不 孕 症

Infertility

• concept• Infertility is that married couples,with nor

mal 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

Causes of Infertility

According to investigation,

• Virile agent is about 40%.

• Female agent is about 60% .

Oviductal and ovarian agents occupied most of them.

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• 3• 5•

• 2

• 1

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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

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 uterin

e cavity 宫腔内人工授精。

Uterine Infertility• Etiological factor----

1. Uterus congenital malformation : absence of uterus, uterus bicornis, infantile uterus

2. Endometrial lesion : endometritis, endometrial polyp, submucous myoma

3. Endometrial excretion mal-response : inadequate luteal function

• Examination---

• Therapy---

Tubal Infertility-the Most Common agen • Etiological factor1.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 inflammati

on• 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

Ovarian Infertility• Etiological factor---anovulation1. Ovarian legion :congenital ovarian agenesis(Turner’s syn

drome) ,PCOS ， premature ovarian failure( 卵巢功能早衰 ) ， functional ovarian tumor, ovarian endometrioma

2. HPO-axis functional disturbance causes anovulatory menstruation ， amenorrhea,etc.

3. 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

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 )

Virile infertility-- primary of spermatogenic and sperm-transport disorder

• Affecting spermatogenesis factor1. Congenital anomaly:congenital cryptorchidism

( 隐睾 ) ， congenital testicular dysgenesis 。2. General chronic consumption:long-term malnutri

tion.3. Chronic intoxication. Mind overstress may affect

sperm development. 4. 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.

• Sperm transportation obstructed

1. TB of epididymidis and vas deferens ； impotence or premature ejaculation.

2. Immune factor ： virile As-Ab sperms coagulation

3. Endocrine dysfunction ： hypothyroidism, hypercorticism, hypopituitarism, etc.

• • 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

• 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≥ 6

000 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。