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1、Infertilityand assistedreproductivetechniques(ART)不孕症和辅助生殖技术Zi-JiangChen，M.D,Ph.D陈子江InfertilityandARTDefinitionprimaryinfertility原发性不孕secondaryinfertility继发性不孕InfertilityandARTIncidencerate发病率WHO(1990)about8.3%~14.3%inChinaabout10%Maleorfemalefactorabout30%~40%forrespectively
2、Maleandfemalefactorabout20%~30%Nodemonstrablecausesabout10%InfertilityandARTFactorsofinfertility1.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InfertilityandART3.nidation着床异常4.sperm精子异常5.others其它immunolo
3、gicalcauses免疫因素repeatedabortion重复流产inheritedcauses遗传因素systemiccauses,etc全身全身因素等InfertilityandARTFamiliarCausesabnormaloocyte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InfertilityandARTO
4、therfactors其它因素1.age年龄21~25isthebest；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InfertilityandARTAims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InfertilityandARTDiagnosisFemale:historyofpresentillness
5、现病史physicalexamination体格检查adjuvantexamination辅助检查(Bultrasonography,HSG,AsAB,E2,FSH,LH,T0,Prolactin,TSH)InfertilityandARTDiagnosisMale:semenanalysis精液分析FSH,LH,PRL,T0,TSHBultrasonography,AsAB,PESA,InfertilityandARTTreatmentE2(1)adjustmentofthecycle调整月经周期(2)developmentoftheuteru
6、s促进子宫发育(3)improvementofthecervicalmucus改善宫颈粘液InfertilityandARTTreatmentE2(1)adjustmentofthecycle调整月经周期1)Progynova补佳乐1~2mg/d×21d2)diethylstilbestrol乙底酚0.25mg~0.5mg/d×21d3)progesterone黄体酮20mg/d×4~5d（Mc21~25）10mg/d×6~10dInfertilityandARTTreatmentE2(2)developmentoftheuterusProgyn
7、ova补佳乐2~4mg/d×21dprogesterone黄体酮20mg/d×5dcombinedwithJianRongPian×3cyclesInfertilityandARTTreatmentE2(3)improvementofthecervicalmucuscombinedwithClomifene与克罗米芬合用Progynova补佳乐1~2mg/d×7~10dfromMc10d月经第十天开始InfertilityandARTProgressinStimulation促排用药进展1.Clomifene克罗米芬100mg/d×5~7d2.G
8、nRHaandGnRHaantagonist促性腺激素释放激素及其拮抗剂Alarelin阿拉瑞林,Dacapeptyl达必佳,Buser
