1. The core mechanism of endocrine disorders
The endocrine system finely regulates reproductive function through hormones (such as FSH, LH, estrogen, and progesterone).

Disorder refers to an imbalance in hormone secretion, and its main manifestations include
Feedback axis disturbance: The hypothalamic-pituitary-ovary axis (HPO axis) is dysregulated, resulting in abnormal signals for follicular developmentMetabolic interference: Thyroid dysfunction (hyperthyroidism/hypothyroidism), insulin resistance (such as PCOS) directly inhibit ovarian function
Organic diseases: Pathological changes such as pituitary tumors and premature ovarian failure destroy hormone synthesis.

1.

oocyte developmental disorders
Follicular dysplasia: Hormone imbalance causes follicular growth to stagnate and the number of oocytes retrieved is reduced by 30%-50%Decreased egg quality: A hyperandrogenic or low-estrogen environment increases the rate of chromosome abnormalities in eggs and increases the risk of embryo aneuploidy.

2. Reduced endometrial receptivity
Abnormal intimal thickness: Insufficient progesterone leads to thin intimal membrane (<7 mm) and insufficient implantation space; excessive estrogen leads to excessive intimal hyperplasia (> 14 mm) and poor blood flow perfusionImbalance of immune microenvironment: Abnormal thyroid antibody or NK cell activity triggers embryo rejection.

3. Difficulty maintaining pregnancy
Luteal insufficiency: Insufficient progesterone secretion increases the risk of early abortion by 2 - 3 timesMetabolic complications: Insulin resistance increases the incidence of gestational diabetes and preeclampsia.

Excellent embryo rate ↓ 40% 5%-10% 5%-10% Reaction rate to promote emissions ↓ 50% DHEA replenishment + micro-stimulation solution t 3%-5%

Control oocyte ejection, The removal rate during the egg retrieval cycle↑25%

1. Preconditioning phase (1-3 months)
nDrug adjustment
·PCOS: Metformin (1500mg/day) improves insulin sensitivity
·Hypothyroidism: Levothyroxine (TSH target value 1.0-2.5mIU/L)
·Decreased ovarian reserve: DHEA (25mg tid) combined with coenzyme Q10.
· Lifestyle interventions: For individuals with a BMI greater than 24, losing 7%-10% of their body weight can help restore the natural ovulation rate to 65%.
2. Optimization of ovulation promotion program
·High-response population (such as PCOS): Antagonist regimen +Gn low-dose start (150IU) to prevent OHSS
·Low-response people (such as premature ovarian failure): Microstimulation regimen (clomiphene + low-dose Gn) has a cycle cancellation rate of ↓30%.
3. Pre-graft intimal preparation
·Standard regimen: Estrogen Progyalone (6mg/day) is increased gradually, and when the intima is greater than 8mm, it is converted to progesterone
·Obstacle thin endometrium: Intrauterine infusion of granulocyte colony stimulating factor (G-CSF), the effective rate of endometrium growth is>60%.

5. Answers to key questions

Q1: Does endocrine disorders have to be cured before they can be tested?
·Normal range of thyroid function (TSH, FT4) maintained for ≥1month
·Fasting insulin in patients with PCOS <10mIU/L
·Patients with ovulation disorders have regular ovulation ≥2 cycles after induction.
·Women with ovulation disorders achieved regular ovulation after induction, and this condition was sustained for at least 2 cycles.
Q2: How can patients with endocrine disorders undergo in vitro fertilization?
Subclinical hypothyroidism: There was no statistical difference between the live birth rate after treatment and the normal population
Multiple egg retrieval is required to accumulate embryos.
Multiple egg retrievals are required to accumulate sufficient embryos.
Q3: What are the endocrine factors that lead to repeated transplantation failures, and what can be done to address them?
·Uncontrolled thyroid antibody positive (anti-TPO>60IU/ml)
·Vitamin D deficiency (<30ng/ml)
·Hyperhomocysteinemia (>8μmol/L).
·Hyperhomocysteinemia (≥8 μmol/L).
Countermeasure: Active vitamin D + Mecobalamin

6. Summary

Endocrine disorders can be effectively managed through precision medicine
·Personalized pretreatment is the basis for success-three-month drug adjustment for the cause is crucial
·Dynamic monitoring throughout the entire process-hormone levels, endometrial receptivity, and immune indicators need to be evaluated weekly
·Interdisciplinary collaboration to ensure safety-joint intervention by reproductive endocrinology, nutrition, and psychology reduced the pregnancy loss rate to <10%.