Microsoft Word - 15_Patient info sheet on SSR_V1_Chi

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盈霆蔡
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1 香港中文大學婦產科學系威爾斯親王醫院輔助生育技術中心手術取精 - 病人資訊何謂手術取精? 手術取精是生殖治療手術之一此項手術主要針對精液中不含精子 ( 無精子症 ) 的男性它主要是通過外科手術的方法直接從男性的陰囊內取出精子雖然獲得的精子數目很少, 但在人工受孕 (IVF) 中通過進行卵細胞漿內單精子注射術 (ICSI), 每個卵子只需要一條精子就已經足夠在引入這技術前, 接受精子捐贈是治療該類不育夫婦的唯一方法手術取精對誰有幫助? 精子是在睾丸中形成, 而成熟的精子會儲存於睾丸外的副睾有些男性的睾丸雖然有製造精子, 但精液中卻不含精蟲因此, 在太太接受療程前, 丈夫會先進行一次試驗性的手術取精, 以確保進行人工受孕治療時有精子可用, 同時亦提供冷凍及儲存精子的機會, 以供日後使用手術取精是如何進行? (1) 經皮副睾穿刺取精術 (PESA)/ 睾丸穿刺取精術 (TESA) 有些男性可直接從副睾抽取精子利用幼針穿過陰囊的皮膚到達副睾抽取小量液體, 從中找出精子此技術稱為經皮副睾穿刺取精術 (PESA) 亦可用幼針直接從睾丸抽出少量組織樣本, 然後交到實驗室處理, 從組織中取得精子此技術稱為睾丸穿刺取精術 (TESA) 以上過程可用清醒鎮靜及局部麻醉以減低痛楚 (2) 顯微副睾取精術 (MESA)/ 睾丸切片取精術 (TESE) 另外, 精子可通過陰囊切口取得在陰囊切一個傷口, 在顯微鏡下將副睾的細微管子分出後, 再以微針抽取細微管中少量液體, 然後用顯微鏡檢查是否有精子存在此技術稱為顯微副睾取精術 (MESA) 精子亦可從切細的睾丸組織中取得, 稱為睾丸切片取精術 (TESE) 以上過程可用清醒鎮靜及局部麻醉以減低痛楚 ART/C/PI/All/Form15C/V01/May 14 1

2 手術取精是否一定能取得精子? 並非所有病人用以上技術都合適, 手術中有機會找不到存活的精子不幸的是, 我們不能精確估計男士體內有否製造精子如果能取得精子若能從手術中取得精子, 胚胎專家會評估樣本的質素是否適合用於療程好質素的樣本可用冷凍精子法儲存以供隨後的治療週期使用如果精子不適合用冷凍精子法儲存, 以上的程序需要重覆, 並在人工受孕中抽取卵子時同時進行若未能取得精子如果不能從 PESA/TESA 程序中取得精子, 我們會於覆診時討論是否值得做 MESA/TESE 如果最終都未能取得精子, 你們並不適合使用人工受孕 (IVF) 中通過進行卵細胞漿內單精子注射術 (ICSI) 醫生會與你們討論其他可行方法, 例如, 接受精子捐贈領養或接受無子女手術取精的風險一般情況下, 手術取精是一項安全的手術手術有機會出現出血瘀傷形成血腫及發炎的風險清醒鎮靜及局部麻醉通常都是安全的有機會出現的風險包括 : 心律失常低或高血壓及抑制呼吸手術取精當天注意事項手術前 4 小時內你不可進食或飲水手術後, 你將會返回病房休息手術中使用的鎮靜藥物有可能使你出現短暫但輕微的副作用, 如疲倦頭暈頭痛噁心或嘔吐等你也有可能有昏昏欲睡的感覺, 為安全計, 建議最好由家人陪同出院藥物影響可持續一天, 於出院 24 小時內, 閣下不應飲酒攀爬駕駛車輛操作機器或做重大的决定 ( 例如簽署法律文件 ) 但如果你感到嚴重不適或有以下不常見的副作用如呼吸不暢氣道阻塞心律不正或意識錯亂, 請盡快前往威爾斯醫院或附近醫院的急症室尋求協助, 並告知醫生有關你的療程手術後, 你可能會感到輕微不適, 可服用一般的止痛藥舒緩不適建議你穿著有承托力的內褲及鬆身的褲子, 直至不適感消失你出院時, 我們會告知你覆診日期手術結果將於覆診時討論 ART/C/PI/All/Form15C/V01/May 14 2

3 Assisted Reproductive Technology Unit Department of Obstetrics & Gynaecology The Chinese University of Hong Kong Prince of Wales Hospital Surgical Sperm Retrieval Patient information sheet What is Surgical Sperm Retrieval (SSR)? Surgical Sperm Retrieval is a technique that can be used to help those couples where the male partner does not ejaculate sperm (azoospermia). Sperm is obtained directly from the man's scrotum by means of a small surgical procedure. Although only a small number of sperm are obtained, this is usually sufficient for IVF with ICSI as only one sperm is required for each egg. Until the introduction of this technique, the only treatment available for these couples was using donor sperm. Who might benefit from Surgical Sperm Retrieval? Sperm are formed in the testes. They mature and are stored in a 'reservoir' just outside the testis called the epididymis. In some men, although sperm are being produced in the testis they cannot reach the ejaculate. Therefore, a trial procedure usually preform before your wife undergo IVF treatment to ensure that sperm will be found for treatment. This also gives us the opportunity to freeze sperm for later use in some cases. How is Surgical Sperm Retrieval performed? (1) Percutaneous Epididymal Sperm Aspiration (PESA)/ Testicular Sperm Aspiration (TESA) In some men it is possible to extract sperm directly from the epididymis. A fine needle is passed through the skin of the scrotum and placed in the epididymis. Small amounts of fluid are then sucked into a tube and examined for the presence of sperm. This technique is called Percutaneous Epididymal Sperm Aspiration (PESA). Or, sperm can be extracted directly from the testicles by passing a fine needle directly into the testicle and a small amount of ART/C/PI/All/Form15E/V01/May 14 1

4 tissue is sucked into the needle. The tissue is then prepared in the laboratory and examined for the presence of sperm. This technique is known as Testicular Sperm Aspiration (TESA). These procedures can be done under conscious sedation with local anaesthesia for pain relief. (2) Microscopic Epididymal Sperm Aspiration (MESA)/ Testicular Sperm Extraction (TESE) Alternatively, sperm will need to be retrieved using an incision to the scrotum. Epididymis is examined under the operating microscope. Small amounts of fluid are then sucked and examined for the presence of sperm. This technique is called Microscopic Epididymal Sperm Aspiration (MESA). Or, sperm will need to be retrieved by cutting small piece of testicular tissue. This is called Testicular Sperm Extraction (TESE). These procedures can be done under conscious sedation with local anaesthesia for pain relief. Are sperm always obtained using Surgical Sperm Retrieval? Not all patients are suitable for this technique and it may not be possible to recover any viable sperm. Unfortunately, it is not always possible to predict which men will be producing sperm. What happens if sperm are obtained? If sperm is found in the trial biopsy, the samples are examined by the embryologist to assess their suitability for treatment. If the sample is of good quality this may be frozen and stored for use in a subsequent treatment cycle. If sperm is not available for freezing, we will need to perform the procedure again on the day of egg collection. What happens if sperm are not obtained? If no sperm are found in the PESA/TESA, then we will discuss in clinic whether it is worthwhile to perform MESA/TESE. If no sperm are found after the procedure, then IVF with ICSI will not be suitable for you and we will discuss alternatives such as using donor sperm, adoption or accept childlessness. ART/C/PI/All/Form15E/V01/May 14 2

5 Are there any risks with Surgical Sperm Retrieval? In general, SSR is also a safe operation. The procedure carries a small risk of bleeding, bruising, haematoma formation and infection. Conscious sedation and local anaesthesia is generally safe. It carries small risk of arrhythmia, hypotension or hypertension and respiratory depression. What happens on the day of the Surgical Sperm Retrieval? You should not have anything to eat or drink for 4 hours before the procedure. Following the procedure you will return to your ward to rest for a while, before being taken home. Possible mild side effects related to conscious sedation include dizziness, malaise, headache, nausea and vomiting. You will also be a little drowsy from the sedative drugs. For your safety, you should be taken home by relatives. The residual effects of these medications may impair your functioning. You should not consume alcohol, climbing, drive, operate machinery or sign legal documents for at least 24 hours. You may experience some mild discomfort following the procedure, which should be relieved by simple painkillers. We advise that you wear some supportive underwear and loose trousers until the discomfort has settled. An appointment will be given before discharge. You will be follow-up in our clinic to discuss the result. ART/C/PI/All/Form15E/V01/May 14 3

UTI (Urinary Tract Infection) - Traditional Chinese

UTI (Urinary Tract Infection) Urinary tract infection, also called UTI, is an infection of the bladder or kidneys. Urethra Kidney Ureters Bladder Vagina Kidney Ureters Bladder Urethra Penis Causes UTI