不孕症和辅助生殖技术

Infertilityandassistedreproductivetechniques(ART)不孕症和辅助生殖技术,Zi-JiangChen，M.D,Ph.D,InfertilityandART,Definitionprimaryinfertility原发性不孕secondaryinfertility继发性不孕,InfertilityandART,Incidencerate发病率WHO(1990)about8.3%14.3%inChinaabout10%Maleorfemalefactorabout30%40%forrespectivelyMaleandfemalefactorabout20%30%Nodemonstrablecausesabout10%,InfertilityandART,Factorsofinfertility1.oocyte卵子abnormalovulation，lackofovaryreserve排卵异常，卵巢储备缺乏2.reproductivetract生殖道异常fallopian、uterus、pelvic,etc输卵管、子宫、盆腔等异常,InfertilityandART,3.nidation着床异常4.sperm精子异常5.others其它immunologicalcauses免疫因素repeatedabortion重复流产inheritedcauses遗传因素systemiccauses,etc全身全身因素等,InfertilityandART,FamiliarCausesabnormaloocyte卵子异常fallopianfactor输卵管因素cervicalfactor宫颈因素endometriosis(adenomyoma)内异症（子宫腺肌病）myomaofuterus子宫肌瘤abnormalsperm精子异常immunologicalcauses免疫因素,InfertilityandART,Otherfactors其它因素1.age年龄2125isthebest；2.nutrition营养chronicdisease；excessivefatorthin;3.cigarette,alcoholandanaesthetic;烟、酒和麻醉剂4.psychologicalfactors心理因素5.pollution污染,InfertilityandART,Aims目的1.病因在何方2.病变性质3.病变类别4.病变部位5.评估其可治性,InfertilityandART,DiagnosisFemale:historyofpresentillness现病史physicalexamination体格检查adjuvantexamination辅助检查(Bultrasonography,HSG,AsAB,E2,FSH,LH,T0,Prolactin,TSH),InfertilityandART,DiagnosisMale:semenanalysis精液分析FSH,LH,PRL,T0,TSHBultrasonography,AsAB,PESA,InfertilityandART,TreatmentE2(1)adjustmentofthecycle调整月经周期(2)developmentoftheuterus促进子宫发育(3)improvementofthecervicalmucus改善宫颈粘液,InfertilityandART,TreatmentE2(1)adjustmentofthecycle调整月经周期1)Progynova补佳乐12mg/d21d2)diethylstilbestrol乙底酚0.25mg0.5mg/d21d3)progesterone黄体酮20mg/d45d（Mc2125）10mg/d610d,InfertilityandART,TreatmentE2(2)developmentoftheuterusProgynova补佳乐24mg/d21dprogesterone黄体酮20mg/d5dcombinedwithJianRongPian3cycles,InfertilityandART,TreatmentE2(3)improvementofthecervicalmucuscombinedwithClomifene与克罗米芬合用Progynova补佳乐12mg/d710dfromMc10d月经第十天开始,InfertilityandART,ProgressinStimulation促排用药进展1.Clomifene克罗米芬100mg/d57d2.GnRHaandGnRHaantagonist促性腺激素释放激素及其拮抗剂Alarelin阿拉瑞林,Dacapeptyl达必佳,Buserelin3.Gonadotropin促性腺激素HMG,FSH,FSH-HP,Gonal-F,HCG4.Bromocriptinmesilate溴隐亭2.5-7.5mg/d,InfertilityandART,Endometriosisandinfertility内异症及不孕AbdominalMicroscopy腹腔镜IVF/ICSI+GnRHa(Danazol,tamoxifen)Immunityandinfertility免疫及不孕Prednisone强的松5mgqd.1-3monthsChineseherb中药,InfertilityandART,IUI(AIH,AID)人工授精GUIT,GIFT宫腔配子移植IVF-ET体外受精-胚胎移植ICSI单精子卵母细胞内显微注射PGD胚胎着床前的遗传学诊断Others其它配子冷冻技术（精子库、卵子库）未成熟卵体外成熟技术,IVF-ET步骤,胚胎移植,InfertilityandART,ICSI,显微操作系统,1,2,3,1-oocyte(GV)2-oocyte(M)3-oocyte(M),1-Fertilizedegg(day1)2-embryo(day2,2cells)3-embryo(day3,4cells)4-embryo(day3,7cells),1,2,3,4,InfertilityandART,PGD步骤选择诊断时期取样及标本处理单个细胞的遗传学分析,PGD工作站,FISH结果性别诊断,XX,XY,FISH结果非整倍体诊断（21三体）,21,21,21,21,21,21,FISH结果非整倍体诊断（性染