Infertilityand

assistedreproductivetechniques(ART)

不孕癥和輔助生殖技術Zi-JiangChen，M.D,Ph.D

精選pptInfertilityandARTDefinitionprimary

infertility原發性不孕secondaryinfertility繼發性不孕精選pptInfertilityandARTIncidencerate發病率WHO(1990)about8.3%~14.3%

inChina

about10%

Maleorfemalefactorabout30%~40%

for

respectively

Maleandfemalefactorabout20%~30%

Nodemonstrablecausesabout10%精選pptInfertilityandARTFactorsofinfertility1.oocyte卵子abnormalovulation，lackofovaryreserve排卵異常，卵巢儲藏缺乏2.reproductivetract生殖道異常fallopian、uterus、pelvic,etc輸卵管、子宮、盆腔等異常

精選pptInfertilityandART3.nidation著床異常4.sperm精子異常5.others其它immunologicalcauses免疫因素repeatedabortion重復流產inheritedcauses遺傳因素systemiccauses,etc全身全身因素等精選pptInfertilityandARTFamiliarCausesabnormaloocyte卵子異常fallopianfactor輸卵管因素cervicalfactor宮頸因素endometriosis(adenomyoma)內異癥〔子宮腺肌病〕myomaofuterus子宮肌瘤abnormalsperm精子異常immunologicalcauses免疫因素

精選pptInfertilityandARTOtherfactors其它因素1.age年齡21~25isthebest；2.nutrition營養chronicdisease；excessivefatorthin;3.cigarette,alcoholandanaesthetic;煙、酒和麻醉劑4.psychologicalfactors心理因素5.pollution污染精選pptInfertilityandARTAims目的1.病因在何方2.病變性質3.病變類別4.病變部位5.評估其可治性精選pptInfertilityandARTDiagnosisFemale:historyofpresentillness現病史physicalexamination體格檢查adjuvantexamination輔助檢查(Bultrasonography,HSG,AsAB,E2,FSH,LH,T0,Prolactin,TSH)精選pptInfertilityandARTDiagnosisMale:semenanalysis精液分析FSH,LH,PRL,T0,TSHBultrasonography,AsAB,PESA,

精選pptInfertilityandARTTreatmentE2(1)adjustmentofthecycle調整月經周期(2)developmentoftheuterus促進子宮發育(3)improvementofthecervicalmucus改善宮頸粘液精選pptInfertilityandARTTreatmentE2(1)adjustmentofthecycle調整月經周期1)Progynova補佳樂1~2mg/d×21d2)diethylstilbestrol乙底酚0.25mg~0.5mg/d×21d3)progesterone黃體酮20mg/d×4~5d〔Mc21~25〕10mg/d×6~10d精選pptInfertilityandARTTreatmentE2(2)developmentoftheuterus

Progynova補佳樂

2~4mg/d×21dprogesterone黃體酮

20mg/d×5dcombinedwithJianRongPian×3cycles

精選pptInfertilityandARTTreatmentE2(3)improvementofthecervicalmucuscombinedwithClomifene與克羅米芬合用

Progynova補佳樂

1~2mg/d×7~10dfromMc10d月經第十天開始

精選pptInfertilityandARTProgressinStimulation促排用藥進展1.Clomifene克羅米芬100mg/d×5~7d

2.GnRHaandGnRHaantagonist

促性腺激素釋放激素及其拮抗劑Alarelin阿拉瑞林,Dacapeptyl達必佳,Buserelin3.Gonadotropin促性腺激素HMG,FSH,FSH-HP,Gonal-F,HCG4.Bromocriptinmesilate溴隱亭2.5-7.5mg/d精選pptInfertilityandARTEndometriosisandinfertility內異癥及不孕AbdominalMicroscopy腹腔鏡IVF/ICSI+GnRHa(Danazol,tamoxifen)Immunityandinfertility免疫及不孕Prednisone強的松5mgqd.×1-3monthsChineseherb中藥

精選pptInfertilityandARTIUI(AIH,AID)人工授精GUIT,GIFT宮腔配子移植IVF-ET體外受精-胚胎移植ICSI單精子卵母細胞內顯微注射PGD胚胎著床前的遺傳學診斷Others其它配子冷凍技術〔精子庫、卵子庫〕未成熟卵體外成熟技術精選pptIVF-ET步驟胚胎移植InfertilityandART精選pptICSI精選ppt顯微操作系統精選ppt1231---oocyte(GV)2---oocyte(MⅡ)3---oocyte(MⅠ)精選ppt1----Fertilizedegg(day1)2----embryo(day2,2cells)3----embryo(day3,4cells)4----embryo(day3,7cells)1234精選pptInfertilityandART

PGD步驟選擇診斷時期取樣及標本處理單個細胞的遺傳學分析精選pptPGD工作站精選pptFISH結果—性別診斷XXXY精選pptFISH結果—非整倍體診斷〔21三體〕21,21,2121,21,2