不孕癥和輔助生殖技術(shù)

1、Infertility and assisted reproductive techniques(ART)不孕癥和輔助生殖技術(shù),Zi-Jiang Chen，M.D , Ph.D,Infertility and ART,Definition primary infertility原發(fā)性不孕 secondary infertility繼發(fā)性不孕,Infertility and ART,Incidence rate發(fā)病率 WHO(1990) about 8.3%14.3% in China about 10% Male or female factor about 30%40% for respec

2、tively Male and female factor about 20%30% No demonstrable causes about 10,Infertility and ART,Factors of infertility 1. oocyte卵子 abnormal ovulation ，lack of ovary reserve 排卵異常，卵巢儲備缺乏 2. reproductive tract 生殖道異常 fallopian、uterus、pelvic,etc 輸卵管、子宮、盆腔等異常,Infertility and ART,3.nidation著床異常 4.sperm精子異常

3、5.others其它 immunological causes免疫因素 repeated abortion重復(fù)流產(chǎn) inherited causes遺傳因素 systemic causes,etc全身全身因素等,Infertility and ART,Familiar Causes abnormal oocyte卵子異常 fallopian factor輸卵管因素 cervical factor宮頸因素 endometriosis(adenomyoma)內(nèi)異癥（子宮腺肌?。?myoma of uterus子宮肌瘤 abnormal sperm精子異常 immunological causes免

4、疫因素,Infertility and ART,Other factors其它因素 1.age年齡 2125 is the best； 2.nutrition營養(yǎng) chronic disease；excessive fat or thin; 3.cigarette,alcohol and anaesthetic; 煙、酒和麻醉劑 4.psychological factors心理因素 5.pollution污染,Infertility and ART,Aims目的 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,Infertility and ART,Diagnos

5、is Female: history of present illness現(xiàn)病史 physical examination體格檢查 adjuvant examination輔助檢查 (B ultrasonography, HSG,AsAB, E2,FSH,LH,T0,Prolactin,TSH,Infertility and ART,Diagnosis Male: semen analysis精液分析 FSH,LH,PRL,T0,TSH B ultrasonography, AsAB, PESA,Infertility and ART,Treatment E2 (1)adjustment of

6、 the cycle 調(diào)整月經(jīng)周期 (2)development of the uterus 促進(jìn)子宮發(fā)育 (3)improvement of the cervical mucus 改善宮頸粘液,Infertility and ART,Treatment E2 (1)adjustment of the cycle調(diào)整月經(jīng)周期 1)Progynova 補(bǔ)佳樂 12mg/d21d 2)diethylstilbestrol 乙底酚 0.25mg 0.5mg/d21d 3)progesterone 黃體酮 20mg/d45d（Mc2125） 10mg/d610d,Infertility and ART

7、,Treatment E2 (2)development of the uterus Progynova補(bǔ)佳樂 24mg/d21d progesterone黃體酮 20mg/d5d combined with JianRongPian3cycles,Infertility and ART,Treatment E2 (3)improvement of the cervical mucus combined with Clomifene與克羅米芬合用 Progynova補(bǔ)佳樂 12mg/d710d from Mc10d 月經(jīng)第十天開始,Infertility and ART,Progress in

8、 Stimulation 促排用藥進(jìn)展 1.Clomifene 克羅米芬 100mg/d57d 2.GnRHa and GnRHa antagonist 促性腺激素釋放激素及其拮抗劑 Alarelin阿拉瑞林, Dacapeptyl達(dá)必佳, Buserelin 3.Gonadotropin促性腺激素 HMG,FSH,FSH-HP,Gonal-F,HCG 4.Bromocriptin mesilate溴隱亭 2.5-7.5mg/d,Infertility and ART,Endometriosis and infertility內(nèi)異癥及不孕 Abdominal Microscopy腹腔鏡 IVF

9、/ICSI +GnRHa (Danazol ,tamoxifen) Immunity and infertility免疫及不孕 Prednisone強(qiáng)的松 5mg qd. 1-3months Chinese herb中藥,Infertility and ART,IUI(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 胚胎著床前的遺傳學(xué)診斷 Others 其它 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步驟,胚胎移植,Infertility and ART,ICSI,顯微操作系統(tǒng),1,2,3,1-oocyte(GV) 2-oocyte(M) 3-oocyte(M,1-Fertilized egg (day 1) 2-embryo (day 2,2cells) 3- embryo (day 3,4cells) 4-embryo (day 3,7cells,1,2,3,4,Infertility and ART,PGD步驟 選擇診斷時(shí)期 取樣及標(biāo)本處理 單個細(xì)胞的遺傳學(xué)分析,PGD工作站,FISH結(jié)果性別診斷,XX,XY,FISH結(jié)果非整倍體診斷（21三體,21,21,21,21,21,21,FISH