Therapeutics of Clinical Drugs 臨 床 藥 物 治 療 學 從 諾 貝 爾 醫 學 獎 探 究 IVF 與 用 藥 ART 新 竹 不 孕 症 試 管 嬰 兒 中 心 藥 師 黃 柏 燈 摘 要 IVF (in vitro fertilization) ART (assisted reproductive technology) IVFART 壹 前 言 3040 (IVF) (ART) 1978 400 1 貳 不 孕 病 因 (a) 35~40%(b) 30~35%(c) 10~15%(d) ( ) 10~15%(e) 5~10% 2 參 輔 助 生 殖 技 術 (ART) (artificial insemination, AID/AIH) (intrauterine insemination, IUI) (IVF) (gamete intrafallopian transfer, GIFT) (zygote intrafallopian transfer, ZIFT) (intracytoplasmic sperm injection, ICSI) (assisted hatching, AHA) (testicular sperm extraction, TESE) (microsurgical epididymal sperm aspirationmesa 274 藥 學 雜 誌 第 109 冊 107
臨 床 藥 物 治 療 學 Therapeutics of Clinical Drugs percutaneous epididymal sperm aspiration PESA) 3 肆 藥 物 選 擇 ART clomiphene citrate (CC) ( 3~75~950100 mg) (gonadotropin, Gn) 1315 (human urochoriogonadotropin, HCG) (GnRH) (r-fsh) Gn 3~6 15%5% 2% 21-hydroxylase dehydroepiandrosterone (DHEA) () (DHEA>200 mg/dl)dhea CC dexamethasone CC DHEA CC CC (prolactinprl >26 ng/ml) PRL GnRH 2 2 HCG ZIFT CC FSH IUI IVF CC IUI doxycycline ART 5 (GnRH-agonist, GnRH-a) GnRH 610 Gn LH FSH 2 (estradiole2) 35 pg/ml HMG FSH (GnRHantagonist, GnRH-ant) cetrorelix () GnRH-a Gn GnRH-a LH FSH IVF 5~6 GnRH-ant LH 108 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.4
IVF ART 2 GnRH-a GnRH-ant LH IVF 30~50% 4 表 一 ART 性 腺 刺 激 素 分 類 與 特 徵 / (LH) lutropin- rlh/ 100% LH Luveris; Lhadi (HCG) Human Urochoriogonado tropin uhcg/ <100% HCG Pregnyl; Novarel choriogonado tropin- (FSH) Menotropin urofollitropin (UF) UF follitropin- follitropin- rhcg/ ufsh:ulh/ ufsh:ulh/ rfsh/ 100% HCG 50:50% 75:25% 66:33% 99:1% 99.9:0.1% 100% 100% Ovidrel Pergonal; Merional Nomegon Menopur Metrodin; Follegon Metrodin HP; Fostimon Gonal-F Puregon 表 二 常 見 ART 用 藥 Progestins (P) 1. 2. 3. Clomiphene citrate (CC) Clomid 1. 2. Gonadotropin (Gn) HMGFSH 1. 2. Gonadotropinreleasing hormoneagonist (GnRH-a) goserelin buserelin triptorelin leuprolide nafarelin 1. 2. 3.LH 4. 5. Human chorionic gonadotropin HCG 5000 1500 (IU) 1. 2.- 3. (HCGhCG) Gonadotropinreleasing hormoneantagonist (GnRH-ant) cetrorelix ganirelix 1.GnRH-a1~5 2. 伍 ART 手 術 演 進 100 IVFAHA ART ART 3,4 陸 ART 時 效 探 討 與 兩 性 不 孕 診 治 IVF IUI ART6 6 274 藥 學 雜 誌 第 109 冊 109
臨 床 藥 物 治 療 學 Therapeutics of Clinical Drugs IUI ART ART 35 1 3~5 ART AIH AID 3~6 (IUI) (IVF) 2~3 1 (~21) 10 (Gn) ( 10~13) ( HCG) 34~3616 15 IVFGIFT ZIFT5 2 AHA () IVF 5 表 三 ART 手 術 流 程 與 應 用 時 機 ( I V F ZIFT) (GIFT) ( ICSI) (AHA) CC Gn GnRH-a GnRH-ant HCG 25-50% CC Gn GnRH-a GnRH-ant HCG 30-40% 60~70% 30% ART 95% 25% (MESAPESA TESE) 1. 2. 3. IUI 4. 5. 1. 2. 3. 4. 1. / 2. 3.IUI 4. 5. 1. 2. 3. 4. 1. 2. 3. IVF 4. 5. 6. 110 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.4
IVF ART 參 考 資 料 : 1. 1999: 27-158 2. Giudice LC, Kao LC. Endometriosis: Lancet, 2004; 364: 1789-1799. 3. Oktay K, Buyuk E, Veeck L., et al: Embryo development after heterotopic transplantation of cryopreserved ovarian tissue: Lancet, 2004; 363: 837-840. 4. Bhattacharya S, Hamilton MP, Shaaban M., et al: Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial: Lancet, 2001; 357: 2075-2079. 5. Huirne JA, Lambalk CB. Gonadotropin-releasinghormone- receptor antagonists: Lancet, 2001; 358: 1793-1803. Discussion of IVF and ART from Nobel Prize for Medicine Bo-Deng Huang Pharmacy of JOG & IVF Center of Hsin-Chu Abstract Many inclusive diseases of cancerous lesions or early or late pregnancy induced infertility make more and more social and familial problems today. Luckily, IVF centers improve and change theses conditions by ART and medical-pharmacological cooperation from IVF father Robert G. Edwards (Winner of Nobel prize for medicine). Therefore, early diagnosis and treatment strategy of ART regimen nowadays is very important topic in clinical pharmacy of Formosa. 274 藥 學 雜 誌 第 109 冊 111