_and assisted reproductive technologies 不孕症与辅助 课件

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1、InfertilityandAssistedReproductiveTechnologies不孕症与辅助生殖技术XINLUObstetrics&GynecologyHospitalFudanUniversity2006-5-11/19ContentsInfertilityDefinition;Causes;ExaminationsandDiagnosis;Treatment;AssistedReproductiveTechnologies(ART);Intrauterineinsemination(

2、IUI);Invitrofertilizationandembryotransfer(IVF-ET);Intracytoplasmicsperminjection(ICSI);Gameteintrafallopiantransfer(GIFT);DEFINITIONofInfertility不孕症定义WhatisInfertility?Infertilityisdefinedtwoyearsofunprotectedintercoursewithoutpregnancy.(WHO,oneyear)P

3、rimaryInfertility:nopreviouspregnancies原发不孕haveoccurred;SecondaryInfertility:apriorpregnancyhas继发不孕occurred;FemaleReproductiveductanatomy女性生殖道解剖Femaleovary卵巢fallopian输卵管uterus子宫cervix宫颈Vagina阴道FemaleReproductivePhysiology女性生殖生理1.下丘脑-垂体-卵巢轴内分泌调节FemalMal

4、e(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6.下生殖道hypothalamusovarypituitary子宫ovary4.子宫Causes原因CausesPercentageFemalefactors40-55%Malefactors25-40%Bothmaleandfemalefactors20%Immunologicunexplainedfactors10%FemaleFactors女方因素Ovulatorydysfu

5、nction（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,a

6、dhesion;2.Uterinefactors:cogenitalanatomicabnormalities;endometriumdisorder,tumor;3.Cervicalfactors:Infection,cogenitalabnormalities;4.Extra-genitaltractfactors;Infection,cogenitalabnormalities;FemaleFactorsSummaryFollopiantubeUterineovaryoocyteCervix

7、Extra-genitaltractspermHypothalamusPituitaryThyroidAdrenalMaleFactors男方因素1.Abnormalspermatogenesiscongenital;chronicdiseases;infectiousfactors;2.Obstructive:spermtransportabnormalities;3.Immunologicfactors;4.Endocrinedisorders;5.Sexualdysfunction;BothM

8、aleandFemaleFactors1.Nodemonstrablecause;2.Psychologicalfactors;3.Immunologicfactors;countfor10%;autoimmuneresponse;auto-antibodies;ExaminationandDiagnoses检查和诊断InitialVisit初诊Theinitialvisitisthemostimportant;Theinfertilityisaproblemofco