人工受精-Intrauterine Insemination (IUI) or Artificial insemination with husband sperm (AIH)

版主: 克莉絲

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寶醫師
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註冊時間: 2013年 10月 15日, 07:38

2019年 1月 2日, 02:33

作者: 陳啟煌醫師
台北醫學大學附設醫院不孕科主任
台北醫學大學醫學系副教授

什麼是子宮內受精?
子宮腔內人工授精(IUI)是專門準備的助孕醫療介入,男性精液將由“離心機洗滌去雜質及激活濃縮後跨過子宮頸慢慢送入子宮腔,使精子更快達到輸卵管遠端達到受孕的目的。精子濃縮到子宮腔內,繞過子宮頸。這是接近排卵時間(釋放的卵)

IUI並不適合每個懷孕困難的夫婦,但是什麼時候適當使用會導致懷孕率接近
同一年齡段的夫妻(例如30歲的人可以預期每個週期懷孕率約10-20%)。許多夫妻喜歡避免更複雜的治療方法如IVF。
在許多情況下IUI便宜些,更便宜。但是,建議在最多三次之後不成功,應考慮到體外受精(IVF)。

考慮IUI治療的原因

女性不孕症
1不明原因的不孕症
這是IUI最常見的條件。
伴有輕度卵巢刺激,出現較好的妊娠率
IUI。
2輸卵管疾病
應該至少有一個正常通暢的輸卵管和卵巢。
3子宮內膜異位症
宮腔內人工授精用於輕度形式,但不用於嚴重
子宮內膜異位症。
4. 年紀
這種方法已被證明在婦女38歲以下適應較佳。

男性不育
輕度精子異常
IUI是一種有效的治療方法,有少量精子異常。但精子質量很差(數量少,減少運動或異常形狀的精子及自然週期'IUI結果非常差,但如此情況下,不建議IUI。


排卵誘導/宮內授精
自然生理週期在一個女人的月經週期中,她的卵巢會有一顆主導含有卵子的卵泡。開始後14天一個女人的最後一個時期,這個卵子會長大,卵子會成熟並被釋放(或排卵)。然後卵存活約24小時,在此期間它進入輸卵管並等待受精。這是女人的受孕著床的肥沃時光。通常通過血液測試確認排卵(測量水平在女性週期的特定階段的激素)或經陰道的超音波可觀察卵泡發育和子宮內膜厚度及是否有病灶。

心理社會影響
長期遠離伴侶的男性
選擇讓他們的精子冷凍後人工授精並不建議,解凍後精子耗損及活動力影響成敗。

IUI治療方案
IUI可以作為自然週期的一部分來完成。多醫生建議將其與克羅米芬或FSH的排卵誘導相結合注射,若內膜薄者,可直接用低劑量FSH的排卵誘導期望理想的可排卵泡約4-6顆最佳。

IUI過程注意:
在女性的月經期間開始的兩天:
1使用自然週期IUI,您需要到醫院生殖中心就診
2使用克羅米酚/ IUI克羅米芬檸檬酸鹽片劑
(1或2)通常從周期的第3-7天開始,並且您在第9-11天回診,驗血,然後通抽血或尿液試劑盒進行每日監測使用破卵針可能需要引起準時排卵的時機。
3使用FSH / IUI時,FSH注射將經期第2-5天開始,第一次注射通常由一名護士進行。如果需要,他們還會教您和/或您的伴侶如何進行皮下注射。然後每天注射FSH直到大約在第9-11天同時進行超聲波第11天的此後取決於排卵時機。當監測表明卵巢(和卵子)準備就緒時,最終使用注射hCG在36-48小時後施行人工授精。
4.再多數地區如台灣,人工生殖法規範IUI必須具夫妻身分。

我們建議人工授精前男禁慾3天。以自慰的方式取出精子精處理兩小時後,
只需幾分鐘。沒有涉及麻醉。醫師會將無菌窺器放入陰道,清除子宮頸上的粘液,然後通過一個小一次性導管灌助至少1000萬隻高活動力的濃縮精子子宮。這個簡單的程序通常不會很痛苦,但偶爾也會發生一些輕微的抽筋不適。然後你可以立即起床,重返工作崗位並開始正常的日常工作。我們也會建議人工授精隔日在同房一次。

可能的風險和並發症極少
感染
感染是罕見但重要的風險,不到500分之一
案例。如果您有既往盆腔感染史,您可能會得到
抗生素,以盡量減少這種風險。

程序失敗
在2%的IUI病例中,不可能將導管穿過子宮頸
完成程序。在這種情況下,精子可以放置得很高
在子宮頸中,它有自己的方式進入子宮。

卵巢過度刺激
合格及經驗豐富的不孕專科醫師調控,
很少女性會發展為卵巢過度刺激綜合徵(OHSS)
引起嚴重不適,噁心和腹脹。現代生殖醫學的進步,這是
一個較少見的併發症來自促排卵,但你如果出現任何這些症狀,請聯繫醫院。

多胎妊娠
促排卵超過3顆以上的卵泡排卵,多胎妊娠的風險本就較高。雖然華人世界的文化可接受雙胞胎,然而雙胞胎過程不可測的風險如早產,破水,安胎,妊娠高血壓所帶來的壓力及花費等負擔消耗更是醫師要謹慎把關的。
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