不育成因 (四)

其他

l   輸卵管疾病

輸卵管疾病即是指輸卵管阻塞或受損。

子宮內膜異位症、腹部或婦科手術後形成的疤痕組織、細菌感染以及輸卵管結紮，都有可能導致輸卵管阻塞或受損。視乎形成輸卵管疾病的根本原因，有關症狀可能包括子宮異常出血、痛經、行房疼痛，盆腔痛以及停經。

l   年齡增長

隨著年齡增長，女性受孕及成功生産的機會率就會下降。女性在二十幾歲時的生育能力是三十幾嵗時的接近兩倍。女性的生育能力從30歲後便開始慢慢衰退，40歲之後衰退的情況會變得更嚴重。

l   子宮外孕

這是指受精卵著床在子宮腔以外的情況。子宮外孕常見於輸卵管處，當受精卵在輸卵管處受阻時，就會在該處開始發育。在罕見的情況下，受精卵可以著床在其他部位，例如卵巢上、子宮頸内或者腹部。

l   高催乳素血症

什麽是高催乳素血症？

這是指腦垂體產生過量催乳激素的情況。催乳激素是一種促進女性乳汁分泌的荷爾蒙，通常在懷孕期間及產後會大量產生。

過量的催乳激素會導致卵巢所產生的雌性激素減少和抑制排卵。雌性激素不足會降低骨質密度、增加患上骨質疏鬆症的風險和心臟病的機會。

為什麼會患上高催乳素血症？

高催乳素血症的最常見成因是於製造催乳激素的腦垂體出現良性腫瘤。甲狀腺功能不足或者服用某些藥物都會導致高催乳素血症。

症狀:

－月經失調

－乳溢症（非懷孕期間分泌乳汁）

l   復發性流產

是指女性連續三次或以上自然流產的現象。

35歲以上的女性更易出現流產。吸煙、咖啡因、酒精以及藥物都會增加流產風險。復發性流產的成因衆多，最常見的是遺傳缺陷、感染或者子宮頸過於脆弱而無法承載胎兒（宮頸機能不全）。

導致男性及女性不育的成因

這些成因包括體重過重或過輕、性傳染病、接受某種療程或藥物、吸煙、生活壓力、工作以及環境因素例如接觸某種殺蟲劑、金屬或化學溶劑。
 

參考資料: fertility.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向自己的婦產科醫生查詢，而不應單倚賴以上提供的資料。

不育成因 (三)

l   女性生殖系統的結構問題

此類問題可影響卵子從卵巢到子宮的輸送、受精卵進入子宮以及在子宮内的生長過程，從而導致受孕困難。

l   子宮內膜異位症

什麽是子宮內膜異位症？

子宮內膜異位是指子宮內膜組織生長到子宮腔以外，並粘附在卵巢及輸卵管等腹腔器官上的現象。

與在子宮内生長的組織一樣，異常生長的組織與月經週期荷爾蒙有關。正常的子宮內膜組織分佈在子宮内並透過月經，從陰道排出。而粘附在子宮以外的異常組織則不能透過陰道排出，從而形成血池和疤痕組織。這些疤痕組織會堵塞輸卵管或者影響排卵。此外，在卵巢内生長的內膜異位組織可能會形成一種被稱爲「子宮內膜瘤」的卵巢腫塊，同樣會干擾排卵。

為什麼會患上這症狀？

有些專家認爲此症狀是由於月經組織逆流至輸卵管而引起。不過，此理論尚未能得以完全證實，一個比較完整的解釋還有待進一步研究。

症狀:

－經痛；

－經期過長或經血過多；

－復發性盆腔痛或者行房疼痛；

－某些情況下沒有明顯徵狀。

l   子宮纖維瘤

什麽是子宮纖維瘤？

子宮纖維瘤亦被稱爲子宮肌瘤，是指在子宮内部或子宮上生長的非癌性腫瘤。子宮肌瘤是從子宮的平滑肌細胞生長而來，可以生長在子宮的内部或外部。

為什麼會出現這種情況？

子宮纖維瘤的成因尚未確定，但這些纖維瘤需要雌性激素才能生長，所以在停經之後一般會縮小。

症狀:

視乎纖維瘤的數量、大小以及部位，症狀可能包括：

－嚴重痛經

－經期過長或經血過多

－若纖維瘤壓住直腸或膀胱，可能出現排便或排尿困難

－痔瘡

某些情況下，若纖維瘤較小，可能並無任何症狀，只有在進行不育檢查時才會發現。

(續)

參考資料: fertility.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向自己的婦產科醫生查詢，而不應單倚賴以上提供的資料。

不育成因 (二)

l   多囊卵巢綜合症（PCOS）

什麽是PCOS？

PCOS是指於卵巢內製造大量細小的卵泡，從表面看來，卵巢的形狀和大小都正常，可是卵泡過盛，未能得以成熟，影響甚至乎會導至不排卵。  PCOS患者體内通常出現促卵泡激素（FSH）不足，促黃體生成素（LH）過量的情況。

缺乏FSH令到卵泡無法成熟，阻礙排卵。結果不成熟的卵泡就在卵巢裏面形成細小的囊腫。

同時，在大量的LH作用下產生更多的雌性激素以及雄性激素包括睾酮（男性荷爾蒙），令子宮內膜組織異常增厚，同時會出現暗瘡及或面部毛髮異常生長的現象。

為什麼會患上PCOS？:

某些專家認爲PCOS是遺傳性疾病，不過其具體成因尚未確定。

症狀:

月經無規律、嚴重失調甚至停經；

暗瘡異常生長；

面部、胸部以及大腿毛髮過盛；

體重增加及肥胖；

不育。

l   卵巢早衰

是指卵巢在40嵗正常停經期之前就不再排卵並停止運作。這一疾病的成因尚未確定，但是，接受化學或藥物治療、患有自身免疫疾病以及遺傳變異，都會導致過早停經。

l   下丘腦性閉經

當下丘腦停止產生促性腺激素釋放素（GnRH）時，就會導致月經停止，從而出現這種病症。該病症常見於壓力持續、體重改變、營養不良以及運動過度的女性身上。下丘腦性閉經的罕見成因包括基因異常導致單一性促性腺激素缺乏或者GnRH受體變異。

l   排卵功能障礙

這情況包括排卵停止（沒有排卵）、排卵過少以及女運動員三聯症。成因通常是荷爾蒙失調、飲食失調、運動過度以及其他内科疾病而出現停止排卵或者排卵過少或不規則的情況。

(續)

參考資料: fertility.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向自己的婦產科醫生查詢，而不應單倚賴以上提供的資料。

不育成因 (一)

簡介

正計劃生育的夫婦如果經過一年嘗試而仍然未能成功懷孕，應及早向醫生求助。

一對生育年齡夫婦有正常的性生活，若連續在12個月內沒有採用任何避孕措施卻受孕失敗，醫學上便會定義為不育。本港有六分之一的夫婦受不育問題困擾。

儘早求診非常重要，因為生育能力測試及檢驗可能需要較長時間，而女性過了35歲之後，生育能力就會開始逐漸下降。

不育成因

不育的成因有許多，在發達國家（包括香港）當中，最常見的成因是精子異常、排卵問題以及輸卵管疾病。其中, 有少部份的不育個案會由多重成因或一些未知因素引起,，在這情況下，有可能會需要組合不同的治療方法。

男性不育

約有30%的不育個案是由於男性生殖系統問題所引起，主要是精子的製造或輸送不良。

l   精子製造異常

這是男性不育的最常見成因，有75%的個案由此引起。其中包括精子數量過低、精子活動能力較弱以及精子形狀異常。有關病變可能是由基因缺陷、感染、睾丸損傷，荷爾蒙失調、輻射或者某類藥物引起。

l   生理結構問題

不育可能由製造或輸送精子的管道出現阻塞或閉塞而引致。睾丸感染，睾丸癌或者進行手術後都會嚴重影響精液的品質；而射精管阻塞或閉塞有可能令精子無法到達陰道。

免疫系統病變

在此情況下，男性的抗體會攻擊自身的精子，從而影響其授精能力。

女性不育

女性不育估計約佔全部個案4成。

任何令女性生殖器官阻塞或受損或者損害荷爾蒙平衡的因素都可能導致女性不育。

l   排卵異常

這是女性不育的最常見成因。排卵異常的女性可能會出現經期不調甚至停經。這一情況可能是由多種病症引起，例如：

多囊卵巢綜合症（PCOS）

卵巢早衰

下丘腦性閉經

排卵功能障礙

(續)

參考資料: fertility.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向自己的婦產科醫生查詢，而不應單倚賴以上提供的資料。

The IVF process / ICSI procedure consists of the following stages

The IVF process / ICSI procedure consists of the following stages:

 Confirmation of marital status;
 Assessment and counseling;
 Investigations including blood group, full blood count, Rubella antibody, hepatitis B and C antibodies, HIV antigen/antibody and VDRL;
 Hormone assays;
 Signing of c onsent forms;
 Ovarian stimulation using hormone stimulating hormone to produce a number of eggs;
 Monitoring ovarian response by ultrasound and serum oestradiol level as indicated;
 Collection of eggs under ultrasound guidance;
 Preparation of the sperm for combining with the eggs in the laboratory, leading to fertilization. For ICSI, individual sperm are isolated and injected into each mature egg;
 Replacement of embryos into the uterus.
 Luteal support to assist endometrial preparation and subsequent implantation.






Reference: fertility.com.hk/
The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

IVF & ICSI (1)

Infertility treatment :

• IVF (In vitro fertilization), 
• ICSI (Intracytoplasmic sperm injection)

It involves ovarian stimulation to produce a number of eggs, which are collected under ultrasound guidance. With IVF, the eggs are mixed with prepared sperm and fertilization takes place over the next few hours. With lCSl, a single selected sperm is injected into the egg to fertilize it.

The resulting fertilised eggs are allowed to develop for 23 days Embryos are selected for transfer in to the uterus. Following embryo transfer, any remaining suitable embryos are cryopreserved for future transfer.

Indications for IVF may include:

Blocked, damaged or absent fallopian tubes;

Endometriosis;

Ovulatory problem;

Unexplained infertility; and

Sperm problems

ICSI may be applicable in particular when:

The sperm count is very low;

The sperm have low motility;

Very few normal sperm are present;

An attempt at IVF has resulted in failure of fertilization; and

Sperm are retrieved directly from the testis or epididymis using a

surgical technique.

Reference: fertility.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

Intrauterine insemination (IUI) and / or ovulation induction

This may be considered when at least one fallopian tube is patent and semen analysis is normal or near normal.


It involves ovarian stimulation with clomiphane citrate and / or follicle stimulating hormone (FSH or human menopausal gonadotropin). The response to these medications is monitored by ultrasound. Ovulation is triggered by human chorionic gonadotropin (HCG) 5,000 IU when not more than four ovarian follicles reach at least 1.6 cm diam. The semen sample is prepared and is then inseminated into the uterine cavity 24-36 hours later.

Occasionally intravaginal or intracervical insemination is performed when IUI is not technically possible or acceptable by the couple.
Insemination may have to be abandoned when more than four matured ovarian follicles are present.
In some cases, couples may request to have insemination only without prior ovarian stimulation or to have ovarian stimulation only followed by natural coitus.

Reference: fertility.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

Infertility treatment - Time intercourse, time intercourse conception

This is the most basic treatment for infertility by which patients can attempt pregnancy through timed intercourse. Patients may use a self-help urine test kit to detect the surge in Luteinizing hormone (LH) which occur prior to ovulation.

Alternatively vaginal ultrasound examination may be performed to monitor follicular development and an injection of human chorionic gonadotropin (HCG) is given to trigger ovulation when follicular maturation is observed. This method is the least invasive but is only applicable in the presence of at least one patent fallopian tube and natural ovulatory cycles.








Reference:  fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

In addition the following will be emphasized:

1. Prohibitions imposed by the Human Reproduction Technology Ordinance on unmarried partnership, sex selection and commercial dealings of gametes or embryos;
2. The requirement to have written consent from both husband and wife
3. Treatment procedures;
4. Possible side effects and risks including mood changes, anxiety, headaches, abdominal bloating or cramps, bleeding, infection,
5. ovarian hyperstimulation syndrome, ectopic pregnancy, miscarriage, multiple pregnancy and fetal anomaly.
6. Other adverse outcomes including failure at various stages of treatment such as failure of ovarian follicular development, egg collection, fertilization, embryo development or implantation and non-survival of rozen-thawed embryos
7. Costs
   
   
   

Reference: fertility.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

Before any treatment (3)

Patients are asked to consider carefully all possible implications before receiving RT services, such as:

A.          the implications of the reproductive technology (RT) procedure on themselves, their family and relatives, their social life, and any resulting or existing children;

B.          the financial implications of the RT procedure (e.g. there is the the possibility of multiple pregnancy);

C.          their feelings about manipulation of their own gametes or embryos outside their bodies, and the possible storage and disposal of gametes embryos;

D.         the chances that treatment may fail;

E.          the possibility of the need of embryonic/fetal reduction;

F.           the alternative of adoption of a child;

G.         the possibilities that the implications of and feelings about their RT procedure may change as personal circumstance changes;

H.         all the terms and conditions set out in the consent form;

Reference:fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

Before any treatment (2)

Assessment and counselling will take into account the welfare of the child as well as the couple's physical, mental and social well-being, including the following factors:

A.          their commitment to having and bringing up a child or children;

B.          their ability to provide a stable and supportive environment for any child born as a result of treatment;

C.          their medical histories and the medical histories of their families;

D.         their ages and likely future ability to look after or provide for a

E.          child’s need;

F.           their ability to meet the needs of any child or children who may be born as a result of treatment, including the implications of any possible multiple births or disability;

G.         any risk of harm to the child or children who may be born, including the risk of inherited disorders, problems during pregnancy and of neglect or abuse;

Reference:fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.

Before any treatment (1)

Management

Before treatment is offered patients are given relevant information and fair and unprejudiced counselling. Only married couples are eligible to use treatment involving reproductive technology. The female partners are normally between the ages of 18 and 45 and should enjoy good health with no contraindication to pregnancy.

Assessment and counselling

Counselling is available to help patients to cope with consequences of infertility and reproductive technology (RT) services. Couples seeking treatment are given adequate time to consider the matter after counselling before they make a decision as to whether to undergo the RT procedure. Counselling is also offered to support infertile people who are not suitable for RT procedure or those whose treatment has failed to allow them to adjust their expectation and to accept the situation. When indicated, patients are referred for specialist counselling or support group counseling as appropriate. International Social Service (Hong Kong Branch) is an independent organization offering psychological counselling, family therapy and remodelling of interpersonal relationships.
 


Reference:fertility.com.hk

The information aims to provide educational purpose only. Anyone reading it should consult obstetricians and gynecologists before considering treatment and should not rely on the information above.