排(pai)(pai)(pai)(pai)卵(luan)(luan)障(zhang)礙導致(zhi)的(de)(de)(de)不孕慢性(xing)(xing)(xing)(xing)(xing)(xing)(xing)排(pai)(pai)(pai)(pai)卵(luan)(luan)障(zhang)礙是(shi)(shi)很多(duo)內(nei)分(fen)泌(mi)疾(ji)病(bing)的(de)(de)(de)共(gong)同表現，占(zhan)婦女的(de)(de)(de)20%～25%。臨(lin)床表現主要(yao)為(wei)(wei)月經(jing)(jing)(jing)不規則甚至閉經(jing)(jing)(jing)，周期短于(yu)26天或長于(yu)32天提示有(you)排(pai)(pai)(pai)(pai)卵(luan)(luan)異常。病(bing)史還(huan)可(ke)反映多(duo)毛癥(zheng)(zheng)、男(nan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)化、溢乳(ru)及(ji)雌激(ji)(ji)素(su)(su)(su)(su)(su)過少等(deng)內(nei)分(fen)泌(mi)病(bing)紊亂(luan)的(de)(de)(de)信號。1993年世界衛(wei)生(sheng)組織(WHO)制定(ding)了(le)無(wu)排(pai)(pai)(pai)(pai)卵(luan)(luan)的(de)(de)(de)分(fen)類標(biao)準，共(gong)分(fen)為(wei)(wei)三大(da)(da)類。WHOⅠ型(低(di)(di)促性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)激(ji)(ji)素(su)(su)(su)(su)(su)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)無(wu)排(pai)(pai)(pai)(pai)卵(luan)(luan))，WHOⅡ型(正(zheng)常促性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)激(ji)(ji)素(su)(su)(su)(su)(su)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)無(wu)排(pai)(pai)(pai)(pai)卵(luan)(luan))，WHOⅢ型(高(gao)促性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)激(ji)(ji)素(su)(su)(su)(su)(su)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)無(wu)排(pai)(pai)(pai)(pai)卵(luan)(luan))。WHOⅠ型：包括下丘腦(nao)閉經(jing)(jing)(jing)(壓(ya)力、減(jian)(jian)重(zhong)、鍛煉、神經(jing)(jing)(jing)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)厭食及(ji)其他)、Kallmann綜合征(zheng)(促性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)激(ji)(ji)素(su)(su)(su)(su)(su)釋放激(ji)(ji)素(su)(su)(su)(su)(su)前體細胞移(yi)行異常)和(he)促性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)激(ji)(ji)素(su)(su)(su)(su)(su)弊(bi)端等(deng)。典型的(de)(de)(de)表現是(shi)(shi)低(di)(di)促性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)激(ji)(ji)素(su)(su)(su)(su)(su)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)功(gong)(gong)能(neng)減(jian)(jian)退(tui)：FSH低(di)(di)、E2低(di)(di)而泌(mi)乳(ru)素(su)(su)(su)(su)(su)和(he)甲(jia)狀腺(xian)(xian)素(su)(su)(su)(su)(su)正(zheng)常。WHOⅡ型：臨(lin)床上所碰到的(de)(de)(de)大(da)(da)部分(fen)患者(zhe)。即具有(you)正(zheng)常促性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)激(ji)(ji)素(su)(su)(su)(su)(su)的(de)(de)(de)卵(luan)(luan)巢(chao)功(gong)(gong)能(neng)紊亂(luan)，伴有(you)不同程度的(de)(de)(de)無(wu)排(pai)(pai)(pai)(pai)卵(luan)(luan)或月經(jing)(jing)(jing)稀發(fa)。包括：PCOS，卵(luan)(luan)泡膜細胞增(zeng)生(sheng)癥(zheng)(zheng)和(he)HRAN綜合征(zheng)(多(duo)毛，無(wu)排(pai)(pai)(pai)(pai)卵(luan)(luan)，胰島素(su)(su)(su)(su)(su)抵抗(kang)和(he)黑棘皮癥(zheng)(zheng))。典型表現是(shi)(shi)：FSH、E2和(he)泌(mi)乳(ru)素(su)(su)(su)(su)(su)正(zheng)常，但LH/FSH常異常升(sheng)高(gao)。WHOⅢ型：北京五洲婦兒醫(yi)院大(da)(da)夫介紹(shao)說(shuo)患者(zhe)主要(yao)是(shi)(shi)終末器官的(de)(de)(de)弊(bi)端或抵抗(kang)，表現為(wei)(wei)高(gao)促性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)激(ji)(ji)素(su)(su)(su)(su)(su)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)功(gong)(gong)能(neng)減(jian)(jian)退(tui)，包括卵(luan)(luan)巢(chao)早衰和(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)腺(xian)(xian)發(fa)育不全(卵(luan)(luan)巢(chao)抵抗(kang))。典型表現為(wei)(wei)FSH及(ji)LH升(sheng)高(gao)，低(di)(di)E2。這類患者(zhe)的(de)(de)(de)特點是(shi)(shi)對誘發(fa)排(pai)(pai)(pai)(pai)卵(luan)(luan)的(de)(de)(de)反應差，卵(luan)(luan)巢(chao)功(gong)(gong)能(neng)已減(jian)(jian)退(tui)。

確(que)定(ding)(ding)(ding)(ding)無排(pai)(pai)卵(luan)及(ji)(ji)其(qi)(qi)病(bing)(bing)因。基礎體(ti)(ti)溫(BBT)測(ce)(ce)(ce)定(ding)(ding)(ding)(ding)表可幫助判(pan)斷，基礎體(ti)(ti)溫升高0.5～1.0度提示有(you)無排(pai)(pai)卵(luan)及(ji)(ji)黃(huang)(huang)體(ti)(ti)期(qi)的(de)長(chang)短。這項測(ce)(ce)(ce)試(shi)(shi)雖然簡易(yi)、費用低(di)，但患者花費的(de)精力較(jiao)大(da)，并且約20%單項體(ti)(ti)溫的(de)病(bing)(bing)例(li)經其(qi)(qi)他(ta)方法(fa)(fa)測(ce)(ce)(ce)試(shi)(shi)有(you)排(pai)(pai)卵(luan)。判(pan)定(ding)(ding)(ding)(ding)有(you)無排(pai)(pai)卵(luan)的(de)第二種方法(fa)(fa)是尿LH測(ce)(ce)(ce)定(ding)(ding)(ding)(ding)，在月(yue)經的(de)首先(xian)0～16天期(qi)間測(ce)(ce)(ce)試(shi)(shi)(絕大(da)多數患者在這一窗口期(qi)排(pai)(pai)卵(luan))，檢(jian)測(ce)(ce)(ce)LH峰比BBT測(ce)(ce)(ce)定(ding)(ding)(ding)(ding)的(de)準(zhun)確(que)性高，但測(ce)(ce)(ce)定(ding)(ding)(ding)(ding)LH花費較(jiao)大(da)，出(chu)(chu)現(xian)LH表示有(you)排(pai)(pai)卵(luan)可能(neng)(neng)，但也有(you)的(de)患者出(chu)(chu)現(xian)LH峰卻(que)不排(pai)(pai)卵(luan)，可能(neng)(neng)與(yu)未破(po)裂卵(luan)泡(pao)黃(huang)(huang)素化(hua)綜(zong)合征(zheng)有(you)關。檢(jian)測(ce)(ce)(ce)排(pai)(pai)卵(luan)的(de)其(qi)(qi)他(ta)方法(fa)(fa)有(you)：測(ce)(ce)(ce)定(ding)(ding)(ding)(ding)黃(huang)(huang)體(ti)(ti)中期(qi)孕酮(P大(da)于3ng/ml)水平、月(yue)經中期(qi)成熟(shu)卵(luan)泡(pao)出(chu)(chu)現(xian)(1.6～2.2cm)、排(pai)(pai)卵(luan)期(qi)盆腔游離液體(ti)(ti)、內(nei)膜活檢(jian)(月(yue)經首先(xian)天或(huo)周期(qi)23天)子宮(gong)內(nei)膜呈分泌期(qi)改變(bian)。