男性不孕症之相關檢查

約有2000個基因與精蟲生長有關
其中只有30個基因位於Y染色體

http://www.jhrsonline.org/article.asp?issn=0974-1208;year=2013;volume=6;issue=3;spage=176;epage=182;aulast=Esteves

Spermatogenesis starts in adolescence and is controlled by genetic factors. It has been estimated that 2000 genes are essential for the full process to be completed; of these, only 30 genes are present in the Y chromosome. ^[12],[13]

男性不孕症之相關檢查

Table 1: Genetic tests in unexplained male infertility

COH過程需考量2波FSH window

長療程可能優於短療程
pill+fixed GnRHantagonist可能優於flexible  GnRHantagonist

 we believe that stable and early suppression of endogenous gonadotrophins may be advantageous to achieve follicular synchronization and the highest clinical pregnancy rates. This may be achieved by either a long GnRH agonist protocol or a ‘long’ GnRH antagonist protocol (i.e. OC pretreated fixed GnRH antagonist protocol). In this respect, short or flexible regimens seem to be far from optimal. 

誘導排卵COH過程需考量2波FSH window




http://humrep.oxfordjournals.org/content/22/11/2805.full

IVF胚胎染色體正常比率

Day3前胚胎染色體正常率約30-35%
早期囊胚期染色體正常率約42%
成熟囊胚期染色體正常率約65%

著床前後子宮內膜線體之變化

著床前後子宮內膜線體之變化

http://humupd.oxfordjournals.org/content/13/4/365.full

GnRHantagonist 造成子宮內膜雌激素&黃體接受體表現下降

GnRHantagonist 造成子宮內膜雌激素ER alpha&黃體接受體PR表現下降

This study has shown that under the effect of a GnRH antagonist and rFSH with luteal phase progesterone supplementation, there is a significant down-regulation of PR in the surface epithelium. 


http://humrep.oxfordjournals.org/content/22/11/2981.full

clomid使用於誘導排卵會造成子宮內膜延後黃體化1-2天

FSH使用於誘導排卵會造成子宮內膜提早黃體化1-2天

clomid使用於誘導排卵會造成子宮內膜延後黃體化1-2天&子宮內膜變差
reduction of pinopod formation in the mid-luteal phase (Creus et al., 2003). 
The glandular density is reduced 

http://humupd.oxfordjournals.org/content/12/5/617.full

COH時間越長,可能造成子宮內膜老化, 進而降低懷孕率

COH時間越長, 延長濾泡期, 植入時間往後延後之結果，可能造成子宮內膜受E2刺激時間延長,造成子宮內膜老化,  進而降低懷孕率

http://humrep.oxfordjournals.org/content/21/4/1012.full

延後2天取卵可取較多卵子

傳統取卵時機為達3顆卵子>1.7cm
若不考慮內膜老化因素(轉為冷凍胚胎保存), 延後2天取卵可取較多卵子,

http://humrep.oxfordjournals.org/content/20/9/2453.full

http://www.ncbi.nlm.nih.gov/pubmed/15236997?dopt=Abstract