妇产科尤昭玲教授经典案例

国 际 医 疗 部 特 需 专 家

妇产科  尤 昭 玲 教授

主任医师，二级教授，博士生导师

享受国务院政府特殊津贴专家

湖南中医药大学第一附属医院终身教授

第四批全国名中医药专家学术经验继承工作导师

世界中医药联合会妇科分会会长

中华中医药学会第二届全国中医妇科名医

中华中医药学会首席健康科普专家

诊 疗 范 围

中西医结合治疗不孕症、卵巢早衰、宫腔粘连、多囊卵巢综合症、IVF-ET中医调治、

输卵管功能障碍、剖腹产后疤痕子宫、妇科肿瘤等妇科疑难病症。

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案  例（一）

某，女，18岁，未婚，无性生活史。初诊时间：2018.12.23

主症：DOR

既往治疗经历：2017年2月9日起口服补佳乐何黄体酮，18.月7月停药，9月继续吃

2018年8月起出现月经不调，B超显示子宫卵巢偏小

月经史：13岁初潮，月经周期30 — 90天，经期5天，末次月经12月19日，自诉月经量、色正常，有小血块，伴轻微痛经。白带（-），外阴（-），食寐可，二便调。

孕产史：无性生活史。

其它：白带正常，食寐可，二便调。

相关辅助检查：

基础内分泌检测：
时间	AMH	FSH	LH	E2	T	PRL	P	HCG	INHB
2014.2.6		58.38	25.34	＜10	0.59	10.85	0.2
2017.2.9		52.28	28.18	21	1.09	10.14	0.3
2018.6.19					2.11
2018.7.12		21.5	5.02
2018.8.10		23.1	11.8
2019.3.27	<0.06<>
2019-3-29 非经期		29.90	26.90	404.00	1.73	137	1.57

B超检查：

时间

子宫大小 内膜厚度

左巢大小 卵泡个数、大小

右巢大小 卵泡个数、大小

盆腔积液

2014.2.6

30*18*27 内膜：5mm

20*12

20*10

2016.8.2

34*49*19 5.5

15*10

13*11

2017.2.9

29*20*32 3.9

18*8

未扫及

2017.6.14

36*23*39 4.5

35*23 26*22

17*9

2017.8.6

36*22*38 5

22*15

20*11

2017.9.17

34*19*28 4

24*20

22*19

2017.10.28

31*24*30 4

26*15 ＞10较大4*3

27*16 ＞10较大5*4

2017.12.24

43*28*22 4

不清

不清

2018.3.18

36*17*27 3

24*14

25*15 6*5

2018.6.19

43*26*35 左4.5右3.6纵膈？

未显示

17*10

2018.7.25

31*22*30 3.3

16*8

17*10

2018.9.30

32*21*30 4

27*15

29*17

2019-3-24 长沙妇幼

36*25*46   纵膈子宫 右侧内膜7.3 左侧内膜6.9

20*13 1个  14*14？

22*10

2019-6-24 省妇幼四维 D5天

38*24*38 5mm 纵膈？

囊肿27*18*21

肠气干扰

2019-10-26 光秀

30*20*46（欠佳） 完全性纵膈 内膜1:2.8mm  不清不均 内膜2:3.0mm  不清不均 0级、无蠕动、左缺失

11*6*9 左侧、平颈、远宫、尚可 低回声

15*9*10 右侧、下段、远宫、欠佳 低回声

病案1小结：

患者年龄小18岁，未婚，无明显诱因导致卵巢储备功能下降，因闭经1年，前来我院尤昭玲教授妇科工作室门诊就诊，根据既往病史，结合相关检查，发现患者双侧卵巢萎缩，窦卵泡数量0个，内膜菲薄，故而闭经。经尤教授3个月中药、膏方的精心调治，患者于2019.4.15、2019.5.9、2019.5.27、2019.6.9、2019.7.15、2019.8.19月经按期来潮，且经量、经色基本正常，后每2个月就诊1次，持续调理中。

病案1特点：

  无明显诱因致DOR，闭经1年，持续调治后月经复潮。

Case history 1

Miss He,female,18, unmarried, asexual life history. First visit time: 2018.12.23.

Main symptoms: DOR

Past treatment experience: She took PGV and progesterone orally from February 9, 2017 to July, 2018,and took PGV and progesterone again in September,2018. Irregular menstruation started in August 2018, B-ultrasound showed that the uterus and ovaries were too small.

Menstruation history: menarche:13-year-old ;menstrual cycle:30-90 days; menstrual period : 5 days; last menstruation: 2018.12.19.Menstruation situation:menstrual volume (-), color (-), small blood clots, mild dysmenorrhea. Leucorrhea (-), vulva (-).Diet and sleep were normal.Bowel movements and urination were normal.

Maternity history: No sexual life history.

Others: Normal leucorrhea.Diet and sleep were normal.Bowel movements and urination were normal.

Related auxiliary examination:

Basic Endocrine Investigations：
Time	AMH	FSH	LH	E2	T	PRL	P	HCG	INHB
2014.2.6		58.38	25.34	＜10	0.59	10.85	0.2
2017.2.9		52.28	28.18	21	1.09	10.14	0.3
2018.6.19					2.11
2018.7.12		21.5	5.02
2018.8.10		23.1	11.8
2019.3.27	<0.06
2019-3-29 Non-menstrual period		29.90	26.90	404.00	1.73	137	1.57

Ultrasound report：
Time	Uterus size and Endometrial thickness	Left ovarian size and Number and size of follicles	Right ovarian size and Number and size of follicles	Pelvic Fluid
2014.2.6	30*18*27 Endometium：5mm	20*12	20*10
2016.8.2	34*49*19 5.5	15*10	13*11
2017.2.9	29*20*32 3.9	18*8	Not scanned
2017.6.14	36*23*39 4.5	35*23 26*22	17*9
2017.8.6	36*22*38 5	22*15	20*11
2017.9.17	34*19*28 4	24*20	22*19
2017.10.28	31*24*30 4	26*15 ＞10 a little bigger 4*3	27*16 ＞10 a little bigger 5*4
2017.12.24	43*28*22 4	Not clear	Not clear
2018.3.18	36*17*27 3	24*14	25*15 6*5
2018.6.19	43*26*35 Left 4.5Right3.6 Uterine septum？	Can’t be seen	17*10
2018.7.25	31*22*30 3.3	16*8	17*10
2018.9.30	32*21*30 4	27*15	29*17
2019-3-24 Changsha Women and Children	36*25*46   Utering Septum Right side endometrium7.3 Right side endometrium6.9	20*13 1 (one) 14*14？	22*10
2019-6-24 Provincial Women and Children siwei D5 day	38*24*38 5mm Utering Septum？	Cyst measuring 27*18*21	Air causing obstruction
2019-10-26 Guang xiu	30*20*46（Sub optimal） Complete Uterine Septum Endometrium1:2.8mm  Unclear and uneven Endometirum 2:3.0mm  Unclear and uneven 0 Degree、Not mobile and left missing	11*6*9 Leftside,平颈、远宫、尚可 Low echogenecity	15*9*10 Right side, lower pole、远宫、欠佳 Low echogenecity

Case 1 Summary：

The patient was 18 years old girl, who never had sexual encounter and there was no obvious cause for the decline of ovarian reserves. She visited the gynecology outpatient clinic of Professor You Zhaoling with the complaint of amenorrhea for 1 year. Based on the past medical history, combined with physical examination and related investigations, it was found that the patient had bilateral ovarian atrophy. The number of antral follicles is 0, and the endometirum is thin, causing amenorrhea.  After 3 months of meticulous treatment by Professor You with traditional Chinese medicine and ointments, the patient started menstruating and had her periods on 2019.4.15, 2019.5.9, 2019.5. She is currently advised to visit the doctor every 2 months and continue to regulate the body.

Case 1 specific features：

  DOR of unknown etiology，amenorrhea for 1 year, and after treatment she esumed normal menstrual cycle.

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病  案（二）

黄某，32岁，湖南人，初诊时间：2019.3.11，求一胎。

主症：DOR（FSH高、AMH低）、内膜薄、 左囊肿+手术、输卵管功能障碍（左外孕+切除）、POR（2次手术史）

既往治疗经历：

2012年人流1次+清宫+月经量无明显改变

2016年卵巢囊肿剥除术（左侧）

          2018年10月+因左侧宫外孕 +左侧输卵管切除

月经史：13岁初潮，周期28-60天，经期5天，量、色基本正常。末次月经：2019.3.3，量、色基本正常，伴轻度痛经。

2018.12.13，甲状腺功能检查：FT3：5.15    FT4：17.69    TSH：1.54

相关检查：

基础内分泌检测：
时间	AMH	FSH	LH	E2	T	PRL	P	HCG	INHB
2018.11.13	0.39
2018.11.29		6.39	3.21	30.30	0.24	375.50	0.30	0.10
2019.1.16								15.0
2019.5.16				96			0.6

B超检查：

时间

子宫大小 内膜

左巢大小 卵泡个数、大小

右巢大小 卵泡个数、大小

盆腔积液

209.1.31 郴州第一

45*33mm 内膜：4mm

22*17 mm 混合回声包块，28*18

25*15 mm

2019.3.9

48*28 mm 内膜：5mm

25*10 mm 高回声包块，21*11

33*22 mm 囊性无声回区，21*18

2019.3.11 湘潭四维

38*27*39 mm 内膜：5mm 1级、无蠕动、左阻大

22*12 mm 卵泡：2个

35*22 mm 6个、18*13

2019.4.1 湘潭四维

45*34*42 mm 内膜：7mm

37*22 mm 卵泡：2个， 最大24*13 mm 输卵管切除

35*15 mm 卵泡：3个

2019.5.4 郴州第四

50*40 mm 内膜：8.5mm

27*18 mm

28*22 mm 18*15mm

2019.6.8

40*30*39 mm 内膜：6mm

25*18 mm 卵泡：3个、16*11

22*13 mm 卵泡：4个

病案2小结：

患者32岁，为年轻患者，因左侧卵巢囊肿及左侧宫外孕，2次行腹腔镜手术，导致DOR，术后半年试孕未果，于2019年3月11日来我院尤昭玲教授妇科工作室门诊就诊，尤教授根据患者既往病史，结合患者相关检查，分析患者不孕的主要原因，制定如下治疗方案：右侧输卵管试孕4次、如怀孕排除宫外孕保胎，如未孕建议ART。

   经过半年的中药及膏方调治，患者于2019年9月21日确定妊娠：HCG：152     P:22.39ng/L，2019年9月23日就诊时基本情况良好，并继续保胎治疗。

病案2特点：

  2次手术导致DOR，在尤教授指导下用右侧输卵管积极试孕，经半年调治，成功受孕。

Case history 2

Miss Huang,32 ,from Hunan, first visit time:2019. 3.11 .To prepare a pregnancy for first child.

Main symptoms: DOR (high FSH, low AMH), thin endometrium, left cyst + surgery, tubal dysfunction (left external pregnancy + resection), POR (2 surgical history)

Past treatment experience:

In 2012, there was no significant change in one abortion + Curettage + menstrual volume

In 2016， removal of ovarian cyst  (left)

In October 2018 ， left salpingectomy for left ectopic pregnancy

Menstrual history:menarche:13-year-old ;menstrual cycle:28-60 days; menstrual period : 5 days; last menstruation: 2019.3.3.Menstruation situation:menstrual volume (-), color (-), mild dysmenorrhea.

2018.12.13, thyroid function test:FT3：5.15    FT4：17.69    TSH：1.54

Related auxiliary examination:

Basic endocrine testing:
Date	AMH	FSH	LH	E2	T	PRL	P	HCG	INHB
2018.11.13	0.39
2018.11.29		6.39	3.21	30.30	0.24	375.50	0.30	0.10
2019.1.16								15.0
2019.5.16				96			0.6

B-ultrasound：
Date	Uterine size Endometrial thickness	Left ovarian size Number and size of follicles	Right ovarian size Number and size of follicles	Pelvic effusion
209.1.31 Chenzhou First People's Hospital	45*33mm endometrium：4mm	22*17 mm Mix echo packet blocks，28*18	25*15 mm
2019.3.9	48*28 mm endometrium：5mm	25*10 mm High echo package block，21*11	33*22 mm Cystic silent gyrus，21*18
2019.3.11 Xiangtan Four-dimensional ultrasound	38*27*39 mm endometrium：5mm Level 1, no peristalsis,  large left fallopian tube resistance	22*12 mm follicles：2个	35*22 mm 6个、18*13
2019.4.1 Xiangtan Four-dimensional ultrasound	45*34*42 mm endometrium：7mm	37*22 mm follicles：2个， 最大24*13 mm left salpingectomy	35*15 mm follicles：3个
2019.5.4 Chenzhou Fourth Hospital	50*40 mm endometrium：8.5mm	27*18 mm	28*22 mm 18*15mm
2019.6.8	40*30*39 mm endometrium：6mm	25*18 mm follicles：3个、16*11	22*13 mm follicles：4个

The summary of case history2 :

The patient was 32 years old female. Due to left ovarian cyst and left ectopic pregnancy, she underwent laparoscopic surgery twice, which led to DOR.After the surgery she tried to coneive for six months but failed.Then she visited our hospital on March 11, 2019, Professor Zhaoling You, Department of Gynecology. In the outpatient department (OPD), Professor You analyzed the major cause of infertility in this patient. Based upon the patient’s previous medical history, combined with the physical examination and investigations, Professor You formulated the following treatment plan: IVF - Right fallopian tube 4 trials, exclude ectopic pregnancy if pregnant, and ART if not pregnant.

After half a year of treatment with traditional Chinese medicine and ointments, the patient was confirmed to be pregnant on September 21, 2019: HCG: 152 P: 22.39 ng/L, and her condition was stable when she visited the doctor on September 23, 2019, and the feto-maternal monitoring and protection was continued.

The characteristics of case history 2:

   Two surgeries led to DOR. Under the guidance of Professor You, the patient used IVF through the right fallopian tube to conveive. After six months of treatment, she successfully conceived a child.

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病  案（三）

彭某，31岁，湖南人，初诊时间：2019年3月13日，已顺产1女孩（4岁），无孕求，要求调经。

主症：DOR、内膜菲薄、乳腺结节

既往经历：10年前紧急避孕药服用史、无家族史

月经史：13岁初潮，周期30d-4M，经期6-7天，末次月经：2019年11月2日。

现经量少，颜色正常，无血块，伴轻度痛经。

孕产史：孕1顺产1

白带正常，食寐可，二便调。

基础内分泌检测：
时间	AMH	FSH	LH	E2	T	PRL	P	HCG	INHB
2017.6.10		19.09	24.58	142	1.07	6.86	0.2
2017.11.7		17.58	14.33	224
2018.9.18		121.4	41.1	25
2019.4.13	0.05

B超检查：

时间

子宫大小 内膜

左巢大小 卵泡个数、大小

右巢大小 卵泡个数、大小

盆腔积液

2018-3-20 本院

42*32*44 2mm

19*8

18*12

2018-9-18 中医附二

36*27*40 2mm

19*9

17*8

20 mm

2019.4.3 本院

34*38*30 2.2 mm

18*13

18*9

24 mm

2021.2.6 江湾

44*32*41 3.9mm欠清、欠匀 结合带+整体欠匀 0级、未见、双缺失

20*16*18 左下、下段、远离、尚可 未见 增粗25*11 mm

15*11*13 右下、下段、远离、尚可 未见

左40*22 右29*20 25*21 mm

2021.6.19 市中心

3mm

囊肿：30*26 mm

增粗27*7 mm

盆积液22 mm

病案3小结：

患者31岁，年轻患者，因十年前服用紧急避孕药而导致DOR，表现为：双侧卵巢萎缩，双侧窦卵泡数为0个，且AMH值极低（0.05），为绝经后水平，患者因闭经8个月，于2019年3月13日来我院尤昭玲教授妇科工作室门诊就诊，要求调经，尤教授根据患者既往病史，结合患者相关检查，分析患者闭经的主要原因为：卵巢储备功能下降为主，加之内膜血流0级致内膜菲薄，故月经不潮。经2个月中药及膏方调治，患者于2019年5月12日月经来潮，且经量、经色基本正常，由于患者无怀孕要求，故后续改为每2月复诊1次，维持基本状况，防止卵巢功能进一步衰退。

病案3特点：

  因服用紧急避孕药导致DOR，出现闭经8个月，经2个月调治后，月经按期来潮。

Case history 3

Miss Peng,31 , from Hunan, first visit time: 2019.3.13.1 daughter( 4 years old),natural birth, no pregnancy requirement,menstruation adjustment.

Main symptoms: DOR, endometrial thinning, breast nodules

Past experience: used emergency contraception 10 years ago, no family history.

Menstruation history: menarche:13 years old ;menstrual cycle:30days-4months; menstrual period :6-7 days; last menstruation: 2019.9.2.Menstruation situation:menstrual volume (little), color (-), blood clots(no), mild dysmenorrhea. Pregnancy-Labor History:Pregnancy 1 normal delivery 1

Leucorrhea (-).Diet and sleep were normal.Bowel movements and urination were normal.

Basic endocrine testing:
Date	AMH	FSH	LH	E2	T	PRL	P	HCG	INHB
2017.6.10		19.09	24.58	142	1.07	6.86	0.2
2017.11.7		17.58	14.33	224
2018.9.18		121.4	41.1	25
2019.4.13	0.05

B-ultrasound：
Date	Uterine size Endometrial thickness	Left ovarian size Number and size of follicles	Right ovarian size Number and size of follicles	Pelvic effusion
2018-3-20 The First Hospital of Hunan University of Chinese Medicine	42*32*44 2mm	19*8	18*12
2018-9-18 The Second Hospital of Hunan University of Chinese Medicine	36*27*40 2mm	19*9	17*8	20 mm
2019.4.3 The First Hospital of Hunan University of Chinese Medicine	34*38*30 2.2 mm	18*13	18*9	24 mm
2021.2.6 Jiangwan	44*32*41 3.9mm Uneven and fuzzy Combination zone + overall lack of uniformity Grade 0, not seen, double missing	20*16*18 Lower left, lower section, away,generally Not seen Thicken 25*11 mm	15*11*13 Lower right, lower section, away,generally Not seen	Left40*22 Right29*20 25*21 mm
2021.6.19 Changsha Central Hospital	3mm	Cyst：30*26 mm	Thicken27*7 mm	ascites22 mm

The summary of case history3 :

The patient is 31-year-old who took emergency contraceptives ten years which ago led to DOR. The manifestations were: bilateral ovarian atrophy, bilateral antral follicles were 0, and the AMH value was extremely low (0.05), which is a postmenopausal level. On March 13, 2019, the patient came to Professor You Zhaoling's outpatient gynecology clinic in our hospital due to amenorrhea for 8 months. Based on the patient's past medical history, combined with the relevant examinations and investigations of the patient, Professor You diagnosed the main etiology for the patient's amenorrhea as follows: Ovarian reserves are decreased, and intimal blood flow is 0 grades, which leads to endometrial thinning, so menstruation is not normal. After 2 months of treatment with traditional Chinese medicine and ointments, the patient had menstruation on May 12, 2019, and her menstrual volume and menstrual color were normal. Since the patient had no pregnancy requirements, the follow-up was advised as every 2 months visit to prevent further decline of ovarian function.

The characterwastics of case hwastory 3:

    DOR was caused by taking emergency contraceptives, and patient had amenorrhea for 8 months. After 2 months of treatment, normal menstruation was resumed.

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病  案（四）

曹某，31岁，湖南人，初诊时间：2018年2月12日。求一胎。已婚2年，未孕。

主症：DOR

既往经历：无特殊。

月经史：13岁初潮，周期28-50天，经期6天，末次月经：2018年1月23日。月经量、色基本正常，有小血块，无痛经。

白带正常，食寐可，二便调。

孕产史：孕0

白带正常，食寐可，二便调。

甲状腺功能：正常。

基础内分泌检测：

时间

AMH

FSH

LH

E2

T

PRL

P

HCG

INHB

2018.1.24 C2

13.13

3.62

17

0.28

14.54

0.27

2018.1.25

0.149 （0.24-11.78）

B超检查：

时间

子宫大小 内膜

左巢大小 卵泡个数、大小

右巢大小 卵泡个数、大小

盆腔积液

2018.2.4 中信四维 C15

41*36*42 10.8mm 纳式囊肿：7*6

31*22*29 卵泡1个、15*14

29*13*27 低回声

试管经历：

2018年3月13日（二诊）时，自诉夫妻双方试管前期检查已准备就绪，预计2018年4月拮抗剂方案进周取卵。要求试管同时，辅助治疗。

2018年3月29日（三诊）时，患者自诉已孕，尿检（阳性），确定早孕，要求中药保胎至3个月。

病案4小结：

患者31岁，年轻患者，无明显诱因导致DOR，表现为：双侧卵巢内窦卵泡数少1个，且AMH值较低（0.149），表现为月经周期推迟，最长50天，患者因已婚2年未孕，欲试管助孕，并于2018年2月12日来我院尤昭玲教授妇科工作室门诊就诊，要求试管同时全程中药调理改善卵巢功能。

根据患者既往病史，结合患者相关检查，分析患者不孕的主要原因为：卵巢储备功能下降为主，故月经周期推迟。尤教授建议患者试管助孕的同时积极试孕。经调治，2018年3月13日（二诊）时，患者诉月经于2018年2月20日按期来潮，且经量、颜色基本正常，本次月经后未避孕。2018年3月29日（三诊），确定早孕，取消试管，后中药一直保胎至3个月。

病案4特点：

原预备调理后试管进周取卵，后经1个半月调治，成功自孕。

Case history 4

Miss Cao,31 , from Hunan, first visit time: 2018.2.12.To prepare a pregnancy for first child.Married for 2 years and not pregnant.

Main symptoms: DOR

Past experience: nothing special.

Menstruation history: menarche:13-year-old ;menstrual cycle:28-50 days; menstrual period : 6 days; last menstruation: 2018.1.23.Menstruation situation:menstrual volume (-), color (-), small blood clots, no dysmenorrhea.

Leucorrhea (-).Diet and sleep were normal.Bowel movements and urination were normal.

Pregnancy-Labor History:G0P0A0.

Leucorrhea (-).Diet and sleep were normal.Bowel movements and urination were normal.

Thyroid function: normal.

Basic endocrine testing:

Date

AMH

FSH

LH

E2

T

PRL

P

HCG

INHB

2018.1.24 C2

13.13

3.62

17

0.28

14.54

0.27

2018.1.25

0.149 （0.24-11.78）

B-ultrasound：
Date	Uterine size Endometrial thickness	Left ovarian size Number and size of follicles	Right ovarian size Number and size of follicles	Pelvic effusion
2018.2.4 Zhongxin Four-dimensional ultrasound C15	41*36*42 10.8mm Cervical adenocele：7*6	31*22*29 Follicles：1、15*14	29*13*27 Low echo

In vitro fertilization history:

On March 13, 2018, at the time of second visit, the husband and wife reported that the pre-test tube examination was normal, and at that time it was expected that for IVF the hormone antagonist treatrment will be available for egg retrieval in April 2018. She requested adjuvant treatment should be given at the same time.

On March 29, 2018 (the third visit), the patient reported that she was pregnant (naturally), and the urine test confirmed the early pregnancy and Chinese medicine were started for fetal protection for 3 months.

The summary of case history4 :

The patient was 31 years old with no obvious cause of DOR. The manifestations were that the number of antral follicles were less in both ovaries, and the AMH value was low (0.149), and the menstrual cycle was long, the longest one lasted for 50 days. She was unable toget pregnant for 2 years after marriage and wanted to conceieve through IVF. She visited the Professor You Zhaoling's outpatient gynecology clinic on February 12, 2018, and requested that with IVF she wants to be be treated with traditional Chinese medicine to improve ovarian function at the same time.

According to the patient's past medical history, combined with physical examination and relevant investigations, the major reasons for the patient's infertility are diagnosed.The decline of ovarian reserve is the main reason, so the menstrual cycle is delayed. Professor You suggested that patients actively try pregnancy at the same time as IVF. After treatment, on March 13, 2018 (second visit), the patient stated that her menstrual cycle started on schedule on February 20, 2018, and her menstrual volume and color were normal. She did not use contraception after this menstruation. On March 29, 2018 (third visit), the early pregnancy was confirmed and the in vitro fertilization was cancelled. After that, the Chinese medicine has been used to protect the pregnancy for first 3 months.

The characteristics of case history 4:

Originally the patient was prepared and the eggs were retrieved for IVF but and after one and a half months of treatment, spontaneous conception was successful without IVF.

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病  案（五）

王某，23岁，湖南人，初诊时间：2014年4月23日。

主症：DOR、内膜菲薄、乳腺结节

既往经历：2013年人流1次，术后月经量正常

2014年3月口服激素行人工周期治疗

月经史：13岁初潮，周期23d-2M+，经期7天。

末次月经：2014年4月9日（黄体酮），本次经量正常，颜色鲜红，有少量血块，无痛经。

孕产史：孕1产0

其它：白带正常，食寐可，二便调。

基础内分泌检测：
时间	AMH	FSH	LH	E2	T	PRL	P
2014.3.19		136.50	72.180	7.220	0.247 （0.481）	9.110 （23.3）	0.3
2014.4.12		119.90	38.80	《3.67	0.44 （2.85）	392.20 （612.7）
2014.6.21		23.95	3.17	27.13
2014.9.3		14.69	2.28	40	0.91（0.84）	30.2（24）	0.3
2014.10.23		24.4	1.7	40	1.18	392.2	0.7
2015.3.21		35.9	3.10	82.21	0.67	301.04	1.05
2015.6.12		21.10	1.30	10.64	0.77	288.32	0.21
2015.12.18 C3		16	11.40	344.61	1.84 （2.85）	400.68 （612.7）	2.26
2016.2.4	小于0.01
2017.8.2	0.54

B超检查：

时间

子宫大小 内膜

左巢大小 卵泡个数、大小

右巢大小 卵泡个数、大小

盆腔积液

2014.3.19

43*33*35 4.4mm

21*16mm

不满意

2014.4.9

51*38mm 6.1mm、 A型

16*16mm 卵泡3-4个

欠清

2014.8.7

5mm

29*43mm

14*12mm类卵巢

15mm

2014.12.5

3.4mm

23*10mm

未探及

2014-12-31

45*36*48 11mm、 B型

25*15mm 卵泡2个

21*10 卵泡2个 最大12*7mm

2015-1-28

50*39*41 12  mm

27*25 卵泡4个 最大19*17

15*10

2015.8.20 C11

8.7mm 7.6*3.5mm

29*14mm

显示欠佳

18mm

2015-10-9

52*40*54 11.2  mm

28*14 卵泡1个14*12

26*18

2015.10.13

53*43*47 10  mm，不均

22*21*20

16*11

2015.11.24

47*36*41 4.5mm 12*7mm

正常

正常

2015-12-4

49*41*46 10.9  mm

23*15 卵泡1个、12*11

16*7

2015.12.29 C12

43*35*44 3.4mm，不匀，夹小液暗区

23*11

21*12

2017.8.2 本院

51*43*51 14.5  mm

23*20

15*9

2018.11.21 常德

58*44*58 13mm，欠匀

26*15

不清

病案5小结：

患者23岁，年轻患者，不明原因导致DOR，表现为：左巢偏小，右巢萎缩，双侧窦卵泡数为3-4个，且AMH值极低（< 0.01），为绝经后水平。患者因婚后不孕，于2014年4月23日来我院尤昭玲教授妇科工作室门诊就诊，要求中药调治，尤教授根据患者既往病史，结合患者相关检查，分析患者不孕的主要原因为：卵巢储备功能急剧衰退，内膜菲薄致不孕。经中药及膏方持续调治，终于恢复卵巢自主排卵，实现生育。

病案5特点：

  不明原因导致DOR，FSH极高，达136.5，AMH极低，<0.01<>，本欲试管助孕，但因左巢小，右巢萎缩，试管医院拒收，故要求中药调治。调治期间，每月月经按期来潮，在尤教授指导下试孕，于2017年1月7日成功顺产1女孩，后继续调治，于2018年6月19日再次顺产1男孩，历经4年多的治疗，终于实现生育愿望，儿女双全。

Case history 5

Miss Wang,31 , from Hunan, first visit time: 2014.4.23.

Main symptoms: DOR, thin endometrium, breast nodules.

Past experience: 1 abortion in 2013, normal menstrual flow after surgery

Artificial cycle treatment with oral hormones in March 2014.

Menstruation history: menarche:13-year-old ;menstrual cycle:23d-2M+; menstrual period : 7 days; last menstruation: 2014.4.9, this time the menstrual volume was normal, the color was bright red, there was a small amount of blood clots, and there was no dysmenorrhea.

Pregnancy-Labor History:G1P0A1.

Others: Normal leucorrhea.Diet and sleep were normal.Bowel movements and urination were normal.

Basic endocrine testing:
Date	AMH	FSH	LH	E2	T	PRL	P
2014.3.19		136.50	72.180	7.220	0.247 （0.481）	9.110 （23.3）	0.3
2014.4.12		119.90	38.80	<3.67	0.44 （2.85）	392.20 （612.7）
2014.6.21		23.95	3.17	27.13
2014.9.3		14.69	2.28	40	0.91（0.84）	30.2（24）	0.3
2014.10.23		24.4	1.7	40	1.18	392.2	0.7
2015.3.21		35.9	3.10	82.21	0.67	301.04	1.05
2015.6.12		21.10	1.30	10.64	0.77	288.32	0.21
2015.12.18 C3		16	11.40	344.61	1.84 （2.85）	400.68 （612.7）	2.26
2016.2.4	Less than0.01
2017.8.2	0.54

B-ultrasound：
Date	Uterine size Endometrial thickness	Left ovarian size Number and size of follicles	Right ovarian size Number and size of follicles	Pelvic effusion
2014.3.19	43*33*35 4.4mm	21*16mm	Dissatisfied
2014.4.9	51*38mm 6.1mm、 type A	16*16mm follicles3-4	fuzzy
2014.8.7	5mm	29*43mm	14*12mm Ovary-like	15mm
2014.12.5	3.4mm	23*10mm	Unexplored
2014-12-31	45*36*48 11mm、 type B	25*15mm follicles2	21*10 follicles2 maximum12*7mm
2015-1-28	50*39*41 12 mm	27*25 follicles4 maximum19*17	15*10
2015.8.20 C11	8.7mm 7.6*3.5mm	29*14mm	Poor display	18mm
2015-10-9	52*40*54 11.2 mm	28*14 follicles114*12	26*18
2015.10.13	53*43*47 10 mm，Uneven	22*21*20	16*11
2015.11.24	47*36*41 4.5mm 12*7mm	normal	normal
2015-12-4	49*41*46 10.9 mm	23*15 Follicles:1、12*11	16*7
2015.12.29 C12	43*35*44 3.4mm，Uneven，Small liquid dark area	23*11	21*12
2017.8.2 The First Hospital of Hunan University of Chinese Medicine	51*43*51 14.5 mm	23*20	15*9
2018.11.21 Changde	58*44*58 13mm，Uneven	26*15	fuzzy

The summary of case history5 :

The 23-year-old patient had unexplained DOR. She was found to have small left ovary, atrophied right ovary, the number of bilateral antral follicles was 3-4, and the AMH value was extremely low (<0.01), which was a postmenopausal level. Due to infertility after marriage, the patient came to Professor You Zhaoling's the outpatient gynecology clinic in our hospital on April 23, 2014, and requested treatment with Chinese medicine. Professor You analyzed the main reasons for the patient’s infertility based on the patient’s past medical history, examination and relevant investigations. It is: Sharp decline in the ovarian reserves, and the endometrial thinning causing infertility. After continuous treatment with traditional Chinese medicine and ointments, the ovarian functions were finally restored and patient started normal ovulation and normal fertility was achieved.

The characteristics of case history 5:

   DOR of unknown etiology，FSH is extremely high, reaching 136.5, and AMH is extremely low, <0.01. The patient wanted IVF, but because the left ovary was small and the right ovary was shrinking, the IVF centre refused. Therefore, Chinese medicine was required for treatment of the patient. During the treatment period, the monthly menstruation was normal on schedule. Under the treatment of Professor You, the patient had spontaneous pregnancy and On January 7, 2017 she successfully delivered a girl. The patient continued the treatement one boy was delivered again on June 19, 2018. After more than 4 years, the patient’s wish was fulfilled by using traditional Chinese medicine and patient has two children.