不 孕 症

1. 不 孕 症 Infertility

2. concept • Infertility is that married couples,with normal sex life and without contraception,cohabit 2 years but didn’t fall pregnant. • Clinically,for early diagnosis and treatment, WHO specified the clinical standard to be 1 year(1995). • Primary infertility 原发性不孕 • Secondary infertility 继发性不孕

5. Causes of Infertility According to investigation, • Virile agent is about 40%. • Female agent is about 60% . Oviductal and ovarian agents occupied most of them.

6. 4 • 3 • 5 • 2 • 1

7. vaginal infertility • 1.transverse vaginal septum 阴道横隔 • 2.imperforate hymen 无孔处女膜 • 3.congenital absence of vagina 先天无阴道 • 4.colpostenosis after injury 阴道狭窄 • 5.Severe colpitis 严重阴道炎

8. Cervical Infertility • 1.estrogen deficiency—after clomiphene 克罗米芬促排卵后 • 2.severe endocervicitis 严重的宫颈管炎 • 3.cervical polyp,cervical myoma 宫颈息肉、宫颈肌瘤 • therapy—artificial insemination in uterine cavity 宫腔内人工授精。

9. Uterine Infertility • Etiological factor---- • Uterus congenital malformation : absence of uterus, uterus bicornis, infantile uterus • Endometrial lesion : endometritis, endometrial polyp, submucous myoma • Endometrial excretion mal-response : inadequate luteal function • Examination--- • Therapy---

10. Tubal Infertility-the Most Common agen • Etiological factor 1.congenital oviduct dysgenesis 输卵管先天发育不全。 2.salpingitis 输卵管炎症-oviduct emphraxis输卵管阻塞。 3.pelvic adhesion—pelvic endometriosis,pelvic inflammation • examination oviduct unobstructed test输卵管通畅试验(输卵管通水、通气)：子宫输卵管造影可明确阻塞部位和子宫有无畸形，有无子宫粘膜下肌瘤以及子宫内膜或输卵管结核病变。 • therapy ---treat the primary disease test tube baby---第一、二、三代试管婴儿

11. Ovarian Infertility • Etiological factor---anovulation • Ovarian legion :congenital ovarian agenesis(Turner’s syndrome) ,PCOS，premature ovarian failure(卵巢功能早衰)，functional ovarian tumor, ovarian endometrioma • HPO-axis functional disturbance causes anovulatory menstruation，amenorrhea,etc. • General disease :severe malnutrition, hyperthyroidism affect ovary function result to anovulation. • examination---ovary function: B-us monitors ovulation,BBT,cervical mucus,endometrial diagnostic curettage • therapy---promote ovulation

12. Immune Infertility • Immune agent • （1）alloimmunity 同种免疫As-Ab • （2） autoimmunity(自身免疫): pellucid zone autoantibody(透明带自身抗体)

13. Virile infertility-- primary of spermatogenic and sperm-transport disorder • Affecting spermatogenesis factor • Congenital anomaly:congenital cryptorchidism (隐睾)，congenital testicular dysgenesis。 • General chronic consumption:long-term malnutrition. • Chronic intoxication. Mind overstress may affect sperm development. • Local reasion :orchitis(睾丸炎)，TB of testis(睾丸结核)， varicocele(精索静脉曲张)cause fewer sperm，aspermia，etc.

14. Sperm transportation obstructed • TB of epididymidis and vas deferens；impotence or premature ejaculation. • Immune factor ：virile As-Ab sperms coagulation • Endocrine dysfunction：hypothyroidism, hypercorticism, hypopituitarism, etc.

15. 询问既往有无慢性病如腮腺炎，结核等；了解性生活情况，有无性交困难。除全身检查外，重点应检查外生殖器有无畸形或病变，尤其是精液检查询问既往有无慢性病如腮腺炎，结核等；了解性生活情况，有无性交困难。除全身检查外，重点应检查外生殖器有无畸形或病变，尤其是精液检查

16. male examination Semen examination 精液检查 正常精液量为2-6ml,平均3-4ml, pH为7.5-7.8，在室温中放置20分钟完全液化。精子数≥ 6000万/ml，活动数≥60%，异常精子≤20%则认为有生育能力；若精子数为2000万-6000万/ml，则生育力差；若少于2000万/ml,则生育力极差。