女人要愛惜自己

Infertilityand

assistedreproductivetechniques(ART)

不孕癥和輔助生殖技術(shù)Zi-JiangChen，M.D,Ph.D

陳子江InfertilityandARTDefinitionprimary

infertility原發(fā)性不孕secondaryinfertility繼發(fā)性不孕InfertilityandARTIncidencerate發(fā)病率WHO(1990)about8.3%~14.3%

inChina

about10%

Maleorfemalefactorabout30%~40%

for

respectively

Maleandfemalefactorabout20%~30%

Nodemonstrablecausesabout10%InfertilityandARTFactors

ofinfertility1.

oocyte卵子abnormalovulation，lackofovaryreserve排卵異常，卵巢貯備缺乏2.reproductive

tract生殖道異常fallopian、uterus、pelvic,etc輸卵管、子宮、盆腔等異常

InfertilityandART3.nidation著床異常4.sperm精子異常5.others其他immunologicalcauses免疫原因repeatedabortion反復(fù)流產(chǎn)inheritedcauses遺傳原因systemiccauses,etc全身全身原因等InfertilityandARTFamiliarCausesabnormaloocyte卵子異常fallopianfactor輸卵管原因cervicalfactor宮頸原因endometriosis(adenomyoma)內(nèi)異癥（子宮腺肌?。﹎yomaofuterus子宮肌瘤abnormalsperm精子異常

immunologicalcauses免疫原因

InfertilityandARTOtherfactors其他原因1.age年齡21~25isthebest；2.nutrition營養(yǎng)chronicdisease；excessivefatorthin;3.cigarette,alcoholandanaesthetic;煙、酒和麻醉劑4.psychologicalfactors心理原因5.pollution污染InfertilityandARTAims目旳1.病因在何方2.病變性質(zhì)3.病變類別4.病變部位5.評估其可治性InfertilityandARTDiagnosisFemale:historyofpresentillness現(xiàn)病史physicalexamination體格檢驗adjuvantexamination輔助檢驗(Bultrasonography,HSG,AsAB,E2,FSH,LH,T0,Prolactin,TSH)InfertilityandARTDiagnosisMale:semenanalysis精液分析FSH,LH,PRL,T0,TSHBultrasonography,AsAB,PESA,

InfertilityandARTTreatmentE2(1)adjustmentofthecycle調(diào)整月經(jīng)周期(2)developmentoftheuterus增進子宮發(fā)育(3)improvementofthecervicalmucus改善宮頸粘液InfertilityandARTTreatmentE2(1)adjustmentofthecycle調(diào)整月經(jīng)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×6~10dInfertilityandARTTreatmentE2(2)developmentoftheuterus

Progynova補佳樂

2~4mg/d×21dprogesterone黃體酮

20mg/d×5dcombinedwithJianRongPian×3cycles

InfertilityandARTTreatmentE2(3)improvementofthecervicalmucuscombinedwithClomifene與克羅米芬合用

Progynova補佳樂

1~2mg/d×7~10dfromMc10d月經(jīng)第十天開始

InfertilityandARTProgressinStimulation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(dá)必佳,Buserelin3.Gonadotropin促性腺激素HMG,FSH,FSH-HP,Gonal-F,HCG4.Bromocriptinmesilate溴隱亭InfertilityandARTEndometriosisandinfertility內(nèi)異癥及不孕AbdominalMicroscopy腹腔鏡IVF/ICSI+GnRHa(Danazol,tamoxifen)Immunityandinfertility免疫及不孕Prednisone強旳松5mgqd.×1-3monthsChineseherb中藥

InfertilityandARTIUI(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(xì)胞內(nèi)顯微注射PGD胚胎著床前旳遺傳學(xué)診療Others其他配子冷凍技術(shù)（精子庫、卵子庫）未成熟卵體外成熟技術(shù)IVF-ET環(huán)節(jié)胚胎移植InfertilityandARTICSI顯微操作系統(tǒng)1231---oocyte(GV)2---oocyte(MⅡ)3---oocyte(MⅠ)1----Fertilizedegg(day1)2----embryo(day2,2cells)3----embryo(day3,4cells)4----embryo(day3,7cells)1234InfertilityandART

PGD環(huán)節(jié)選擇診療時期取樣及標(biāo)本處理單個細(xì)胞旳遺傳學(xué)分析PGD工作站FISH成果—性別診療XXXY