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1. Đánh giá hiệu quả của phương pháp tiêm tinh trùng đông lạnh thu nhận
từ phẫu thuật vào bào tương noãn tại bệnh viện phụ sản Trung Ương.
2. Phân tích một số yếu tố ảnh hưởng đến hiệu quả của phương pháp tiêm
tinh trùng đông lạnh thu nhận từ phẫu thuật vào bào tương noãn.
2
34/567
869:;<7=7>:
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DThqRH:|}t87MC|}tH12d;)FB_,-
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++2+7 |}t,E|=Phác đồ ngắn: |}t12
A7 ht;,-=I58d112JOP
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.7)!R/+cJt*=S;)FB'g$W
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1.2.1. Đông lạnh phôi
oQF(),LM+q:5Q()
=>8+99(!F;5+9;,-FR+9
1@36;+95Q7p*(u.,9FR12+91@
F;+916=I9YR129(!:5!+5
R,5+97)s5+1@+5+9(!,519
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1.2.2. Đông tinh trùng
KLM)F12JO512+8,Y(_FA6
1 ,jF/Oj!35_=SF3+Qi_(12
A1 9R,N9eYPJOi2+`AY=
1.2.3. Đông noãn
o9N112JO512+{E8,9(_F12
A)F72<0N),9jA1
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,/Oj!35_‡Z8,Z#Z=
>N,N912+Z()DEDR,d+,Z
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(Q);5,-9Nc_+=
1.2.4. Xin, cho phôi, noãn, tinh trùng
EY/12+,9YA6,9YN3.7MF+Z
.AN6A1=k*12+,9Y+9
ip)YYRj+9=
1.2.5. Tiêm tinh trùng vào bào tương noãn (ICSI)
DEDCgF+(+GH(),LM.A75
jf(uA7))1@N=KLM)F0+,R512U(
3ZZ,Z#Y+9=r7MF3DEDY++qO7)
#nZ*,-tS=
5
1.2.6. Kỹ thuật lấy tinh trùng từ tinh hoàn và mào tinh
E5,LM)F5Q79j_,9Y
ACa+H.d6,9d.`=SA12
11:)))3.7MF+Z)DEDR7 N=
1.2.7. Hỗ trợ phôi thoát màng (assisted hatching)
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1.2.8. Chẩn đoán di truyền tiền làm tổ (PGD)
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1.2.9. Nuôi cấy noãn non (IVM)
S1:)BCD7gDTkH(),LM9B
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Các vị trí có thể thu nhận được tinh trùng từ cơ quan sinh dục
E@n.8)3)3.`303
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F3F)!=>d7PZ+`<7)(u
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1.4.1. Phân loại và nguyên nhân.
•S_0Z+`{79.5q1@jZF{
g S1 ){ 5 1 2+ F ) . F Q
CF+.+ F+.H3 ˆ C* B K((H3d +Z
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g T9,9.d{C7a+g>w"H•\X().
)3YR.FF.;Q3*(u.F/1*
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9
1.4.2. Các biện pháp điều trị cho bệnh nhân vô tinh
T *,LM†2Z36(),LMA
7))1@NCDEDH3@*YP12+797 i
Ap)F)12Z3!7+ZjA=
o67 *712M,LM9(!A7)9
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3)F+`MMA;)F)=
g I`M12,RMM7)YR()*
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CE"TrH3.€,.)m()7_/_(2=!Y3,nZ
m+*_/7),7)F/,LM7=
g I`M(_FA,2+7 DED=oQF()(<)5
12+E"rT3172( q3Yq1@7cB3Z.P8
BFY =SP12+)FAYR12
M;)F)=tF3+1@+5+(_FA;
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• OS+]\{1+B!+@=!7j
A3*12+7`YRY7 iAp=
g >P12+79.F);QCF+.+
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7`c112_=
10
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R()+5+12(<=KLMSll7+`YR#,Z#p
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?@W@3#OP''$+#!^R
1.5.1. Lấy tinh trùng từ mào tinh bằng vi phẫu thuật (Microsurgical Epididymal
Sperm Aspiration-MESA)
kl"()+1@+5+As+`M:)3
125+.)9:P1,9A._Z.`
ˆC((3$%''H=S,LM)F3)e12*(*
7)nY3A;5F)e12M+=S
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,Z $\g$[X= SF 7 DED3 U ( )F # ( ,Z W[gWVX
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9712Askl"1;%\X:(Ct(.
7)3$%%&‡.gIa7)3?\\\H=
SFY*FR1ijQ(_m1cb1
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1,LM)F{++55)*7Ap=k*1Rn
<,5()7 ,LM)F3(12A12/7)YR12
P(!Ct(.7)3$%%&H=
1.5.2. Lấy tinh trùng từ mào tinh bằng xuyên kim qua da (Percutaneous Epididymal
Sperm Aspiration-PESA)
7 kl"3Il"()*+1@+5+ijQ(_12E‚7)77
/O#$%%[CIl"H3YR127 QF!†37 U()
9,Z•VX=2RIl"()ijQ(_3YR12/
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kl"Ck(3$%%&H=>/B_F,9Y,57/U
(mU((Q)P,LMkl"7)Il"
11
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1.5.3. Lấy tinh trùng từ tinh hoàn bằng chọc hút (Testicular Sperm Aspiration-TESA)
EY/+1@+5+R12A;)6Rˆ5
)<=K*,?$|Fb@P12f.3,LM)FY
()h>.("+gh>"H=oQF()P,LM@Z3.z
7)YR,9QF)Q=
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.,LMh>"CSF7)3$%%'H]'^=S*B5
nZPSll7)h>"31_F,9Y,5PU(3
+Q+9FU(Y7 ,LMDED
1.5.4. Lấy tinh trùng từ tinh hoàn bằng phẫu thuật xẻ tinh hoàn (Testicular
Sperm Extraction-TESE)
KLM)F1@)ˆ5=oRYR12
A,LM)F35`(_F12e125b612f
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tF(.3r>"=•PQY(!n5p3U(
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1.6.1.Định nghĩa
SP(!(),LM12s(1Pf3+9:
*>@(bCg$%•
EH*,12f.(!=
1.6.2. Lich sử về kỹ thuật trữ lạnh
>#$&&•3+((a(557/,Z#YA
,12(1PF=>#$'••kaaN1P2u7/$
Q)(1PA=>1+Z#$%[%3,I(7)8N
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A :)$P,LMn<7)12+5R=
13
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YY,LM9(!,9C3$%V[3$%•WH=k*P,5
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>*@(b:g$%•
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14
1.6.3. Tác động của nhiệt độ thấp lên hệ sinh vật
•*_+3<!*</;(!=
S;P#,U$'35),<N)5f
7/5**_+(<3()/Z5<F7/
P(!=E ,I(7)8`p5_ZnZ9
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7M(u3Y<n5p9)3p)R5*!
)3m1Z1:*()(!3N97)*ZnZ•==
1.6.3.1.Cơ chế vật lý của sự đông lạnh tế bào:
>1 %\XRi)3Y7cn<.Fp
)=Ei7p)@n<_n5p9(!
)Y()+M1 n5p9(!=oRR€@)F
+Z7/12M9_(b=
• EM9C+(H()MP9Z121 7)_(b
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,(!p,ejZF7)*F(M+B#:(!R9=KL
M)F<()x.‘7)12B.R,R59=SR12!
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7)1 ,p)R53*#:(! R7)c.Fp
:BYn5pp)53YZj
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1.6.3.2. Các tổn thương của tế bào trong quá trình đông lạnh:
E5q1@YRQF)jZF:,Z*;g$V
g•\
E))+ZZn?({*(n5p9(!37)*
(,N9=•*g$%•
E3,9*+ZB)YRjZFQF
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)37),9YaF)!*:*)F5q1@r>"
,912fP3,)12N9:7/*(u3q1@
)FeQF)=
gS;*$VjV
E3FQFq1@i)F
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.QF79d=S,5q1@)F/YR+c5123p
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)P(!365))(+.1B6+9$()=
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c8*3919_F)1.AEw?()R
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R),9)_*)3())+8(7)+5F7A
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g KR5*()(!=
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1.6.4. Chỉ số đánh giá hiệu quả của trữ đông tinh trùng.
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1.6.5.Các quy trình đông lạnh tinh trùng thu nhận từ phẫu thuật[10]
1.6.5.1. Giới thiệu
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24
1.7.3. Các nghiên cứu trên thế giới về hiệu quả của ICSI giữa sử dụng tinh trùng
tươi, tinh trùng đông thu nhận từ mào tinh và tinh hoàn.[21],[22],[23]
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25