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子宫颈病变怎么办？如何治疗？

发布日期：2024-07-08 12:42:13编辑：秩名


子宫颈在引导精子从阴道向较上方的生殖道移动的过程中起着积极作用。在女性育龄期，一个正常的子宫颈能分泌一些又细又滑而且有弹性的黏液来保护精子不受阴道内的酸性侵蚀。黏液分泌细胞的先天畸形或者损伤都会降低子宫颈分泌黏液的能力，使得精子在穿过子宫颈时，有困难或根本不可能通过子宫颈到达子宫。①子宫颈损伤。子宫颈损伤通常是由一些简单的外科手术引起的，如扩张术和刮除术、人工流产，或对脱落细胞的检查和治疗处理。这些手术可能损伤黏液分泌细胞或子宫颈组织，如果出现大量瘢痕，子宫颈就会变得粗糙而狭窄。如果因为以上原因子宫颈不能发挥正常功能，可以通过轻轻地伸展使之得以恢复正常。②激素原因。排卵前由于雌激素的增加，子宫颈腺就分泌出一些生育型黏液。如果子宫颈没有受到损伤，而且它的结构也正常，那么没有黏液或者黏液量少就有可能是因为细胞内缺少雌激素受体，或者是因为受体需要较多雌激素来刺激黏液的分泌。有理论认为，一些受体对雌激素的需要量更大。③激素治疗子宫颈病变。如果黏液分泌少却没有明显的生理方面的原因，而且病历也显示患者排卵正常，那么用一些激素类药物来提高排卵周期有可能增加黏液分泌量。因为卵子滤泡会因促卵泡激素的刺激而增大，这些激素药物可以帮助分泌雌激素从而刺激子宫颈。如果子宫颈细胞只需要少量的雌激素就可以起作用，那么改善排卵状况就有可能使黏液的分泌状况也因此得以改善。
 
如果手术和激素治疗都不能使子宫颈恢复正常功能，那么运用宫腔内人工授精方法，不经过子宫颈就可以直接将精子注入子宫。当精液中精子含量低，或者不孕的原因难以查清时，经常运用宫腔内人工授精的方法。
 
目前宫腔内人工授精要求男性在受精前几个小时提供精液样品。样品经过“清洗”，也就是说将精子从精液中分离并集中起来。然后将集中起来的精子通过导管注入子宫。
 
大多数医院会在每个周期内进行1次或2次宫腔内人工授精。第1次精子通常就在预期排卵前注入，第2次在排卵后24个小时后注入。可以使用排卵试纸来测试促黄体生成激素什么时候大量出现，从而断定排卵的时间。有时候可以用超声波来检测卵巢的滤泡是否已被排空或正在准备排卵。
 
宫腔内人工授精的成功率比较小。如果一名40岁以下的患者因宫颈病变导致不孕，其人工授精的成功率为3%～7%。如果进行4～6个周期的治疗，怀孕率为10%～25%。年龄超过40岁的患者接受人工授精的成功率只是40岁以下患者的50%。对那些原因不明的不孕患者，或者是由于男方原因导致的不孕，怀孕率就更低，每1个周期仅为2%～5%。
 
帮助受精的4种人工方法是：宫颈内人工授精、宫腔内人工授精、宫颈内人工授精结合超速排卵(运用刺激性腺的药物来刺激排卵)与宫腔内人工授精结合超速排卵。宫腔内人工授精与刺激性腺的超速排卵结合的方法导致的怀孕率最高(33%)。在未怀孕之前一般进行4个周期的治疗过程。受孕率最低(仅为10%)的方法是宫颈内人工授精。在4个周期的治疗后，其他两种方法，宫腔内人工授精和宫颈内人工授精结合超速排卵导致的怀孕率分别为18%和19%。在每一个治疗组里有230多对夫妇。
 
宫腔内人工授精是一种技术含量相对较低、费用也比较低的方法，所以在尝试其他费用昂贵的方法之前最好先试试它。
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