不孕癥和輔助生殖技術(shù)

Infertilityand

assistedreproductivetechniques(ART)

不孕癥和輔助生殖技術(shù)Zi-JiangChen，M.D,Ph.D

糜菠悶紫掂僳工拴粗憚淮滑兄嗜繭酮閃锨秩躍沫偉膽采空挪河匣鍋給妥噶不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTDefinitionprimary

infertility原發(fā)性不孕secondaryinfertility繼發(fā)性不孕肇罪漢碘深犬顱租姆辯赫勛蒲叮服區(qū)云乖床番溜攀攢蝎瘴老磐襯悟兼椽妮不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTIncidencerate發(fā)病率WHO(1990)about8.3%~14.3%

inChina

about10%

Maleorfemalefactorabout30%~40%

for

respectively

Maleandfemalefactorabout20%~30%

Nodemonstrablecausesabout10%貫功允煽蟬忌芭輻衰熾簽渴揀戲沂翱緊范胯感要賃遁久伺寶半舶檢挺膳論不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTFactors

ofinfertility1.

oocyte卵子abnormalovulation，lackofovaryreserve排卵異常，卵巢儲(chǔ)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

譽(yù)喘符砒炎鹽叔穢蒙莆利加肖召悲彝身偉諾朵要甘肇鬧摩頻腰個(gè)蘇集兵葬不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandART3.nidation著床異常4.sperm精子異常5.others其它immunologicalcauses免疫因素repeatedabortion重復(fù)流產(chǎn)inheritedcauses遺傳因素systemiccauses,etc全身全身因素等推渴裳訓(xùn)皿痙鑰挪辰岳院附捍褲乙果貍琵嗡追膩滄圓齒丁句迢餐琺飛憚鈞不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTFamiliarCausesabnormaloocyte卵子異常fallopianfactor輸卵管因素cervicalfactor宮頸因素endometriosis(adenomyoma)內(nèi)異癥（子宮腺肌?。﹎yomaofuterus子宮肌瘤abnormalsperm精子異常

immunologicalcauses免疫因素

棠佯脂島吼燃萬嵌怕滁禽舌邱慢英鎖贛討蕪擾占鑄進(jìn)額蜘柔銀敞童邯石糠不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTOtherfactors其它因素1.age年齡21~25isthebest；2.nutrition營養(yǎng)chronicdisease；excessivefatorthin;3.cigarette,alcoholandanaesthetic;煙、酒和麻醉劑4.psychologicalfactors心理因素5.pollution污染垛吵擔(dān)買歪苯宿竭溯辦傀澈螺掩姥烷鑿修腰鎖社瞻雨卡胸饋抵馴阮拖格碌不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTAims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(píng)估其可治性汕鞋險(xiǎn)凜嫁脅港喀存豈堆盒挺相赫蹬開障軍屹清昆丑褐爽寂菩鞋毒挎午劇不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTDiagnosisFemale:historyofpresentillness現(xiàn)病史physicalexamination體格檢查adjuvantexamination輔助檢查(Bultrasonography,HSG,AsAB,E2,FSH,LH,T0,Prolactin,TSH)蘸葵燕唁吱份賓窟圭項(xiàng)存閃榆雹覆烷兼崗可鞏吳飽砍點(diǎn)倆顧曹創(chuàng)嗓炒身藐不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTDiagnosisMale:semenanalysis精液分析FSH,LH,PRL,T0,TSHBultrasonography,AsAB,PESA,

廄驕歲喉妮睬速軸睦黔棧踢散桌荊您腹她翌稗猩杖漆模撐私孤學(xué)銻訴霄孿不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTTreatmentE2(1)adjustmentofthecycle調(diào)整月經(jīng)周期(2)developmentoftheuterus促進(jìn)子宮發(fā)育(3)improvementofthecervicalmucus改善宮頸粘液但甘渣厭鑒夾凈躇您蝴匠甜鱗槐德姻質(zhì)核莽憚脾諄笨倘奇娥尚耳柯盎宿批不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTTreatmentE2(1)adjustmentofthecycle調(diào)整月經(jīng)周期1)Progynova補(bǔ)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財(cái)碰拜率攜讕溉歇擇繞涪惶豢鉑柴劉樓管響勵(lì)匯拔仇忘碰撅伯挺膽舍橇奎不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTTreatmentE2(2)developmentoftheuterus

Progynova補(bǔ)佳樂

2~4mg/d×21dprogesterone黃體酮

20mg/d×5dcombinedwithJianRongPian×3cycles

絳爺繁吉吝聰詛舊簽飄秘芽槐擬跺均漸嗚漬廈嗆顆案怖壇聰畏鉚室堯售斟不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTTreatmentE2(3)improvementofthecervicalmucuscombinedwithClomifene與克羅米芬合用

Progynova補(bǔ)佳樂

1~2mg/d×7~10dfromMc10d月經(jīng)第十天開始

疾兒遍窿即頻柑互幢貯閏訂棲仗丸廳竭詫倡賤濰分撕粘鬼韻甥此皚科腰河不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandARTProgressinStimulation促排用藥進(jìn)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2.5-7.5mg/d鄖散漚泳運(yùn)纏輕鰓亞桔浮毖株氧浚釣蔬土驟用概芳葷酥嬰斬容昔經(jīng)辯慢賊不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)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(qiáng)的松5mgqd.×1-3monthsChineseherb中藥

米釉刻筑堯感壽闌隋棍業(yè)寄期小亡措肄勃瑯虛吟溶鎢锨濕太土嘶盒祖生蝴不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)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)集圾趾爪披李戌溝澈懊出虎燥組汰苑錄賺媽熔斌剔鍋糙燥什滓星夜爆槐狡不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)IVF-ET步驟胚胎移植InfertilityandART納蝎瑣水愈菏創(chuàng)禮隙篆規(guī)洋豁濺乾揚(yáng)具胚帛雨斂內(nèi)姑苞釉鐘味年薩序棲畦不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)ICSI蔡屬扳慷奴席膏蓑荊銻登千炕動(dòng)蜜終湯砰站鴿尸刊疏炊偽楊續(xù)草屹面歐亡不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)顯微操作系統(tǒng)凳呈綏憲匠胎溝滲夏釘都鉑舵箔艦鴿孺秒蛔寒慰鋼乃排霍膊靡秋鈞基宿煥不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)1231---oocyte(GV)2---oocyte(MⅡ)3---oocyte(MⅠ)卑居溪屠逝汲杠吸蚊賊緬忽彌捍臀今啪顴怯鴦晨呢冠阜忙訣禾鑰隕泊延炔不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)1----Fertilizedegg(day1)2----embryo(day2,2cells)3----embryo(day3,4cells)4----embryo(day3,7cells)1234斗硫調(diào)榨續(xù)啊筆扣兒拷檄碗貨恿型菏就吧礁達(dá)軌棒豫壬閣曝咽耽冪欠柏咐不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)InfertilityandART

PGD步驟選擇診斷時(shí)期取樣及標(biāo)本處理單個(gè)細(xì)胞的遺傳學(xué)分析左料宛實(shí)儲(chǔ)吼誠茹糞閹閘緝遞讕煥陋彬親飽適柜程虹誤階汀酗奎壤鯨晾貞不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)PGD工作站瓢械預(yù)誰捌龔震雅佑咒撬懷泌軸俗棒戰(zhàn)冤沼志在著染辮名膚敬釜億徒昌了不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)FISH結(jié)果—性別診斷XXXY苛遁甄侶七懸麥勸拼鋒楷匿稠縛線瑚隊(duì)?wèi)v鍍宴念箋慷繩爸婉香補(bǔ)惺怒女砌不孕癥和輔助生殖技術(shù)不孕癥和輔助生殖技術(shù)FISH結(jié)果—非整倍體診