試管嬰兒(IVF)的流程

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敷屏卜阙
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1 試管嬰兒 (IVF) 的流程 < 費用約 10~15 萬 > Flow chart for In Vitro Fertilization (IVF) <About NT$ 100,000~150,000> 誘導排卵 : 進入月經週期之後, 利用排卵藥物, 刺激卵巢產生較多的卵泡排卵藥物 : GnRH Gonal-F HMG LH Stimulate ovulation: Within the menstrual cycle, use ovulatory drugs to stimulate the ovary to produce more ovarian follicles. Ovulatory drug: GnRH Gonal-F HMG LH 追蹤卵泡之成熟度 : 藉助超音波偵測儀, 定期的監測卵泡發育的情形, 並抽血檢驗追蹤血液中動情激素的數值變化, 以決定何時取卵是最佳的時機 Monitor the maturity of the ovarian follicles: Monitor the development status of the ovarian follicles regularly with ultrasound, sample the blood to test and monitor the estrogen hormone in order to determine the optimal time for oocytes retrieval. 采卵前 36 小時, 要注射人類絨毛膜性腺激素 hcg 以準備采卵作業 36 hours before oocytes retrieval, as a preparation, injection of Human Chorionic Gonadotropin (hcg) is necessary. 取卵 : 采全身麻醉, 在陰道超音波的導引下取出卵子, 手術所需時間很短, 術後沒有傷口, 不必住院 Ovum retrieval: Under general anaesthesia, retrieve the oocytes with the guidance of trans-vaginal ultrasound. The operation lasts only a short time without invasive cuts and hospitalization

2 取精 : 取卵當天上午請先生取精, 如需手術取精者, 請事先告知泌尿科醫師 Semen retrieval: obtain the husband's semen on the same day of oocytes retrieval. If the semen retrieval requires operation, please inform the urologists in advance. 體外授精 : 取出的卵泡液直接送入實驗室處理, 再將卵子篩選出來而先生的精液經過洗滌篩選處理後, 與太太的卵子經過 2~5 天的培養精子條件欠佳者, 可做單一精蟲顯微注射 (ICSI) In vitro fertilization: Send the obtained ovarian follicles to the laboratory for selection, and then choose the best quality oocytes. If the husband s sperm, after washed and purified, seems not quite good after 2~5days cultivation with the wife s ovum, Intracytoplasmic Sperm Injection (ICSI) can be applied. 胚胎植入 : 受精卵發育成為成熟的胚胎, 再將胚胎植入輸卵管或子宮腔內 Embryo Transfer: after the fertilized oocyte develops to mature embryo, transfer the embryo into the fallopian tube or uterus. 協助孵化 : 胚胎外殼透明層打洞説明著床 Assisted hatching: drill the outer layer (zona pellucida) of the embryo for embedding. 多餘的胚胎冷凍 Freeze the extra embryos 補充黃體素, 兩周後驗孕 Progesterone supplement. Perform pregnancy test two weeks later.

3 如果您對以上流程仍不清楚, 請洽詢您的主治醫師或與生殖醫學中心聯絡 ( 電話 : 轉分機 8540) If you are still not quite clear about the above contents, please consult your doctor or you can contact the Infertility Center (Tel: ext. 8540)

4 技術名稱 Technology 簡介 Brief Introduction 適用情況 Application 子宮頸黏液含抗精子抗體 The vaginal mucous discharge 人工授精 Intrauterine Insemination IUI contains anti-sperm antibody. 精子經過實驗室處理洗滌後中輕度子宮內膜異位 Medium or mild endometriosis 注射到子宮頸口或子宮腔不明原因之不孕症 Infertility of unknown cause After purified and washed in the 精子數目不足 ( 但至少在每毫升一千萬 laboratory, the sperm is injected at 以上活動力在 30% 以上的男性不孕 ) Mild oligospermia (but thecervix or into the uterus cavity. with 10 millions sperms per milliliter and the activity is higher than 30%.) 體外受精及胚胎移植 In vitro fertilization and embryo 以性腺刺激素刺激產生多個卵子 Use hmg to simulate to produce more follicles 把卵子抽吸出來於體外受輸卵管完全阻塞或損壞 Bilateral fallopian tubes are completely obstructed or damaged transfer ( 試管嬰兒 ) test-tube baby 精後約 72 小時至 120 小時, 再精子精蟲數目稀少或異常 Severe oligospermia 植入子宮腔內 72~120 hours after 不明原因之不孕症 Infertilityof unknown cause (IVF&ET) In vitro fertilization, transfer the fertilized oocyte into the uterus cavity. 取出精子和卵子後, 直接放嚴重子宮內膜異位症 Serious endometriosis 至少有一側之輸卵管通暢配子輸卵管內植入 Gamete intrafallopian transfer ( 禮物嬰兒 ) (GIFT) 入輸卵管壺腹部內並且在體 At least one side of the fallopian tube is unobstructed 外受精 After obtaining the sperms 子宮內膜異位症或子宮頸黏液異常 and ooocytes, transfer them into Endometriosis or cervical mucus abnormality the fallopian tube ampulla directly 不明原因之不孕症, 輕度男性精子稀少症 for In vivo fertilization. Infertility of unknown cause and mild oligospermia. 胚胎輸卵管內植入 Tubal Embryo Transfer (TET) 單一精蟲卵漿內顯微注射術 Intracytoplasmic Sperm Injection 過程與 IVF 相似, 只是受精卵 ( 合子 ) 發育到一定階段時把它放進輸卵管內 ( 而不是子宮腔內 )The process is similar to IVF, but the fertilized ovum (zygote) is transferred into the fallopian tube instead of the uterus cavity after it develops to a certain stage. 體外顯微受精技術的一種挑選一個精子把它直接不明原因之不孕症 Infertility of unknown cause 至少有一側之輸卵管通暢 At least one side of the fallopian tube is unobstructed 精子數目非常少和 / 或無力畸形者 Necrospermia

5 (ICSI) 注入卵漿內 A Microinsemination technology. Select a sperm and inject it into the oocyte cytoplasma directly. 需要將卵子取出 ( 卵巢刺激排卵與 IVF 相同 ) It is necessary to take out the ovum (The stimulation of ovulation is the same to IVF) 精子的受精能力非常差的男性不孕症患者 Male infertility caused by bad fertilization ability 副睪穿刺精子吸取術 Microsurgical epidymal sperm aspiration (MESA) 精子是直接從副睪 ( 位於睪丸附近, 是精子成熟及儲存的地方 ) 抽出之後用 ICSI 技術 ( 單一精蟲卵漿內顯微注射 ) 進行受精 The sperm is directly obtained from the epididymis, which is located around the testis, and is the place where the sperm matures and is stored. Then, use ICSI to assist fertilization. 嚴重男性不孕者 Serious male sterility 射精之後精液內找不到精子 ( 無精症 ) There is no sperms in the semen (azoospermia) 先天異常 ( 如輸精管缺陷 ) congenital abnormality (such as Epididymis varicocele) 睪丸穿刺精子吸取術 Testicular Sperm Aspiration (TESA) 進行睪丸活檢直接從睪丸組織中取得精子之後以 ICSI 技術 ( 單一精蟲卵漿內顯微注射 ) 進行受精 Perform testis biopsy to get sperms from the testis. Then, use ICSI technology to assist fertilization. 嚴重男性不孕者 Serious male infertility 副睪穿刺或抽吸中找不到精子 No sperm can be found through Microsurgical epidymal sperm aspiration 副睪缺損 Epididymis deficiency 試管嬰兒 Test-tube baby 一般而言, 試管嬰兒的整個進行過程, 就是太太必須在月經週期的前一週期的第 21 天, 開始接受促性腺刺激素分泌賀爾蒙類似劑 (Gonadotropin Releasing Hormone analog, GnRHa), 藉以阻斷下視丘對腦下垂體的刺激作用, 讓它沒有辦法自行分泌性腺刺激素, 治療時間約 14~18 天. 然後在確定進入月經週期之後, 再利用排卵藥物, 刺激太太的卵巢產生較多的卵泡, 同時必須藉助超音波偵測儀, 定期的監測卵泡發育的情形, 並抽血檢

6 驗追蹤血液中動情激素的數值變化, 以決定何時取卵是最佳的時機 Generally speaking, during the whole process of test-tube baby, the wife must receive Gonadotropin Releasing Hormone analog (GnRHa) on the 21st day of the previous menstrual cycle, which can block the stimulation of hypothalamus on the pituitary, so that it can not excrete gonadotropin. After 14~18 days treatment when a new menstrual cycle begins, use ovulatory drugs to stimulate the ovary to product more ovarian follicles. At the same time, monitor the development status of the ovarian follicles regularly with trans-vaginal ultrasound and monitor the serum estrogen hormone level in order to determine the optimal time for oocytes retrieval. 而卵巢中最小的卵泡直徑只有 0.1~0.2mm 大小, 稱為原始卵母細胞, 月經初期卵泡直徑約 5mm 大小, 卵泡的生長情形, 會受到卵泡刺激激素 (Follicle Stimulation Hormone, FSH) 的作用, 讓卵泡繼續生長到約 8mm 大小, 動情激素就開始增加分泌, 當卵泡直徑增加到 15mm 大小時, 動情激素的分泌更為亢進, 大量的動情激素會促使腦下腺釋放出黃體刺激激素 (Luteinizing Hormone, LH), 以促使卵泡表面的部份組織變薄, 然後在采卵前 36 小時, 須提醒病人要注射人類絨毛膜性腺刺激素 (Human chorionic gonadotropin, hcg), 以準備采卵作業 The minimum ovarian follicles in the ovary is only 0.1~0.2mm in diameter, and is called as primordial oocyte. In the Menstrual phase, the diameter of the ovarian follicle is 5mm. The development of the ovarian follicle will be influenced by Follicle Stimulation Hormone (FSH). Till the ovarian follicle grows to 8mm in diameter, the estrogen hormone will be excreted. When the follicle grows to 15mm in diameter, the excretion of estrogen hormone is over active, and the enormous estrogen hormone will stimulate the pituitary to release Luteinizing Hormone (LH), which can help to thin the partial organs on the surface of ovarian follicle. 36 hours before the ovum retrieval, it is important to remind the patient to inject Human chorionic gonadotropin (hcg) as a preparation for oocytes retrieval. 采卵當天以陰道超音波導引下施行采卵, 取出的卵泡液直接送入實驗室處理, 再將卵子篩選出來, 放置到另一個新的培養皿內而先生的精液經過洗滌篩選處理後, 與太太的卵子經過 2~5 天的培養, 受精卵發育成為成熟的胚胎, 再將胚胎植入太太的輸卵管或子宮腔內通常黃體刺激激素在刺激排卵之後, 仍殘留在卵泡壁上的顆粒細胞與內膜細胞, 使之變成黃

7 體細胞, 黃體會分泌大量的黃體激素 (Progesterone, P4), 以利於胚胎的著床 On the very day, with the guidance of trans-vaginal ultrasound, oocytes are retrieved. Send the obtained ovarian follicles to the laboratory for treatment, and then select the good quality oocytes and place them on a new cultivate dish. The husband s sperm, after washed and purified, is applied to cultivate with the wife s oocytes for 2~5days. After the fertilized oocyte develops to mature embryo, transfer the embryo into the fallopian tube or uterus cavity. Generally, after stimulating the ovulation, the luteotropic hormone will still remain on the granular cells and endometrial cells to change them into corpus luteal cells. The corpus luteum will excrete enormous Progesterone, which is helpful for embedding. 一般試管嬰兒植入術, 其施行植入的方式可以分為 : Generally, the method for In Vitro Fertilization include: ( 一 ) 體外受精 / 胚胎植入術 (In-Vitro Fertilization/Embryo Transfer, IVF/ ET) 先生的精液經過洗滌篩選後, 直接在胚胎培養室與卵子進行體外培養, 經受精作用後, 受精卵培養到 48 小時以上, 發展到 2 個以上的細胞期 ( 包括 :4 個細胞期,8 個細胞期, 桑椹期或囊胚期, 分別有第 2,3,4 天植入和第 5 天植入等不同時間, 依病人臨床狀況需要決定 )( 圖 1-20, 圖 1-21, 圖 1-22, 圖 1-23, 圖 1-24), 胚胎再經過陰道及子宮頸, 將其植入子宮腔內, 適合於兩側輸卵管皆阻塞或粘黏的婦女, 或是經過多次人工授精失敗的不孕婦女, 都適合做體外受精 / 胚胎植入術 After washed and purified, the husband s semen is directly cultivated with the oocyes in vitro in the Embryo Cultivation Room. After fertilized, the fertilized oocyte is cultivated for more than 48 hours till it develops into over two-cell stage, including four-cell ovum stage, eight-cell stage, morula stage, and blastula stage, which requires transfer respectively on the 2nd, 3rd, 4th, and 5th day according o the clinic status of the patients (see Figure 1-20, 1-21, 1-22, 1-23, and 1-24). Then, through the vagina and cervix, the embryo is transfer into the uterus cavity. IVF/ET is applicable to women whose fallopian tubes

8 are both obstructed, or who suffers from infertility after several failure in artificial insemination. 圖 Figure 1 二前核期 (Two-Pronuclear phase, 2PN) 圖 Figure 2 胚胎發育進入 2 個細胞期 (Two-cell phase) 圖 Figure 3 胚胎發育進入 4 個細胞期 (Four-cell phase) 圖 Figure 4 胚胎發育進入 8 個細胞期 (Eight-cell phase) 圖 Figure 5 胚胎發育進入桑椹期 (Morula phase) 圖 Figure 6 胚胎發育進入囊胚期 (Blastula stage)

2 3 4 5 22 22 23 25 35 38 39 45 46 1

97017626 O O 2 3 4 5 22 22 23 25 35 38 39 45 46 1 intrauterine insemination IUI 202 IUI a 24 IUI b 24 IUI c hcg 36 IUI d hcg 24 48 IUI 202 262 30 2 1 27 1 14.9% 11.5% a 122 151 13.9%, 11.3% b 42 46 2.38%,