Choice of a place and kind of treatment

[Christina]

At me such situation: the ovulation is absent by results of measurement basal T in current of 6 cycles and to a kind of cervical slime, thus cycles regular for 30 days, hormones foll. Phases (lg, fsg, prol., 2, a hydrocortisone) in norm or rate, ljut. Phases (testost., Progesteronum, DGEA, 17 ks) too in norm or rate. Hormones shchitovitki in norm or rate. The endometriosis is not present. That else can cause an anovulation and what to undertake for its or her occurrence? In advance thanks, who will respond all.

[boris]

Uv. Christina!



Almost daily I receive questions anyhow concerning or touching interpretings of data of basal (rectal) temperature. Below I would like to result or bring the small review of the literature, concerning or touching this research. Really, during decades this method was is unique accessible and the most used by the doctors who were deal with problems of fruitless marriage or spoilage. Not the secret, as now, despite of appreciable changes in diagnostics of endocrine disturbances, at availability of more modern and exact diagnostic opportunities, this method remains, strangely enough, dominating.

Basis of a method is the mediated influence of Progesteronum (the basic hormone of the second phase of a cycle) on thermoreceptors of a hypothalamus in this connection the basal temperature in the second phase of a menstrual cycle raises or increases. In 1888 A.V.Reprev has established or installed, that the body temperature before a menses raises or increases, and during monthly goes down. A.I.Rubel (1927) considered or counted, that the subfebrile condition at women can be an endocrine parentage and is in dependence from function of ovaries. In 1938 Rubinstein has described preovulatory depression of temperature which in its or his opinion, is caused estrogennym by influence. In 1950 Palmer eksperementalno has proved, that under influence of estrogens the rectal temperature decreases, and under influence of Progesteronum - raises or increases.

As if to itnterpretatsii these data and attempt to establish or install day of an ovulation by the majority of researchers it is recognized, that day of an ovulation coincides with day before the beginning of rise in temperature (E.P.Majzel, 1965).

In domestic classical managements or manuals on gynecology of the last years it is described five basic types of temperature curves:

I type - rise in temperature in the second phase of a cycle not less than on 0,4 With; there is a "preovulatory" and "premenstrual" temperature drop. Duration of rise in temperature of 12-14 days. Such curve is typical for a normal biphase menstrual cycle;

II type - is available weakly expressed rise of temperature (0,2-0,3) in the second phase. Such curve testifies about estrogen- of a failure;

III type - temperature raises or increases shortly before a menses and there is no its or her "premenstrual" falling. The second phase is shorter than 10 days. Such curve is characteristic for a biphase menstrual cycle with a failure of the second phase;

IY type - a monotonous curve (there are no changes during all cycle). Such curve is marked or celebrated at anovulatory (the ovulation is absent) a cycle;

Y type - atipicheskaja (chaotic) temperature curve. Greater or big are marked or celebrated razmahi temperatures, does not keep within one of the above described types. Such type of a curve can be observed at expressed estrogennoj failures and as can depend on random factors (V.N.Kustarov, P.H.Pahk, 1991).

Rising of basal temperature occurs or happens, as considers or counts series of authors (Moghissi K.S., Syner F.N., Evans T.N., 1972; Ross G.T., Cargille C.M., Lipsett M.B., Rayford P.L., Marshal J.R., Strott C.A., Rodbard D., 1970) when a level of Progesteronum in Serum of a blood exceeds 2,5-4,0 ng/ml (7,6-12,7 ???y/l). However, the monophasic basal temperature has been revealed at of some patients with a normal level of Progesteronum in the second phase of a cycle (Johansson E.D.B., Larsson-Cohn U., Genizell G., 1970). Besides the monophasic basal temperature is noted, approximately, at 20 % of ovulatory cycles (Bauman J.E., 1981; Moghissi K.S., 1976). Simple ascertaining of biphase basal temperature does not prove also normal function of a yellow body (Bauman J.E., 1981). The basal temperature also cannot be applied to definition of time of offensive or approach of an ovulation as and at a luteinization neovulirovavshego a follicle the biphase basal temperature (Yoshimura Y., Tada S., Oda T., Nakamura Y., Maruyama K., Ishikawa F., Ebibara T., Hirota Y., 1989) is observed. Nevertheless duration ljuteinovoj phases according to data of basal temperature and low rate of rise of basal temperature after an ovulation are accepted by many authors (Isakova E.V., 1993, Downs K.A., Gibson M., 1983) as criteria of diagnostics of a syndrome of a luteinization neovulirujushchego a follicle. Series of factors, such as smoking, the intensive brainwork, the previous sexual certificate or act, non-observance of certain time of measurement of temperature can essentially change its or her parameters (Tachezy, 1959). Researches of last years evidently show, that correlation between changes of basal temperature and ovulatory changes in ovaries (confirmed by means of ultrasonic research) does not exceed 40 %.

This method can be used by women as the house test or dough at obviously known absence of a pathology of a menstrual cycle for planning pregnancy.

For definition of day of an ovulation by a method of a choice for today ultrasonic monitoring is. This method allows to receive the objective certificate on presence or absence of an ovulation.

[Christina]

Dear Boris!

Many thanks for the information on temperature. Unfortunately, to spend ultrasonic monitoring I am necessary to be observed in any medical institution, and, having long and excruciating experience of dialogue with your colleagues, having spent a quantity of researches, including gisterosolpingoskopiju, a laparoscopy, etc., at the moment I am where now to go in perplexity to be treated? For now to not waste time gift or for nothing - I try to understand.



On the classification of temperature curves resulted or brought by you, at me a curve 2 - rising in the second phase on 0.2-0.3. Whether it means that the ovulation is absent? How you concern to schemes or plans of an induction of an ovulation with klomifenom, in what cases of hormonal sterility or barrenness they are effective, and what schemes or plans exist still (I have no in view of EKO)?



Thanks for the answer. Christina.



P.S. That could have in view of the doctor, not recommending to address to EKO, speaking: *quot; All of you peerly do not bear or take out ONiN?a*quot;?

[boris]

Uv. Christina!

On the classification of temperature curves resulted or brought by you, at me a curve 2 - rising in the second phase on 0.2-0.3. Whether it means that the ovulation is absent?

It seemed to me, that I have precisely enough defined or determined the attitude or relation to diagnostic value of this method.

How you concern to schemes or plans of an induction of an ovulation with klomifenom, in what cases of hormonal sterility or barrenness they are effective, and what schemes or plans exist still (I have no in view of EKO)?

As to one of comprehensible methods of an induction of an ovulation. Duration of treatment should not exceed 6 months. There are also other schemes or plans of stimulation (Gonadotropinums combined)

P.S. That could have in view of the doctor, not recommending to address to EKO, speaking: *quot; All of you peerly do not bear or take out ONiN?a*quot;?

It is known only to him.



With uv. B.Kamenetsky



PS From your report it is possible to understand, that you try to diagnose and appoint or nominate to yourselves treatment. I do not think, what is it the best decision.

[Christina]

Dear Boris!



Thanks for the answer. There can be you will prompt in what cases of hormonal sterility or barrenness to do or make EKO bessmysleno and whether stimulation of ovaries klomifenom from stimulation applied within the limits of EKO essentially differs?



Many thanks.

[boris]

Uv. Christina



There can be you will prompt in what cases of hormonal sterility or barrenness to do or make EKO bessmysleno



In case of hypergonadotrophic disturbances of a various genesis (when carrying out of stimulation noneffectively and probably application of only donor programs)





Whether stimulation of ovaries klomifenom from stimulation applied within the limits of EKO essentially differs?

Essentially certainly is not present, since t simulation with application klomifena also till now is applied in programs EKO in some centers. And here detelej certainly it is enough.



Yours faithfully B.Kamenetsky

The doctor the -gynecologist, k.m.n.

[Christina]

Dear Boris!

Many thanks for the answer. And how people learn or find out that from them hypergonadotrophic disturbances?

[boris]

And how people learn or find out that from them hypergonadotrophic disturbances?

Usually on reception at the gynecologist-endocrinologist, after the analysis gomonalnyh researches