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1、Infertility and Assisted Reproductive Technologies 不孕症与辅助生殖技术,XIN LUObstetrics & Gynecology Hospital Fudan University,Contents,InfertilityDefinition;Causes;Examinations and Diagnosis;Treatment;Assisted Reproductive Technologies (ART) ;Intrauterine insemination ( IUI);In vitro fertilization and embry
2、o transfer (IVF-ET);Intracytoplasmic sperm injection (ICSI); Gamete intrafallopian transfer (GIFT);,Definition of Infertility 不孕症定义,Infertility is defined two years of unprotected intercourse without pregnancy. (WHO, one year)Primary Infertility : no previous pregnancies 原发不孕 have occurred; Secondar
3、y Infertility: a prior pregnancy has 继发不孕 occurred;,Female Reproductive duct anatomy 女性生殖道解剖,Female ovary 卵巢fallopian 输卵管 uterus 子宫cervix 宫颈Vagina 阴道,女性生殖生理,1. 下丘脑-垂体-卵巢轴内分泌调节 Femal Male ( H-P-O) (H-P-T) GnRH GnRH FSH,LH FSH,LH E/P T 4. 3.输卵管 2. 卵巢周期性排卵 5. 宫颈 6. 下生殖道,下丘脑,卵巢,垂体,子宫,卵巢,4.子宫,Causes 原因,C
4、auses PercentageFemale factors 40-55 %Male factors 25-40 %Both male and female factors 20 %Immunologic unexplained factors 10 %,1. Hypothalamic dysfunction; 2. Pituitary Insufficiency; 3. Ovarian factor (peripheral defect); 4. Others: thyroid or adrenal dysfunction;,Ovulatory dysfunction排卵障碍,hypotha
5、lamus,pituitary,ovary,Pelvic factors 盆腔因素,1. Tubal factors: injury, blockage, adhesion 2. Uterine factors: cogenital anatomic abnormalities endometrium disorder, tumor 3. Cervical factors: infection, cogenital abnormalities 4. Extra-genital tract factors; infection, cogenital abnormalities,Male Fact
6、ors 男方因素,1. Abnormal spermatogenesis congenital; chronic diseases; infectious factors; 2. Obstructive: sperm transport abnormalities; 3. Immunologic factors; 4. Endocrine disorders; 5. Sexual dysfunction;,Both Male and Female Factors,1. No demonstrable cause; 2. Psychological factors; 3. Immunologic
7、 factors; count for 10%; autoimmune response; auto-antibodies;,Examination and Diagnoses检查和诊断,Initial Visit 初诊The initial visit is the most important;The infertility is a problem of couple;The male partner should be present;History: both male and female;The guide to diagnostic and treatment plans;,E
8、xaminations 检查,History collection；FemalePhysical examination;Bimanual examination（双合诊）;Rectal-Vaginal-examination (三合诊）；Laboratory;Assistant imaging;MalePhysical examination;Laboratory-Semen analysis;,Examinations (for female) 女方检查,Special Laboratory Examinations: semen analysis（精液分析）; hormone measu
9、rement; sperm penetration assay (SPA)精子穿透试验; postcoital examinition of cervical mucus （性交后宫颈粘液试验） anti-sperm immunologic examination;Assistant imaging : Unltrasound 超声; Hysterosalpingogram 子宫输卵管碘油造影; Hysteroscopy 宫腔镜;Laparoscopy 腹腔镜；,Methods to monitor ovulation监测排卵的方法,Luteinizing Hormone monitoring
10、: LH surge; after 34-36 hr occur ovulation;Basal Body Temperature: simple, cheap, biphasic pattern;Mid-luteal serum progesterone: 3ng/mL, peak;Premenstrual molimina: 95% presence;Mucus change: thick and cellular, no crystalline fern;Ultrasound monitoring: follicle size 21-23 mm, fluid in the cul-de-
11、sac.,Normal Values for Semen Analysis 精液分析正常值,volume 2.0 mLsperm concentration 20 x 106 /mLmotility 50 %normal morphology 15 %WBC 1x106 /mLData from WHO, 1999 Please keep in mind: 1. Cycle of Spermiogenesis takes about 74 days; 2. Semen parameters in males may vary; 3. Abnormal semen analysis should repeat at least once;,Examination and Diagnoses,Initial evaluationHistoryPhysical exam,Irregular mensesNo ovulation,HSG orHysteroscopyAbnormal of uterine,Normalevaluation,HSGTubal blockage,Abnormal Semen analysis,
