试管婴儿与生殖工程上海医学院 细胞与遗传医学系左 伋
INFERTILITY
Infertility is defined as no ongoing
pregnancy after 9-12 months of sexual
activity without contraception,There is
no distinction between not using
contraception and "trying" to conceive.
STATISTICS
In 1995,15% of women of
childbearing age had ever sought
infertility advice,that includes
medical advice,tests,drugs surgery or
assisted reproductive technologies
(ART),
Infertility among Married
Women,by Education Level
8.5% of women without high school or
equivalent
8.1% of women with just high school or the
equivalent
6.6% of those who have some college,but no
bachelor's
5.6% of women with bachelor's or higher
Infertile Couples
7.1% or about 2.1 million of married
couples were infertile in 1995.
2.3 million were infertile in 1988,and 2.4
in 1982.
6.1 million or 10% of married couples in
1995 had impaired fecundity (either
infertile or had problems conceiving or
carrying a child to term.)
Infertility by Race
7% of Hispanic women are infertile
6.4% of white women are infertile
10.5% of black women are infertile
13.6% of other groups are infertile
The causes of infertility
Male Factor,Sperm production and sperm
quality.
Ovulation,Egg production,egg quality and
preparation of the uterine lining for implantation.
Passage,The joining of sperm and egg in the
Fallopian tubes and transport of the fertilized egg
into the uterus.
Factors causing infertility
Tubal factor,31%
Endometriosis,14%
Uterine Factor,1%
Male Factor,18%
Other factors,18%
Unexplained,15%
The National Institutes of Health found
that from 1938 to 1996,sperm counts in
the United States have fallen annually
about 1.5%,European countries have
fallen at twice that rate,
Female Age and Fertility
The loss of female fertility is due to the loss of high quality
eggs,The receptiveness of the uterus is not decreased,
This loss of fertility magnifies the impact of any other
fertility factors present,
In 1995,there were 59,142 cycles of ART,
11,315 women had a live birth delivery
through ART.
Type of ART procedures
90% in vitro fertilization (IVF)
8% gamete intrafallopian transfer (GIFT)
2% zygote intrafallopian transfer (ZIFT)
11% of ART procedures involved
intracytoplasmic sperm injection to
fertilize eggs (ICSI),
One cycle of IVF costs an average of
$7,800,(Includes everything from
consultation to transfer)
1995 ART Success Rates
CYCLES using fresh embryos from non-donor eggs:
Live births per stimulation,19.6%
Live births per retrieval,22.8%
Live births per transfer,25.1%
Multiple births per transfer,9.1%
CYCLES using frozen embryos from nondonor eggs:
Live births per transfer,15.1% CYCLES using
donor eggs:
Live births per transfer,5.5%
Singletons vs,Multiple Births in ART
49.8% singletons
23.8% twins
4.5% triplets or higher
辅助生殖技术
超排卵治疗的内分泌监测
体外受精和胚胎培养基
人类移植胚胎的评估和选择
人类胚胎辅助孵化技术
人类胚胎和卵子的冷冻保存
人类胚胎活检和着床前遗传学诊断
卵子胞浆内精子注射一、人类体外受精和胚胎培养基培养基的主要类型简单盐溶液＋能量复合性组织培养基 （ Hams’F-10）
培养基的基本成分和作用水,无机离子,气体能量物质
（ 早期丙酮酸,乳酸,后期葡萄糖 ）
氨基酸,维生素,核酸前体,蛋白质,
激素,生长因子,缓冲系统二,人类胚胎共培养系统
早期胚胎在体内和体外的发育
50％ 以上胚胎发育至 4~8细胞期
（ 体外培养第 3天 ） 发生阻断现象二,人类胚胎共培养系统
共培养系统对胚胎发育的影响被动条件：降低 O2代谢水平减少次黄嘌呤含量控制代谢物的变化（葡萄糖?、乳酸?）
稳定 pH和 O2,O2/C O2
主动条件：分泌抗氧化剂牛磺酸释放低分子量组份分泌多种生长因子各种糖蛋白二,人类胚胎共培养系统
共培养系统辅助细胞的建立异体细胞：人输卵管上皮细胞牛输卵管上皮细胞人子宫内膜细胞胎牛子宫细胞自体细胞：人颗粒细胞人卵丘细胞人子宫内膜细胞二,人类胚胎共培养系统
共培养系统在 IVF中的应用增加受精率和提高胚胎质量胚胎活力改善增加冷冻保存胚胎的存活率卵细胞体外成熟和受精的改善有助于胚胎显微操作后的修复三、人类移植胚胎的评估和选择胚胎活性的评估方法胚胎的形态特征卵子质量对胚胎的影响精子质量对胚胎的影响综合因素对胚胎质量的影响三、人类移植胚胎的评估和选择
胚胎活性的评估方法胚胎活性的直接评估（ FDA）
胚胎活性的间接评估三、人类移植胚胎的评估和选择
胚胎的形态特征
2~8细胞的六级分级,1级最佳； 6级最次三、人类移植胚胎的评估和选择
卵子质量对胚胎的影响
精子质量对胚胎的影响
综合因素对胚胎质量的影响四、人类胚胎辅助孵化技术
透明带对于胚胎的保护作用
囊胚的扩张和自然孵化
辅助孵化的基本技术
辅助孵化的技术在 IVF中的应用四、人类胚胎辅助孵化技术辅助孵化技术侵入性辅助孵化：机械方法化学方法激光方法非侵入性辅助孵化：机械方法化学方法五、人类胚胎和卵子的冷冻保存
胚胎和卵子的冷冻保存的原理
冷冻保护剂的作用机制
胚胎和卵子冷冻保存方法
胚胎和卵子冷冻保存的临床应用六、人类胚胎和卵子捐献
受卵者的指征
受卵者的准备
受卵者的激素替代疗法
供卵者的来源
供卵者的基本要求
卵子捐献的临床应用
胚胎捐献的临床应用六、人类胚胎和卵子捐献
受卵者的指征没有自然月经周期：卵巢功能早衰性腺发育不良医源性卵巢衰竭手术切除卵巢具有自然月经周期,IVF失败遗传缺陷六、人类胚胎和卵子捐献
供卵者的基本要求年龄经产生理特征血型遗传病传染病七、人类胚胎活检和着床前遗传学诊断
适合活检的不同发育时期
胚胎活检的基本方法
着床前胚胎遗传学诊断方法七、人类胚胎活检和着床前遗传学诊断
适合活检的不同发育时期第一极体的活检卵裂细胞的活检滋养外胚层细胞的活检七、人类胚胎活检和着床前遗传学诊断
胚胎活检的基本方法吸出法挤压法机械分离法疝形成法八、胚胎增殖和克隆的方法
卵裂球分离技术和胚胎增殖
供者透明带和人工透明带
卵裂球分离技术潜在应用价值
囊胚分割技术和胚胎增殖
细胞核移植技术和胚胎增殖九、超排卵治疗的内分泌监测
自然周期和治疗周期激素分泌的特征
诱发排卵周期卵泡发育与内分泌监测
黄体生成激素预测排卵时间十、卵子胞浆内精子注射
辅助受精技术
PZD,SUZI,ICSI应用概况
ICSI适应症和精子来源
ICSI主要步骤和技术
INFERTILITY
Infertility is defined as no ongoing
pregnancy after 9-12 months of sexual
activity without contraception,There is
no distinction between not using
contraception and "trying" to conceive.
STATISTICS
In 1995,15% of women of
childbearing age had ever sought
infertility advice,that includes
medical advice,tests,drugs surgery or
assisted reproductive technologies
(ART),
Infertility among Married
Women,by Education Level
8.5% of women without high school or
equivalent
8.1% of women with just high school or the
equivalent
6.6% of those who have some college,but no
bachelor's
5.6% of women with bachelor's or higher
Infertile Couples
7.1% or about 2.1 million of married
couples were infertile in 1995.
2.3 million were infertile in 1988,and 2.4
in 1982.
6.1 million or 10% of married couples in
1995 had impaired fecundity (either
infertile or had problems conceiving or
carrying a child to term.)
Infertility by Race
7% of Hispanic women are infertile
6.4% of white women are infertile
10.5% of black women are infertile
13.6% of other groups are infertile
The causes of infertility
Male Factor,Sperm production and sperm
quality.
Ovulation,Egg production,egg quality and
preparation of the uterine lining for implantation.
Passage,The joining of sperm and egg in the
Fallopian tubes and transport of the fertilized egg
into the uterus.
Factors causing infertility
Tubal factor,31%
Endometriosis,14%
Uterine Factor,1%
Male Factor,18%
Other factors,18%
Unexplained,15%
The National Institutes of Health found
that from 1938 to 1996,sperm counts in
the United States have fallen annually
about 1.5%,European countries have
fallen at twice that rate,
Female Age and Fertility
The loss of female fertility is due to the loss of high quality
eggs,The receptiveness of the uterus is not decreased,
This loss of fertility magnifies the impact of any other
fertility factors present,
In 1995,there were 59,142 cycles of ART,
11,315 women had a live birth delivery
through ART.
Type of ART procedures
90% in vitro fertilization (IVF)
8% gamete intrafallopian transfer (GIFT)
2% zygote intrafallopian transfer (ZIFT)
11% of ART procedures involved
intracytoplasmic sperm injection to
fertilize eggs (ICSI),
One cycle of IVF costs an average of
$7,800,(Includes everything from
consultation to transfer)
1995 ART Success Rates
CYCLES using fresh embryos from non-donor eggs:
Live births per stimulation,19.6%
Live births per retrieval,22.8%
Live births per transfer,25.1%
Multiple births per transfer,9.1%
CYCLES using frozen embryos from nondonor eggs:
Live births per transfer,15.1% CYCLES using
donor eggs:
Live births per transfer,5.5%
Singletons vs,Multiple Births in ART
49.8% singletons
23.8% twins
4.5% triplets or higher
辅助生殖技术
超排卵治疗的内分泌监测
体外受精和胚胎培养基
人类移植胚胎的评估和选择
人类胚胎辅助孵化技术
人类胚胎和卵子的冷冻保存
人类胚胎活检和着床前遗传学诊断
卵子胞浆内精子注射一、人类体外受精和胚胎培养基培养基的主要类型简单盐溶液＋能量复合性组织培养基 （ Hams’F-10）
培养基的基本成分和作用水,无机离子,气体能量物质
（ 早期丙酮酸,乳酸,后期葡萄糖 ）
氨基酸,维生素,核酸前体,蛋白质,
激素,生长因子,缓冲系统二,人类胚胎共培养系统
早期胚胎在体内和体外的发育
50％ 以上胚胎发育至 4~8细胞期
（ 体外培养第 3天 ） 发生阻断现象二,人类胚胎共培养系统
共培养系统对胚胎发育的影响被动条件：降低 O2代谢水平减少次黄嘌呤含量控制代谢物的变化（葡萄糖?、乳酸?）
稳定 pH和 O2,O2/C O2
主动条件：分泌抗氧化剂牛磺酸释放低分子量组份分泌多种生长因子各种糖蛋白二,人类胚胎共培养系统
共培养系统辅助细胞的建立异体细胞：人输卵管上皮细胞牛输卵管上皮细胞人子宫内膜细胞胎牛子宫细胞自体细胞：人颗粒细胞人卵丘细胞人子宫内膜细胞二,人类胚胎共培养系统
共培养系统在 IVF中的应用增加受精率和提高胚胎质量胚胎活力改善增加冷冻保存胚胎的存活率卵细胞体外成熟和受精的改善有助于胚胎显微操作后的修复三、人类移植胚胎的评估和选择胚胎活性的评估方法胚胎的形态特征卵子质量对胚胎的影响精子质量对胚胎的影响综合因素对胚胎质量的影响三、人类移植胚胎的评估和选择
胚胎活性的评估方法胚胎活性的直接评估（ FDA）
胚胎活性的间接评估三、人类移植胚胎的评估和选择
胚胎的形态特征
2~8细胞的六级分级,1级最佳； 6级最次三、人类移植胚胎的评估和选择
卵子质量对胚胎的影响
精子质量对胚胎的影响
综合因素对胚胎质量的影响四、人类胚胎辅助孵化技术
透明带对于胚胎的保护作用
囊胚的扩张和自然孵化
辅助孵化的基本技术
辅助孵化的技术在 IVF中的应用四、人类胚胎辅助孵化技术辅助孵化技术侵入性辅助孵化：机械方法化学方法激光方法非侵入性辅助孵化：机械方法化学方法五、人类胚胎和卵子的冷冻保存
胚胎和卵子的冷冻保存的原理
冷冻保护剂的作用机制
胚胎和卵子冷冻保存方法
胚胎和卵子冷冻保存的临床应用六、人类胚胎和卵子捐献
受卵者的指征
受卵者的准备
受卵者的激素替代疗法
供卵者的来源
供卵者的基本要求
卵子捐献的临床应用
胚胎捐献的临床应用六、人类胚胎和卵子捐献
受卵者的指征没有自然月经周期：卵巢功能早衰性腺发育不良医源性卵巢衰竭手术切除卵巢具有自然月经周期,IVF失败遗传缺陷六、人类胚胎和卵子捐献
供卵者的基本要求年龄经产生理特征血型遗传病传染病七、人类胚胎活检和着床前遗传学诊断
适合活检的不同发育时期
胚胎活检的基本方法
着床前胚胎遗传学诊断方法七、人类胚胎活检和着床前遗传学诊断
适合活检的不同发育时期第一极体的活检卵裂细胞的活检滋养外胚层细胞的活检七、人类胚胎活检和着床前遗传学诊断
胚胎活检的基本方法吸出法挤压法机械分离法疝形成法八、胚胎增殖和克隆的方法
卵裂球分离技术和胚胎增殖
供者透明带和人工透明带
卵裂球分离技术潜在应用价值
囊胚分割技术和胚胎增殖
细胞核移植技术和胚胎增殖九、超排卵治疗的内分泌监测
自然周期和治疗周期激素分泌的特征
诱发排卵周期卵泡发育与内分泌监测
黄体生成激素预测排卵时间十、卵子胞浆内精子注射
辅助受精技术
PZD,SUZI,ICSI应用概况
ICSI适应症和精子来源
ICSI主要步骤和技术
