البحث — المستودع الرقمي العراقي

المستخلص: انقطاع الطمث لاسباب ثانوية هو انعدام الدوره الشهريه لمدة ثلاثة الى ستة اشهر للنساء اللواتي لهن دوره شهريه منتظمة.واستنادا لمنظمة الصحة العالمية ان انقطاع الطمث يتضمن مجموعة (WHOI) و(WHOII) والتي تكون (30%) من حالات العقم.وتعاني اكثر النساء ممن يكونون من م | Secondary amenorrhea refers to the lack of cycle for three months in a row or for more than six months in a woman who has had regular menstrual periods before, and its associated with conditions classified as World Health Organization (WHO) group 1 and WHO group 2 and has been estimated to represent almost (30%) of all causes of infertility. In clinical practice, WHO group 2 subjects present much more frequently than WHO group 1 subjects and they appear to be much harder to treat successfully. Among women classified as WHO group 2, those diagnosed with polycystic ovary syndrome (PCOS) constitute the largest group (60 - 85% of cases). These women account for most cases with oligomenorrhea (90%) and represent about (30%) of those with amenorrhea.ObjectiveThe aim of this study was to find out the pregnancy rate following intrauterine insemination (IUI) in women complaining of secondary amenorrhea after induction of ovulation and compare it with those achieve pregnancy by natural way.Material and MethodsSeventy five females with secondary amenorrhea were involved in this study, there ages were ranged between (?30, 30 - 39, ?40) years old with infertility duration ranged between (?2, 3 - 4, 5 - 6, 7 - 8, ?9) years. History and medical examination were done for all women, with tubal patency assessment by HSG or laparoscopy.By cycle day two, hormonal assay (S.FSH, S.LH, S.E2, S.Prolactin and S.Testosterone) were done for all females in addition to ultrasonography to exclude any ovarian pathology.Ovulation induction program was applied for all females which include either clomiphene citrate (CC) alone, recombinant Follicular Stimulating Hormone (r - FSH) alone or combined CC and r - FSH. Vaginal ultrasonography was done for all females on day 12 or13 to assess ovarian response (size and number of mature follicles) and endometrial thickness. Meantime all male partners undergo seminal analysis to assess sperm parameters (sperm concentration, sperm motility and morphology).Thirty eight of females participated for natural pregnancy and thirty seven of females participate for IUI. Washing swim up technique was used for sperm activation for all male partner involved in IUI group.Follow up of all these females for pregnancy test to assess the pregnancy rate for both groups (natural and IUI).ResultsThe pregnancy rate achieved by natural way for a women with secondary amenorrhea is (23.7%), and (18.92%) by IUI way.In this study, it was found that female age, infertility duration, hormonal balance and ovulation induction program affect the pregnancy outcome where the young age group and short infertility duration correlate positively with pregnancy rate. Furthermore, early diagnosis of underlying causes of secondary amenorrhea to achieve hormonal balance by suitable ovulation induction program, have an effect on pregnancy rate, were combined CC and r - FSH produce a significant result among females achieve pregnancy by natural way (13.5%) compared with other ways. While ovulation induction by r - FSH drugs produce a significant results (13.5%) among females achieve pregnancy by IUI way.ConclusionFrom results of this study, it was concluded that young female age, short infertility duration, early diagnosis of underlying causes of secondary amenorrhea and the use of r - FSH drugs for ovulation induction produce a high significant pregnancy rate using IUI program.

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