Female Infertility 女性不孕症

Non-genetic Causes of Female Infertility

Pelvic Issues：Fallopian tube blockage or adhesions, Pelvic adhesions

Uterine Issues：Uterine fibroids, Uterine polyps, Uterine malformations, Intrauterine adhesions (Asherman's syndrome), Cervical stenosis or atresia, Endometriosis

Ovarian Issues：Ovulation disorders, Polycystic ovary syndrome (PCOS), Ovarian tumors, Premature ovarian insufficiency (POI)

Endocrine Disorders：Hyperprolactinemia, Hyperandrogenism, Luteal phase deficiency

Other or Multifactorial Causes：Environmental factors, Stress and psychological factors

基因以外的女性不孕症原因

骨盆腔的問題：輸卵管阻塞或粘黏、骨盆腔粘黏

子宮的問題：子宮腫瘤、子宮瘜肉、子宮畸形、子宮內膜粘黏、子宮頸狹窄或閉鎖、子宮內膜異位症

卵巢的問題：排卵障礙、多囊性卵巢、卵巢腫瘤、卵巢早衰

內分泌的問題：泌乳激素過高症、雄性激素過高症、黃體激素缺乏症

其他原因或多重因素：環境、壓力等

Female Infertility Evaluation

Hormonal Blood Tests

• Anti-Müllerian Hormone (AMH)

• Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)

• Prolactin (PRL)

• Thyroid-Stimulating Hormone (TSH)

• Testosterone (Androgens)

Hysterosalpingography (HSG)

The fallopian tubes play a critical role in natural conception. Blockages, hydrosalpinx (fluid in the fallopian tubes), or adhesions can significantly reduce the chances of natural or assisted pregnancy and may also negatively affect IVF outcomes.

This exam is typically performed after menstruation but before ovulation. A contrast dye is injected through the cervix, and X-ray imaging is used to assess whether the fallopian tubes are open. It also helps evaluate adhesions around the fimbrial end, identify abnormalities such as tubal disease, hydrosalpinx, and uterine malformations.

Hysteroscopy (TCR)

A hysteroscope is used to visualize the inside of the uterine cavity, allowing diagnosis of conditions such as:

• Endometrial polyps

• Intrauterine adhesions (Asherman's syndrome)

• Uterine septum

• Uterine fibroids

• Endometrial inflammation

Transvaginal Ultrasound (TVS)

Ultrasound imaging is used to evaluate uterine structure, monitor ovarian follicle development, and detect abnormalities like:

• Endometrial thickness and pattern

• Uterine fibroids

• Ovarian endometriomas (chocolate cysts)

• Endometriosis

2D Ultrasound：Evaluates follicle count and shape, Determines uterine position (anteverted or retroverted), Measures endometrial thickness, Recommended for routine gynecological checkups or women planning pregnancy

4D Ultrasound：Offers detailed follicle tracking, with each follicle color-coded, Assesses uterine cavity shape and surrounding tissues, Recommended for women with known ovulation disorders or suspected uterine abnormalities

女性不孕症檢查項目

血液荷爾蒙分析(Hormonal study)

• 抗穆勒氏管荷爾蒙（AMH）
• 荷爾蒙檢查（FSH、LH、E2）
• 泌乳激素（PRL）
• 甲狀腺促進素（TSH）
• 雄性荷爾蒙（Testosterone）

子宮輸卵管攝影(HSG)

輸卵管是成功懷孕的重要因素之一，如果輸卵管出現問題，會嚴重影響自然懷孕及人工受孕，而輸卵管水腫也有可能影響試管嬰兒的成功率。

於月經結束後排卵日前，從子宮頸口注入顯影劑，藉由X 光攝影可瞭解輸卵管是否通暢，還能知道輸卵管繖部周圍沾黏的程度， 判斷是否有病變、積水、子宮是否先天畸形等等。

子宮鏡檢查(TCR)

透過子宮鏡發現子宮腔內的病灶，幫助診斷子宮疾病，例如：子宮內膜瘜肉、子宮沾黏、子宮中膈、子宮肌瘤、子宮內膜發炎……等。

陰道超音波檢查(TVS)

透過超音波評估子宮構造上是否有異常，還能追蹤卵巢濾泡生長情形、子宮內膜狀態、肌瘤、巧克力囊腫及子宮內膜異位

2D超音波：濾泡數量和形狀子宮前傾或後傾及子宮內膜厚度適用婦科定期檢查、備孕婦女

4D超音波：濾泡數量和形狀且每顆濾泡以不同顏色標記子宮腔形狀及子宮周邊組織適用已知有排卵問題之婦女、懷疑有子宮腔結構異常之婦女

Female Infertility Treatments and Reproductive Procedures

A. Intrauterine Insemination (IUI)

Artificial insemination (IUI) is a reproductive technique where sperm, after being processed and selected for quality in the laboratory, is directly inserted into the woman's uterine cavity on the day of ovulation. The sperm must swim on its own to the end of the fallopian tube to fertilize the egg.

Suitable candidates for artificial insemination include:

• Women over 35 years old or with decreased ovarian reserve

• Mild endometriosis

• Irregular menstrual cycles

• Mild fallopian tube adhesions or mild blockage

• Unexplained infertility with normal test results

B. In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a reproductive technique where eggs and sperm are retrieved and fertilized outside the body in a laboratory. The resulting embryos are cultured and then implanted into the uterus.

Suitable candidates for IVF include:

• Women over 35 years with age-related decline in reproductive function

• Women with bilateral fallopian tube blockage or adhesions, or moderate to severe endometriosis

• Women with anovulation, polycystic ovary syndrome (PCOS), or poor ovarian response

• Women who have experienced multiple failed IUI attempts (3 or more)

• Unexplained infertility despite normal anatomical and reproductive function tests

• Other factors such as habitual miscarriage or known chromosomal abnormalities in the couple

女性不孕症治療與生殖療程

人工授精(人工受孕)

人工授精 (IUI)，是透過生殖醫療技術將男性精子經過實驗室處理後，挑選出品質優良的精子，在女性排卵日時注入子宮腔內，精蟲須自行游到輸卵管末端與卵子結合。

人工受孕針對女性不孕症的適合對象包含：

• 35歲以上或卵子庫存量減少的女性
• 輕微的子宮內膜異位症
• 月經週期不固定
• 輸卵管輕微粘黏或輕微阻塞
• 檢查後皆正常的不明原因不孕

試管嬰兒療程

試管嬰兒(IVF)，是將卵子與精子取出後，於實驗室進行體外受精，再將受精卵培養成胚胎，將其植入子宮的生殖醫療技術。

試管嬰兒針對女性不孕症的適合對象包含：

• 年齡已超過35歲，因年齡而造成生殖功能衰退的女性
• 雙側輸卵管阻塞或粘黏、中重度子宮內膜異位症女性
• 無排卵、多囊性卵巢症候群、卵巢反應低下症者
• 人工受孕失敗多次：已嘗試3次人工受孕仍未成功
• 不明因素：經不孕症檢查在解剖學及生殖機能無異常，仍無法自然懷孕
• 其他因素：習慣性流產或是夫妻已知染色體異常