不孕症和辅助生殖技术.ppt

1、Infertility and assisted reproductive techniques(ART)不孕症和辅助生殖技术,Zi-Jiang Chen，M.D , Ph.D,Infertility and ART,Definition primary infertility原发性不孕 secondary infertility继发性不孕,Infertility and ART,Incidence rate发病率 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 排卵异常，卵巢储备缺乏 2. reproductive tract 生殖道异常 fallopian、uterus、pelvic,etc 输卵管、子宫、盆腔等异常,Infertility and ART,3.nidation着床异常 4.sperm精子异常

3、 5.others其它 immunological causes免疫因素 repeated abortion重复流产 inherited causes遗传因素 systemic causes,etc全身全身因素等,Infertility and ART,Familiar Causes abnormal oocyte卵子异常 fallopian factor输卵管因素 cervical factor宫颈因素 endometriosis(adenomyoma)内异症（子宫腺肌病） myoma of uterus子宫肌瘤 abnormal sperm精子异常 immunological causes

4、免疫因素,Infertility and ART,Other factors其它因素 1.age年龄 2125 is the best； 2.nutrition营养 chronic disease；excessive fat or thin; 3.cigarette,alcohol and anaesthetic; 烟、酒和麻醉剂 4.psychological factors心理因素 5.pollution污染,Infertility and ART,Aims目的 1.病因在何方 2.病变性质 3.病变类别 4.病变部位 5.评估其可治性,Infertility and ART,Diagno

5、sis Female: history of present illness现病史 physical examination体格检查 adjuvant examination辅助检查 (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

6、of the cycle 调整月经周期 (2)development of the uterus 促进子宫发育 (3)improvement of the cervical mucus 改善宫颈粘液,Infertility and ART,Treatment E2 (1)adjustment of the cycle调整月经周期 1)Progynova 补佳乐 12mg/d21d 2)diethylstilbestrol 乙底酚 0.25mg 0.5mg/d21d 3)progesterone 黄体酮 20mg/d45d（Mc2125） 10mg/d610d,Infertility and A

7、RT,Treatment E2 (2)development of the uterus Progynova补佳乐 24mg/d21d progesterone黄体酮 20mg/d5d combined with JianRongPian3cycles,Infertility and ART,Treatment E2 (3)improvement of the cervical mucus combined with Clomifene与克罗米芬合用 Progynova补佳乐 12mg/d710d from Mc10d 月经第十天开始,Infertility and ART,Progress

8、in Stimulation 促排用药进展 1.Clomifene 克罗米芬 100mg/d57d 2.GnRHa and GnRHa antagonist 促性腺激素释放激素及其拮抗剂 Alarelin阿拉瑞林, Dacapeptyl达必佳, Buserelin 3.Gonadotropin促性腺激素 HMG,FSH,FSH-HP,Gonal-F,HCG 4.Bromocriptin mesilate溴隐亭 2.5-7.5mg/d,Infertility and ART,Endometriosis and infertility内异症及不孕 Abdominal Microscopy腹腔镜 I

9、VF/ICSI +GnRHa (Danazol ,tamoxifen) Immunity and infertility免疫及不孕 Prednisone强的松 5mg qd. 1-3months Chinese herb中药,Infertility and ART,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,Infertility and ART,ICSI,显微操作系统,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