下電灼較小的病灶，同時還能松解盆腔內(nèi)的輕度粘連，或通過鏡管的附屬針頭抽出子宮內(nèi)膜囊腫的內(nèi)容物。
 
(7)卵巢性閉經(jīng)：卵巢性閉經(jīng)的患者，經(jīng)促性腺激素治療后，可能有無效和有效的兩類。因此，對于卵巢性閉經(jīng)患者的檢查要順序進(jìn)行：①測定尿或血中促卵泡激素與黃體生成素；②促性腺激素興奮試驗(yàn)；③有條件的，可作促性腺激素釋放激素垂體興奮試驗(yàn)；④染色體、性染色質(zhì)檢查；⑤腹腔鏡檢查；⑥必要時，可開腹檢查。
 
如果做了卵巢手術(shù)，盡可能在3個月以后考慮懷孕之事，以利于卵巢完全恢復(fù)正常。

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