临床医学infertility不孕症（鹿欣2006）课件

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1、InfertilityandAssistedReproductiveTechnologies不孕症和辅助生殖技术XINLUObstetrics&GynecologyHospitalFudanUniversity2006-3-1ContentsInfertilityDefinition;Causes;ExaminationsandDiagnosis;Treatment;AssistedReproductiveTechnologies(ART);Intrauterineinsemination(IUI);Invitrofertilizationan

2、dembryotransfer(IVF-ET);Intracytoplasmicsperminjection(ICSI);Gameteintrafallopiantransfer(GIFT);DEFINITIONofInfertility不孕症定义WhatisInfertility?Infertilityisdefinedtwoyearsofunprotectedintercoursewithoutpregnancy.(WHO,oneyear)PrimaryInfertility:nopreviouspregnancies原发不孕haveocc

3、urred;SecondaryInfertility:apriorpregnancyhas继发不孕occurred;AgeandInfertility年龄与不孕agefertilityabortionFertilityrate<30yr74%11.9%per1,00030-35yr62%15.0%>35yr54%24.6%>40yr51.0%femalemale10203040506070FemaleReproductiveductanatomy女性生殖道解剖Femaleovary卵巢fallopian输卵管uterus子宫cervix宫颈Va

4、gina阴道MaleReproductiveductanatomy男性生殖道解剖Maletestis睾丸epididymis附睾,prostate前列腺vasdeferens输精管seminalvesicals精囊bulbourethralglands尿道球腺ejaculatoryduct射精管urethra尿道FemaleReproductivePhysiology女性生殖生理1.下丘脑-垂体-卵巢轴内分泌调节FemalMale(H-P-O)(H-P-T)GnRHGnRHFSH,LHFSH,LHE/PT4.3.输卵管2.卵巢周期性排卵5.宫颈

5、6.下生殖道hypothalamusovarypituitary子宫ovary4.子宫NormalGestation-----thebeginningofhumanFollopiantubeUterineovaryoocyteCervixExtra-genitaltractspermCauses原因CausesPercentageFemalefactors40-55%Malefactors25-40%Bothmaleandfemalefactors20%Immunologicunexplainedfactors10%FemaleFactors

6、女方因素Ovulatorydysfunction（排卵障碍）Pelvicfactors（盆腔因素）1.Hypothalamicdysfunction;2.PituitaryInsufficiency;3.Ovarianfactor(peripheraldefect);4.Others:thyroidoradrenaldysfunction;Ovulatorydysfunction排卵障碍hypothalamuspituitaryovaryPelvicfactors盆腔因素1.Tubalfactors:injury,blockage,adhesi

7、on;2.Uterinefactors:cogenitalanatomicabnormalities;endometriumdisorder,tumor;3.Cervicalfactors:Infection,cogenitalabnormalities;4.Extra-genitaltractfactors;Infection,cogenitalabnormalities;FemaleFactorsSummaryFollopiantubeUterineovaryoocyteCervixExtra-genitaltractspermHypot

8、halamusPituitaryThyroidAdrenalMaleFactors男方因素1.Abnormalspermatogenesisconge