Mai ka wā ʻōpio a i ka menopause, ʻo nā ovaries ke kahua o ka hana mau. ʻO ka pae mua o kēia pōʻai menstrual, ʻo ka pae follicular e kūlike i ka maturity o kahi ovarian follicle, i ka manawa o ka ovulation, e hoʻokuʻu i kahi oocyte i mākaukau no ka momona. ʻElua mau homona, LH a me FSH, pono no kēia pae follicular.

Hānau ʻia kēlā me kēia kaikamahine me, i nā ovaries, kahi waihona o kekahi mau haneli kaukani i kapa ʻia ʻo nā follicle primordial, me kēlā me kēia e loaʻa ana kahi oosit. I kēlā me kēia lā 28 a ʻoi paha, mai ka wā ʻōpio a i ka menopause, hana ʻia kahi pōʻaiapuni ovarian me ka hoʻokuʻu ʻia ʻana o ka oosit - ovulation - e kekahi o nā ovaries ʻelua.

Hana ʻia kēia pōā menstrual o 3 mau ʻokoʻa ʻokoʻa:

• ka pae follicular;
• lʻovulation;
• ka pae luteal, a i ʻole ka hope o ka hopena o ka pae.

Hoʻomaka ka pae follicular i ka lā mua o ka menstruation a hoʻopau i ka manawa o ka ovulation, a no laila he awelika o 14 mau lā (ma luna o kahi pōʻaiapuni 28 lā). Kūlike ia i ke kaʻina o ka hānai follicular, i kahi manawa e hoʻoheheʻe ʻia ai kekahi helu o nā follicle primordial a hoʻomaka i ko lākou oʻo ʻana. Aia kēia folliculogenesis i ʻelua papa nui:

• ka loiloi mua o nā follicle: kahi helu o nā follicle primordial (ʻo kekahi 25 mau mile o ka millimeter i ke anawaena) e oʻo a hiki i ke kahua o nā follicle kiʻekiʻe (a i ʻole anthrax);
• ka ulu ʻana o nā antral follicle i ka follicle pre-ovulatory: kahi o nā antral follicle e hemo mai ka cohort a hoʻomau i ke oʻo ʻana, ʻoiai e hoʻopau ʻia nā mea ʻē aʻe. ʻO kēia mea i kapa ʻia ʻo ka follicle mana nui e hōʻea i ke kahua o ka follicle pre-ovulatory, a i ʻole De Graaf follicle, i ka wā o ka ovulation, e hoʻokuʻu i kahi oocyte.

I ka wā o ka follicle, ʻaʻole manaʻo ka wahine i kekahi mau hōʻailona kikoʻī, ʻokoʻa ka hoʻomaka ʻana o ka menstruation e hōʻailona ana i ka hoʻomaka ʻana o kahi pōʻai ovarian hou a no laila ka hoʻomaka ʻana o ka pae follicular.

ʻO nā "conductors" o kēia pōʻaiapuni ovarian he mau hormonone ʻokoʻa i hūnā ʻia e ka hypothalamus a me ka pituitary gland, ʻelua mau gland ma ke kumu o ka lolo.

• hū ka hypothalamus i kahi neurohormone, GnRH (gonadotropin hoʻokuʻu i ka hormone) i kapa ʻia ʻo LH-RH, kahi e hoʻoulu ai i ka pituitary gland;
• i ka pane, hūnā ka pituitary gland iā FSH, a i ʻole ka hormone stimulate follicular, kahi e hoʻoulu ai i kahi helu o nā follicle primordial a laila komo i ka ulu ulu;
• e hūnā kēia mau follicle i ka estrogen e mānoanoa ai i ka uhi ʻana o ka uterine i mea e hoʻomākaukau ai i ka pūpū e loaʻa i kahi hua manu kūpono.
• ke koho ʻia ka follicle ma mua o ka ovological follicle, hoʻonui ka nui o ka huna estrogen, e hoʻonui ana i ka LH (hormone luteinizing). Ma lalo o ka hopena o LH, hoʻonui ka haunaele o ka wai i loko o ka follicle. Haki ka follicle a hoʻokuʻu i kāna oosit. ʻO ka hoʻoipoipo.

Me ka ʻole o kahi pae follicular, ʻaʻohe ovulation. Kāhea ʻia kēia ʻo ka anovulation (ʻole o ka ovulation) a i ʻole dysovulation (nā maʻi ovulation), nā hopena ʻelua i ka ʻole o ka hana ʻana i kahi oositte fertilizable, a no laila infertility. Hiki ke kumu ma kahi o kekahi mau kumu.

• kahi pilikia me ka pituitary a i ʻole hypothalamus (hypogonadism o ke kumu "kiʻekiʻe"), kahi e kumu ai ka haʻalele a i ʻole lawa ʻole ka huna hormonal. ʻO ka huna nui o prolactin (hyperprolactinemia) kahi kumu maʻamau o kēia hana. Hiki iā ia ma muli o kahi pituitary adenoma (kahi tumign benign o ka pituitary gland), i ka lawe ʻana i kekahi lāʻau (neuroleptics, antidepressants, morphine…) a i ʻole kekahi mau maʻi maʻamau (ka hōʻeha kīnā ʻole mau loa, hyperthyroidism, ...). ʻO ke koʻikoʻi koʻikoʻi, haʻalulu i ka naʻau, hiki i ka hoʻoliʻiliʻi kaumaha nui ke hoʻopilikia i ka hana kūpono o kēia axis hypathalamic-pituitary a alakaʻi i ka anovulation kuikawa;
• ʻO Polycystic ovary syndrome (PCOS), a i ʻole ovarian dystrophy, kahi kumu maʻamau o nā maʻi ovulation. Ma muli o ka hana ʻole o ka hormonal, hōʻiliʻili kahi helu maʻamau o nā follicle a ʻaʻole kekahi o lākou e hele a piha.
• hana ʻole ovarian (a i ʻole hypogonadism o ke kumu "haʻahaʻa") hānau (ma muli o kahi kino chromosomal, Turner syndrome e laʻa) a i loaʻa (ma hope o ka hoʻomaʻamaʻa chemotherapy a ʻoki ʻana);
• menopause mua, me ka ʻelemakule ʻōpio o ka mālama oocyte. ʻO nā kumu genetic a pale ʻole paha ke kumu o kēia hanana.

I ke alo o ka anovulation a i ʻole dysovulation, hiki ke hāʻawi ʻia i ka lāʻau no ka stimulate ovarian i ka mea maʻi. Hoʻopili kēia i ka hoʻomaʻamaʻa ʻana i ka ulu ʻana o hoʻokahi a ʻoi aku o nā follicle. Aia nā kuʻina ʻokoʻa. Kūpono kekahi i ka comiphene citrate, kahi antiestrogen i lawe ʻia e ka waha e hoʻopunipuni ai i ka lolo i ka noʻonoʻo ʻana ua haʻahaʻa loa ka pae estradiol, e hoʻowalewale iā FSH i mea e hoʻonāukiuki ai i nā follicle. Hoʻohana nā poʻe ʻē aʻe i nā gonadotropins, hoʻomākaukau i hoʻokomo ʻia i loko o ka FSH a me / a i ʻole LH e kākoʻo i ka oʻo ʻana o nā follicle. I nā kūlana ʻelua, ma loko o ka protocol, ukali pinepine ʻia ka mea hoʻomanawanui me ka nānā ʻana me nā hoʻāʻo ʻana o ke koko e ana i nā pae o ka hormone a me nā ultrasound scan e kāohi ai i ka helu a me ka ulu ʻana o nā follicle. Ke mākaukau kēia mau follicle, hoʻomaka ʻia ka ovulation e kahi injection o HCG.