The term “ovarian ligament” (ovarian ligament) includes the instantaneous oocyte (oocytes) in a woman’s ovary and clinically connects with the ovarian tract. Determining the ovarian system gives every woman the opportunity to be informed about her chance to achieve conception and to plan for the child. Evaluation of ovarian failure is a type of prophylactic study, which is recommended for every woman after 35 years. It is especially important for women whose mother or grandmother entered the menopause (before the age of 45). Most often, the study includes a review of the ultrasound and the determination of the level of some xopmona in the blood.
Propulsion of the ovaries
The woman reaches her fetal peak between the ages of 20 and 30, and her ovarian function is about 50 years old. During this period, the “hypothalamic-pituitary-ovarian” (XXI) undergoes various changes. Follicular depletion in the ovary is the final natural pathway in reproductive growth, which includes the entire XXI oc. However, with the advancement of the body, the organs and systems prematurely reduce their physiological function. Some diseases, such as malignancies, can also lead to the elimination of the productive system. The ovary is an organ that loses almost all of its productive and endogenous function in menopause.
Amongst the women in younger age there is a chance of spontanous impregnation in 20% – 25% of the montly menstruation, while for the women in the end of their thirties and fourties this chance drops to 5%.With the advancement of the productive growth, it increases the percentage of spontaneous abortions, as well as the percentage of malformations of the fetus, as well as the number of fetuses. The reduction in the possibility of pregnancy in women in advanced reproduction age is a result of the deterioration of the quality of the egg. It is important for these women to know that if they do not achieve spontaneous pregnancy in 6 menstrual cycles, they should consult with reproductive endocrinologist.
Epidemiological studies show that in 10% of the cases, menopause starts before the age of 45(normally it starts aroud 50) and in 1 % of the cases it the menstruation stops before the age of 40.In these cases, unsatisfactory ovarian response is often observed during stimulation for the purpose of infertility treatment. According to Nicolaou and Temrleton, the process of rapidly depleting the ovarian glands begins approximately 13 years before the final ciphenation. For women who are in menopause at the age of 45, this process began when they were 32 years old. With these women, there is a need for diagnosis of pancreatic ovarian failure.
Tests for the determination of the ovarian ligament
Determination of the basal values at the core FN levels
The basal values of the follicle-stimulating hormone (FHM) are easy to determine and a good prognostic map for the possibility of changing and stimulating the body. Serum levels of FЅH, higher than 12.5 mIU / ml, are associated with poor ovarian response to stimulation.
Determination of basal values on cepymnite inhibin In the field
Іnhіbіn B is a hormon, which is produced by the granulosa sells of the so calledce oтдeля oт гpaнyлoзнитe ĸлeтĸи нa т.нap. antal follicles in the ovary (follicles with a size of 50 microns to 2 mm). The decrease of the serum levels of inhibin B is associated with advanced reproductive age of the woman. Іnhіbіn В participates in the the pathophysiology of the polycystic ovary syndrome (РСОЅ). Іnhіbіn B is a critiria for the diagnosis of some ovarian carcinomas. For the Bulgarian population, the specific values of Inhibin B are determined by the values between 33 рг / ml and 190 рг / ml.
Clomiphene Citrate Provocative Test (CCCT)
The test is based on the possibility of restoring the production system after the application of the clomiphene citrate (SS). FNH values of 10 IU / ml are considered normal; for borderline – 10 – 12 IU / ml and for abnormal – larger than 12 IU / ml.
GnRH agonist stimulating test (GAS)
The test evaluates the change in estradiol (E2) on day 3, after administration of the GnRH agonist on the second day of the menstrual cycle. The results of the test depend on the pituitary production of gonadotropins and the ovarian response to stimulation.
Gonadotropin stimulating ovarian test (EFORT)
The test is based on the application of gonadotropins and the dynamics of extraradiol (E2) as a function of the ovarian response. For women, when E2 is treated with E2, it is more than 30 pg / ml, and there are adequate ovarian responses, compared with 30 women.
Basal serum levels of Anti-Muler hormon
Anti-Muler hormon(AMH) is produced by the ganglion cells of small and small antal follicles, and our levels can be found in the cells. By reducing the number of follicles in the ovaries, due to the increase in the size of the woman, AMH can be used as an egg carrier. We can talk about the reserved amount of ovarian sticks when the value of the drug is above 2.0 ng / ml. When the result is between 1.0 and 2.0 ng / ml, there is a tendency to reduce the function of the ovaries. The AMX values are less than 1.0 ng / ml and are significantly reduced in ovaries.
- Ultrasound determination of the number of inflammatory follicles (AFS) is no longer objective information about the ovarian system. The test is performed in the second follicular phase (day 2-4 of the menstrual cycle), which determines the follicles with sizes of 2-10 mm in both ovaries. With a small number of anthral follicles, less than 5, there are significantly reduced ovarian changes.
- Determination of cpeded diameter (MOD). It is performed in the first follicular phase (day 2-4 of the menstrual cycle). With values of the anterior ovarian diameter less than 20.6 mm, there is a high probability of reduced ovarian changes.
Please note, that each study has its own objectivity, but based on it can not make a conclusion about the condition of the ovarian styptype. The assessment of the ovarian system is complex and is based on the group of tests.
These diagnostic methods should be known to all gynecologists. In case of doubt or diagnosis of reduced ovarian function, it is necessary to advise the patient that it is not a good idea to postpone the delay.