I HC AN GIANG
SEMINAR
THUT H TR SINH SN
I HC AN GIANG
SEMINAR
THUT H TR SINH SN
NG DN
ThS. H Th Thu Ba
1. Bung San Ny Thanh Hng Anh
2. Nguyt Lynh
3.
4. Ng
5. p
6. Trn
7. Nguyn Ngc H
i
Ni dung Trang
i
ii
1
2
2
2
2
4
IVF (In-vitro Fertilization) 4
ICSI (Intracytoplasmic Sperm Injection) 5
2.2.3. T IVM (Invitro Maturation of Oocytes) 5
Oocyte donation 6
- Frozen Embryo Transfer (FET) 6
6
6
9
9
9
9
3.2.2. Chun b y 13
3.2.3. Th tinh 14
3.2.4. Chuy 16
a vic th tinh trong ng nghim 18
19
20
ii
Ni dung Trang
7
11
th tinh trong ng nghim vi tri cho 12
n c 14
nh chp kt qu ng (ICSI) 16
cung 17
1
ng
-
g7 10
n
2
2.1. V
(WHO, 2000).
- :
-
:
2.1.2.
2.1.2.1
3
2.1.2.
Prolactin
2.1.
-
-
-
-
-
4
2.1.
-
-
- ?
2.1.
2.1.
2.2.
2.2.1. IVF (In-vitro Fertilization)
-
-
-
-
-
t:
-
-
-
-
-
5
2.2.2. ICSI (Intracytoplasmic Sperm Injection)
Ch nh ca ICSI:
-
- .
- .
-
t k thut:
-
-
-
-
-
2.2.3. IVM (Invitro Maturation of Oocytes)
:
-
-
-
-
-
-
-
6
2.2.4. Oocyte donation
.
:
- .
- .
- .
- .
- .
- .
2.2.5. Frozen Embryo Transfer (FET)
- .
- .
- .
2.2.6.
k.
- .
- .
- .
- .
2.2.7.
2.2.7.1.
- .
7
-
-
1:
2.2.7.2.
- cal Epididymal Sperm
Aspiration MESA): L
-
Aspiration PESA): L
- TESA):
-
TESE):
k
.
8
2.2.7.3. h
-
-
-
-
-
-
-
-
-
-
9
t
(In-vitro Fertilization – IVF)
3.1.
1/3
-vitro fertilization IVF
- n.
-
-
-
2 8 2 3
v
3.2.1.
3.2.1.1.
e e
10
(Follice Stimulating Hormone),
s
3 4.
10
-
10 14 -F
-
mg)
CG
(Pre
11
2:
IVF 20) tro
2
a tr
12
3: th tinh trong ng nghim vi tri cho
3.2.1.2.
o
p
Gam
h t
ro
THỤ TINH
TRONG ỐNG NGHIỆM
PHÔI
Tinh trùng
Trứng
Vợ
(mang thai và sinh)
Chồng
Người hiến trứng
13
3.2.2. Chun b y
i vng s d
cy n th n cc
ng huyng th bng mt na so vi n
u qu c
ng th i ta s dt cn thit cho s hong ca
m: ion Ca
2+
, glucose, lactate, bicacbonat, t l Na
+
/K
+
gn ging vi t l ca
ch ng dn trt protein ph n Ca
2+
cn thit cho
phn ng cng th tip tc theo trong phn ng.
Protein c bi kh n chuy
a hu hh vt.
pH cng th tinh trong ng nghim khong 7,n ging vi ca
th y ra n ng
acid.
ng th d nh pH. Bi v khi ta
n sinh ra CO
2
dng s
kt hp gia h
2
ng s nh pH cng.
y trong in vitro hong ph mt c
y mt lp d o ht ng
m s i n cp d
t bi, vi sinh vt bt lp
d n s
2
.
Tr
c th tinh trong mc kit ch.
14
3.2.3. Th tinh
c thu nhn tinh sho c chung vi trng trong mt petri
nhi . Nu s th ng s
Ch cy ch gi ting
c cy cn phch lp t m m tra du
hiu th nh hai tit c c thc hin
n vi.
Sau khi kim tra, tr c chuyng m tip tn
24 gi trong t cy CO
2
.
Vic kim tra th c thc hin t 16 18 gi ng s t tr li t
cy. Trng th tinh s c kim tra ln th pn
cng t cung.
4: n ca
n trong nhu kin tt v nhi king
cng cy
ng thun li cho vi sinh v gim thi
15
c sau khi nm vng k nng cn thit v
Mt s ng hp s th y ra do tinh tr ho c
tr kt hp v khim khuyt
dng (ICSI Intracytoplamic sperm injection).
thut h tr th tinh (assisted fe tinh gia
tri hiu qu
c chng minh, s ng dng ca ICSI trong k thut h tr sinh sn
( c m rng. IC c thc hin bng k thu
c vi s h tr ca h th
thuc s d
giao t u vi phu thut trong ngo i chc
a mt t chc, m
m nh. Nhng ng d u
th k 20 thu u trong sinh hc m t
c bic sinh s thuc ng dng
n gen, to ging, sinh thi, sinh s
t trong nh sinh hn
c k 21 th k sinh hc.
c hin ICSI
Khong 5 gi sau khi ch ng, tr ng Gamete 20 cha
yaluronidase n p t ng. Vi
c h tr b dn t
150 100 mn vi soi ni (stereomicroscope).
Trm
sau khi ly . Tt c ng
c ph mt lp du (Ovoil t n vi
i m 37
0
thc hing
c thc hic (inverted microscope ) vi h th
(micromanipulation) i 200 ln.
ng 5 6 mm s t
c nh bt kim gi trng (holding pipette) vi
ng 30 ng cha
16
tr gi c nh tr
t
ng.
5: nh chp kt qu ng (ICSI)
Tr y trong t cy CO
2
c
thc hin gi tr ICSI, trng th tinh s cho tr l
cy. Sau khi bu cy truy cung.
3.2.4. Chuy
Hai tun sau khi chuy bm th thai bng
hCG trong huyn dch enzym). Nm th
b c hn ng t cung.
t cung.
Chun b ni mc t cung cho vic chuyng estrogen
ng thai m bo v u kin v ni mc t
c c
Vi cn thit trong mt s ng hp b
ni soi b ng qm cht d
17
Chuy
ng t i v,
6: Chuy cung
c chuyt mc t cung nh k thun
ng. i ta chuyn khong 2 3 ng tng t cung. i
nng tc tr l s dng li. t mt v
t nht trong t ng s c nh ng th thu
m ngh trong 2 gi m vin na.
Sau khi chuy c s dng thuc Hormone nhm m
t l c ng cho thu h tr s n
c cung. m th ng thc hin
n s ng 2 3 tu nh thai trong t cung.
Vi c thc hing. M
nghi c ki ng t cung.
c thc hi nh vic th thai. Nng
(hCG) tn ng t n ra.
Kho hin, b c thc hi
nh vic mang thai.
B c chuyn s
T l ch l th tinh gia trng rt cao. hin
nay trn th gii t l ng sau mu tr ng
15%, t cung hoc do sy thai sm. i
n chng.
18
3.3. a ca vic th tinh trong ng nghim
Khc phn nam hay n hong bung trng
c ng dn trng hoc b tng hou ki
g, mt s ng hp c th
- T hi phc hoc bng m ni soi.
- o tc chng.
- Lc ni mc t cung nng.
- u ln (3 6 tht bi.
- ng qu yu, d dng
- c nghng dn tinh, phi ly tin c
phu thut.
- xin trng.
- u yu t kt hp.
- u, np v trng.
19
t lun
Vin hic quan
ng gng do rng
trng, lc ni mc t t t s ng ln
ng h
u tr him mu n hi
ni soi phu thu
c th tinh.
Nhiu k thut hic ng du tr m mu tinh
trong ng nghim g trng ICSI, th tinh ng nghim xin
trngi hiu qu cao.
K thut IVF Vic thc hin so v gi
vn nhanh ti Viu v u tr ca
nhiu b c nhic ting chc.
IVF thc hin so v thut h tr sinh s kim tra
c trong vic thc hii thc hin phu kinh nghim.
K thut ICSI tr t lc kt hp vc t l th
tinh gia tr t l m bo kh
u qu ca m tr sinh.
Do ng nhu tr
y s n ca nhi i cuc sng con
i.
20
u tham kho
Nguyn Th Ngng, Nguy M Ngc Lan.
1999. Him mun - thut h tr sinh sn. H
xut b H
Phan Kim Ngc. 2007. sinh hng vt. H
t bc T H
thut h tr sinh sn ti Bnh vin T c
tuyn]. Bnh vin T c t: />nguoi/hiem-muon/cac-ky-thuat-ho-tro-sinh-san-tai-benh-vien-tu-du/
20.09.2012).
K thut h tr sinh sn [trc tuyn]. Bnh vin T
c t: />muon/icsi-cong-nghe-ho-tro-sinh-san/
Trn Th Hn cn bi ICSI [trc tuyn]. Bnh vin T
c t: