不孕的定一年以上未取任何避孕措施，性生活正常而有成功妊娠。主要分原不孕及不孕。原不孕未受孕；不孕曾孕以後又不孕。根格的定，不孕是一常的，大影到至少10%～15%的育夫。引起不孕的病原因分男性不育和女性不孕。<耀元不孕症科>

病因:

引起不孕的病原因分男性不孕和女性不孕，1992年被世界生在和治不孕症最泛用分。首要的病因依次是：排卵障、精液常、卵管常、不明原因的不孕、子膜位症和其他如免疫不孕。另外因素是因素，包括所有因素超5%的窄。女性不孕主要以排卵障，卵管因素，子膜容受性常主，男性不孕主要是生精常及排精障。

1.女性不孕症 

(1)卵管性不孕卵管在拾卵子和卵子、精子和胚胎方面著重要作用；卵管也是精子能，精卵相遇、受精的所。感染和手操作易使卵管黏膜受，而毛消失，蠕障，以及阻塞或周粘，影卵管的通性功能。因此，卵管阻塞或通而不是女性不孕的重要原因。①感染盆腔感染是致卵管性不孕的主要因素。感染不引起卵管阻塞，且因瘢痕形成，使卵管壁僵硬和卵管周粘，改其卵巢的，影卵管的拾卵及送功能。感染的病原可由需氧和氧菌所致，也可由衣原、核菌、淋病球菌、支原等所致。②子膜位症盆腔子膜位症、卵巢子膜位症可形成腹膜粘，使卵管端外部粘或卵巢周粘，使成熟卵不能被入卵管；引起的泛粘可影受精卵的行。③卵管核卵管核在生殖器核中最常，表卵管增粗肥大、端外翻如斗，甚至端封；卵管僵直、，部分可乾酪或腹膜有粟粒。半卵管核患者同有子膜核。④卵管育後引起卵管水常，成卵管复通後影功能的重要因素。育後卵管近端和胞的病育短有，因此育後越，复通成功率越低。

(2)排卵障致的不孕症 慢性排卵障是很多分泌疾病的共同表，女的20%～25%。床表主要月不甚至，期短於26天或於32天提示有排卵常。病史可反映多毛症、男性化、溢乳及雌激素少等分泌病紊的信。1993年世界生（WHO）制定了排卵的分，共分三大。WHOⅠ型（低促性腺激素性排卵），WHOⅡ型（正常促性腺激素性排卵），WHOⅢ型（高促性腺激素性排卵）。WHOⅠ型：包括下丘（力、重、、神性食及其他）、Kallmann合徵（促性腺激素放激素前胞移行常）和促性腺激素缺陷等。典型的表是低促性腺激素性腺功能退：FSH低、E2低而泌乳素和甲腺素正常。WHOⅡ型：床上所碰到的大部分患者。即具有正常促性腺激素的卵巢功能紊，伴有不同程度的排卵或月稀。包括：PCOS，卵泡膜胞增生症和HAIRAN合徵（多毛，排卵，胰素抵抗和黑棘皮症）。典型表是：FSH、E2和泌乳素正常，但LH/FSH常常升高。WHOⅢ型：患者主要是末器官的缺陷或抵抗，表高促性腺激素性腺功能退，包括卵巢早衰和性腺育不全（卵巢抵抗）。典型表FSH及LH升高，低E2。患者的特是排卵的反差，卵巢功能已退。

(3)免疫性不孕症 目前不孕有的自身抗分：非器官特性自身抗和器官特性自身抗。前者指存在於不同的共同抗原的抗，如抗磷脂抗（APA）、抗核抗（ANA）、抗DNA抗等；後者指只某特性器官自身抗原的抗如抗精子抗（ASAb）、抗卵巢抗（AOVAb）、抗子膜抗（AEMAb）和抗毛膜促性腺激素抗（AhCGAb）等。目前非器官特性自身抗的抗原性比了解，APA和ANA的技也成熟和，床料富；而器官特性自身抗的抗原成分，的化程度低，它不孕的亦因分析、困而不易明，而影自身抗性的不孕患者的理。

(4)不明原因的不孕症 一不孕夫所查的各指都正常，而不孕原因又法解的候，即不明原因的不孕症。推不明原因不孕症的病因可能有以下方面：①不良的分泌物影；②子膜早期胚胎的接受性差；③卵管的蠕功能不良；④卵管端拾卵功能缺陷；⑤素化不破裂合徵；⑥微的激素分泌欠佳，如功能不足；⑦精子和卵子受精能力受；⑧度子膜位症；⑨免疫因素，如抗精子抗、抗透明抗或抗卵巢抗；⑩腹膜巨噬胞功能常；腹腔液中抗氧化功能受。

耀元，其真 -  博士科

耀元科 │地址:台中市南台中路12 │:04-222016660

不孕症、管、生殖分泌、微手│中民科科、中民人工生殖科、中民生殖科、中大附院部主治、教育部部定助理教授、教育部部定、中大科助理教授、中大科、中民子膜、中民科副主、中民科、新加坡大生殖中心不孕症研究, 著外不孕症“FERTILITY AND STERILITY”,“Human Reproduction”,“J Assist Reprod Genet”文查者

2.男性不孕症

(1)生殖器官等常①先天常：睾丸的先天性育常包括睾症、曲精管育不全（Klinefelter）、XYY合徵、男性假性畸形等。Klinefelter合徵染色核型多47，XXY；患者乳房女性化；睾丸小而硬，曲精管玻璃和化，精子生完全停止或重少。睾丸下降常也是男性不育的重要原因。睾丸下降常曲精管生殖胞的目少，睾丸小，重量也下降。睾丸在腹壁或腹腔的位置越高，曲精管的越大。睾丸下降常患者如不治，生育的可能性很小。②精管梗阻：精管、精囊先天性缺如，特徵是精液量少，常不足1ml，精果糖；炎症性梗阻，如附睾核；射精管梗阻少。手或精管等；以及前列腺炎、精囊炎均可引起精液量明下降。③精索曲：可致睾丸血液淤，有效血流量少，生精的正常微境遭到破，最使精原胞退化、萎，精子生成少，活力弱，畸形精子增多，重者可精子。④雄激素靶器官病，分型：完全性如睾丸女性化；不完全性如Reifenstein合徵。

(2)分泌常①主要原因是促性腺激素合成或分泌功能障。Kallmann合徵又性促性腺功能低下型性腺功能退症，下丘GnRH式放功能障，是常染色性病。床特徵是性成熟障，伴有嗅失，睾丸小、睾丸下降常、小及尿道下裂。血清睾酮水平低，LH和FSH水平於同年正常值下限。②性LH缺陷症：患者血清FSH水平正常，LH和睾酮水平低下，男性化不足，乳房育，但睾丸大小正常，精液有少量精子，故又“生育型”睾合徵。③垂瘤LH的分泌影最明，垂瘤是高泌乳素血症的最常原因，PRL高可致患者性退、勃起功能障、乳房育溢乳以及生精功能障。④上腺皮增生症中常不育相的是21-化酶缺陷，皮激素合成少，引起ACTH增加，上腺皮受到ACTH的度刺激而合成大量睾酮，後者抑制垂促性腺激素的分泌，而致不育。

(3)性功能障包括性退、勃起功能障、早、不射精和逆行射精等，精液不能正常射入道。

(4)免疫因素分，由男性生的抗精子自身免疫和由女性生的抗精子同免疫。精子免疫系由於血睾屏障的作用而隔，故男性或女性，精子抗原外抗原，具有很的抗原性。血睾屏障及精免疫抑制因子等因素共同建立了一套完整的免疫耐受制，生睾丸炎、附睾炎、前列腺炎、精囊炎，或行精管等手後，上述免疫耐受制被破，即可能生抗精子免疫反。

(5)感染因素腮腺炎病毒可引起睾丸炎，重者可引起永久性曲精管破和萎而生睾丸功能衰竭；梅毒螺旋也可以引起睾丸炎和附睾炎；淋病、核、病可引起精管梗阻；精液慢性菌感染，或支原、衣原感染可使精液中白胞增多，精液量降低，未成熟精子增加。

(6)理化因素境污染生精上皮快速分裂胞，故易受理化因素害。①、放射和有毒物均可使生精上皮落，或影胞和支持胞功能，妨生精程。生精上皮放射敏感。磷酰胺、氮芥等化物直接害生精上皮和胞功能。②某些境毒素天然激素有似的作用或，例如多氯苯（PCB）、四氯苯（TCDD）、二氯二苯氯乙烷（DDT）、己烯雌酚（DES）等。些毒素通污染空、水和食物而影人健康，包括男性精子的量和量持下降。

(7)物手史片物，抗癌物，化及抗高血物等可直接或接影精子生成。既往盆腔手史、膀胱、前列腺手史有可能引起射精功能退；疝修或睾丸固定有可能影精索或睾丸供血。

(8)不明原因的不育男性不育中31.6%的患者目前常用的查方法仍不能查出切病因。

<耀元不孕症科治>

合不孕症患者的床表、病史以及各室查行。

<耀元科不孕症、管科治>

1.卵管性不孕症的治

根病部位、粘程度、累及、不孕年限、是否合其他不孕原因、以及患者意合的治卵管性不孕的方法。

(1)卵管阻塞的治根卵管阻塞部位和程度的不同不同的治方案。①卵管端粘阻塞可行盆腔粘松解和卵管成形。如度卵管水可行卵管造口，可能卵管切除卵巢功能的影小，一方面既引流了有害的卵管水，又寄望通的改建，恢卵管的功能，而保留自然妊娠的可能；但有後粘再次形成水可能。水重、其功能已完全失不能保留的卵管可行卵管切除。切除量保留其膜，少卵巢血供的可能影。②卵管部阻塞手复通度大，复通率低，建直接行IVF-ET。③的卵管後部阻塞可以考行部位切除後的卵管部端端吻合。

(2)卵管通而不的治如通而不是由端部分阻塞和卵管部阻塞引起，可分按卵管阻塞的方法行治；卵管部和部部分阻塞的患者，腹腔可能有性，可以行腔下卵管插管疏通治。

(3)卵管慢性炎症的治用於卵管粘、阻塞程度，病短者等，否治效果不佳。可行口服活血化瘀中，中保留灌和穴位注射，配合超短波物理治等方法促局部血液循，有利於炎症消除。

(4)外受精-胚胎移植技（IVF-ET）卵管和盆腔整形手後6月至一年仍不能得自然妊娠的患者，得自然妊娠的已很低，一般不主再做成形手，而建直接用管（IVF-ET）。卵管因素不孕的患者向於用IVF，尤其是年大、不孕年限，合其他不孕因素，或上述手非手治效果不好，快用IVF，以免女性最佳生育期，致妊娠率下降。

2.排卵障性不孕症的治

排卵俗促排卵，是治排卵性不孕的主要手段，指有排卵障的患者用物或手方法卵巢的排卵功能。一般以卵泡或少卵泡育目的。主要用於排卵障性不孕的治和/或合腔人工受精技用。

3.免疫性不孕症的治

可少AsAb生、抑制AsAb生、去除合精子的AsAb、克服AsAb干方面著手。

(1)AsAb生隔法用期6月以上的安全套避孕，使原有的抗效降低或消失，又避免了精液抗原入女性生殖道生新的抗，效不定。目前一般其他治方法合用，或在非排卵期使用避孕套。

(2)抑制AsAb生物治分下列，①免疫性不育的病因，如生殖系感染、前列腺炎、精囊炎、附睾炎等，用合的抗菌物。②免疫抑制法，主要用皮固醇物，如尼松、甲基尼松、倍他米松、地塞米松等，一般程六月。

(3)克服AsAb干助生殖技（ART）保守治效可行腔人工授精助孕治，以避黏液屏障。於不明原因不孕、且高度疑免疫，而前述治方法又效者建快用合的ART技（IVF）。

4.不明原因性不孕症的治

（1）期待治不明原因不孕自然程的期後目前尚有研究料。有的研究多短期察。期察的果可能明後是很好的。不明原因不孕的夫，重要的是告知他不治也可能有好的妊娠率，不治妊娠率基的估，床不明原因不孕的夫被分至照（不治）每月有3%～4%的妊娠率。不孕夫一般希望能直接治，不明原因的不孕的不是不育的判，打消她的疑。不明原因的不孕自然妊娠的可能性很大程度上依於女方的年、不孕持和既往妊娠史。多年多不同人群不孕年呈相，自然妊娠著年增加而下降，且女近39～40加速下降。因此，不明原因的不孕的治，年的女比年大的女有高的累妊娠率，妊娠的可能性也著不孕持而下降，可能是由於年增加和已到了生育力低下的段。既往妊娠史也是很重要的，性不孕的夫比原性不孕的夫有高的自然妊娠的率。

（2）物治年而不孕年限短的夫，予他充分的等待，一般至少2年。在此期，予注意妊娠有的其他健康，例如戒菸、超重的重，改善原有的不良等。不明原因不孕的治步“三步曲”：排卵、腔人工授精、外受精－胚胎移植。

在不明原因的不孕治方面，促排卵合或不合腔人工授精（IUI）始於80年代中期，目前在用且有著的增加，氯米芬（CC）和促性激素用在促排卵的治中。

於卵巢刺激，促排卵得以使受精的卵子目以增加妊娠的可能性。在IUI的促排卵中需要多少枚卵泡最合尚定，一般1～2枚卵泡是最佳目。同地，通人工授精增加精子的密度可能一步增加每月的妊娠概率，某程度上，促排卵和/或IUI致每月妊娠率的增加，一段治有累效。

外受精和胚胎移植（IVF－ET），如果持3期以上的促排卵加IUI治仍未成功，意味著治的效果已不很。IVF也提供了一不明原因不孕病因的，看是否不孕的生在受精，在不明原因不孕症夫用IVF常受精，可有11%～22%受精失的。患者在以後的周期改用精子卵泡射（ICSI）的受精方法可以得高的妊娠率。

5.男性不孕症的治

根不同的致病因素用不同的治方法。於病因明的，用相的措施治，以提高其精液量。於不明原因造成的精子量低下，可以用中合整精神、生活改善精液量，若效果不明，或合其他不孕原因、女方年大、不孕年限等，及用助生殖技。

SCI文表 :

Hsieh YY (耀元), Chang CC(其真)   (*Correspondence; **Equal contribution as first author)

(男女 不孕症、管 科)

1.       Chang CC, Hsieh YY**, Lin WH, Lin CS*. Leiomyoma and vascular endothelial growth factor gene polymorphisms: a systematic review. Taiwan J Obstet Gynecol. 2010 Sep;49(3):247-53. (SCI).

2.       Chang CC, Hsieh YY**, Hsu KH**, Lin CS*. Effects of alpha and beta recombinant FSH (Gonal-F, Puregon) and progesterone upon human endometrial cell proliferation in-vitro: a preliminary study. Gynecol Endocrinol. 2011 Feb;27(2):110-6 (SCI).

3.       Chang CC, Hsieh YY**, Hsu KH, Tsai HD, Lin CS*. Deleterious effects of arsenic, benomyl, and carbendazim upon human endometrial cell proliferation in-vitro. Taiwan J Obstet Gynecol. 2010 Dec;49(4):449-54. (SCI).

4.       Chang CC, Hsieh YY**, Hsu KH, Lin CS*. Effects of gonadotrophins (Gonal-F, Puregon) upon human endometrial cell proliferation in-vitro. Taiwan J Obstet Gynecol 2010, Mar;50(1):42-7. (SCI).

5.       Tsai HD, Hsieh YY**, Hsieh JN, Chang CC, Yang CY, Yang JG, Cheng WL, Tsai FJ, Liu CS. Mitochondria DNA deletion and copy numbers of cumulus cells are associated with IVF outcomes. J Reprod Med. 2010 Nov-Dec;55(11-12):491-7. (SCI).

6.       Hsieh YY, Chang CC, Wang YK, Hsu KH, Chen CP, Hsu CM, Tsai FJ. Insulin-like growth factors II exon 9 and E-cadherin-Pml I but not myeloperoxidase promoter-463, urokinase-ApaL I nor xeroderma pigmentosum polymorphisms are associated with higher susceptibility to leiomyoma. Anticancer Res. 2010 Jun;30(6):2203-8. (SCI).

7.       Hsieh YY, Lin YJ, Chang CC, Chen DY, Hsu CM, Lo MM, Hsu KH, Tsai FJ. Human lymphocyte antigen B-associated transcript 2, 3, and 5 polymorphisms and haplotypes are associated with susceptibility of Kawasaki disease and coronary artery aneurysm. J Clin Lab Anal. 2010;24(4):262-8. (SCI).

8.       Chang CC, Hsieh YY**, Wang YK, Hsu KH, Tsai HD, Tsai FJ, Lin CS*. Identification of novel peptides specifically binding to endometriosis by screening phage-displaying peptide libraries. Fertil Steril. 2009;Dec;92(6):1850-5 (SCI).

9.       Hsieh YY, Wan L, Chang CC, Tsai CH, Tsai FJ*. STAT2*C related genotypes and allele but not TLR4 and CD40 gene polymorphisms are associated with higher susceptibility for asthma. Int J Biol Sci. 2009;5(1):74-81. (SCI)

10.      Chen CL, Chang CC, Tsai HD, Hsieh YY*. Puerperal infection of methicillin-resistant Staphylococcus aureus.Taiwan J Obstet Gynecol. 2008 Sep;47(3):357-9. (SCI).

11.      Hsu KH, Chang CC, Tsai HD, Tsai FJ, Hsieh YY*. Effects of yam and diosgenin on calpain systems in skeletal muscle of ovariectomized rats.Taiwan J Obstet Gynecol. 2008 Jun;47(2):180-6. (SCI).

12.      Hsieh YY, Chang CC, Hsu KH, Tsai FJ, Chen CP, Tsai HD*. Effect of exercise training on calpain systems in lean and obese Zucker rats. Int J Biol Sci. 2008 Sep 9;4(5):300-8. (SCI).

13.    &nbp; Bau DT, Hsieh YY**, Wan L, Wang RF, Liao CC, Lee CC, Lin CC, Tsai CH, Tsai FJ*. Polymorphism of XRCC1 codon arg 399 Gln is associated with higher susceptibility to endometriosis.Chin J Physiol. 2007 Dec 31;50(6):326-9. (SCI).

14.      Hsieh YY, Chang CC, Tsai FJ*, Lin CC, Tsai CH. T allele for VEGF-460 Gene Polymorphism at 5'-Untranslated Region is Associated with Higher Susceptibility of Leiomyoma. Biochem Genet. 2008 Jun;46(5-6):356-61.(SCI).

15.      Hsieh YY, Chang CC, Tsai HD*. Comparisons of different dosages of gonadotropin-releasing hormone (GnRH) antagonist, short-acting form and single, half-dose, long-acting form of GnRH agonist during controlled ovarian hyperstimulation and in vitro fertilization. Taiwan J Obstet Gynecol. 2008 Mar;47(1):66-74. (SCI)

16.      Hsieh YY, Bau DT, Chang CC, Tsai CH, Chen CP, Tsai FJ*. XRCC4 codon 247*A and XRCC4 promoter -1394*T related genotypes but not XRCC4 intron 3 gene polymorphism are associated with higher susceptibility for endometriosis. Mol Reprod Dev. 2008 May;75(5):946-51. (SCI).

17.      Hsieh YY, Chang CC, Bau DT, Yeh LS, Tsai FJ*, Tsai CH. X-ray repair cross-complementing group 4 (XRCC4) promoter -1394( *)T-related genotype, but not XRCC4 codon 247/intron 3 or xeroderma pigmentosum group D codon 312, 751/promoter -114, polymorphisms are correlated with higher susceptibility to myoma. Fertil Steril. 2008 Oct;90(4 Suppl):1417-23.(SCI).

18.      Hsieh YY, Chang CC, Bau DT, Tsai FJ*, Tsai CH, Chen CP. The p21 codon 31*C- and DRD2 codon 313*T-related genotypes/alleles, but not XRCC1 codon 399, hOGG1 codon 326, and DRD1-48 polymorphisms, are correlated with the presence of leiomyoma. Fertil Steril. 2009 Mar;91(3):869-77. Epub 2009 Jan 26. (SCI).

19.      Wan L, Chen WC, Tsai Y, Kao YT, Hsieh YY, Lee CC, Tsai CH, Chen CP, Tsai FJ. Growth Hormone (GH) Receptor C.1319 G>T Polymorphism, But Not Exon 3, Retention or Deletion Is Associated With Better First-Year Growth Response to GH Therapy in Patients With GH Deficiency. Pediatr Res. 2007 Dec;62(6):735-40 (SCI).

20.      Lin JC, Chen YO, Chang CC, Hsieh YY*. Novel adjunctive treatment for cervical adhesion with cross-type nelaton catheter: a preliminary report and literature review. Taiwan J Obstet Gynecol. 2007 Mar;46(1):38-42. (SCI)

21.      Hsieh YY, Lee CC, Chang CC, Wang YK, Yeh LS, Lin CS. Angiotensin I-converting enzyme insertion-related genotypes and allele are associated with higher susceptibility of endometriosis and leiomyoma. Mol Reprod Dev. 2007 Jul;74(7):808-14. (SCI)

22.      Chang YL, Hsieh YY**, Tsai HD*. Preliminary report on the effect of a lower dose of gonadotropin-releasing hormone antagonist (cetrorelix) on ovarian hyperstimulation in lower-weight Asian women. Taiwan J Obstet Gynecol. 2006 Dec;45(4):317-20. (SCI)

23.      Hsieh YY, Wang JP, Lin CS. Four novel single nucleotide polymorphisms within the promoter region of p53 gene and their associations with uterine leiomyoma. Mol Reprod Dev. 2007 Jul;74(7):815-20. (SCI)

24.      Yeh LS, Hsieh YY**, Chang JG, Chang WW, Chang CC, Tsai FJ*. Mutation analysis of the tumor suppressor gene PPP2R1B in human cervical cancer. Int J Gynecol Cancer. 2007 Jul-Aug;17(4):868-71. (SCI).

25.      Hsieh YY, Chang CC, Tsai CH, Lin CC, Tsai FJ. Interleukin (IL)-12 receptor beta1 codon 378 G homozygote and allele, but not IL-1 (beta-511 promoter, 3953 exon 5, receptor antagonist), IL-2 114, IL-4-590 intron 3, IL-8 3'-UTR 2767, and IL-18 105, are associated with higher susceptibility to leiomyoma. Fertil Steril. 2007 Apr;87(4):886-95. (SCI)

26.      Hsieh YY, Wang YK, Chang CC, Lin CS. Estrogen receptor alpha-351 XbaI*G and -397 PvuII*C-related genotypes and alleles are associated with higher susceptibilities of endometriosis and leiomyoma. Mol Hum Reprod. 2007 Feb;13(2):117-22. (SCI)

27.      Lin CC, Hsieh YY**, Wang CH, Li YC, Hsieh LJ, Lee CC, Tsai CH, Tsai FJ*. Prenatal detection and characterization of a small supernumerary marker chromosome (sSMC) derived from chromosome 22 with apparently normal phenotype. Prenat Diagn. 2006 Aug 17;26(10):898-902 (SCI)

28.      Hsieh YY, Lin CS. P53 codon 11, 72, and 248 gene polymorphisms in endometriosis. Int J Biol Sci. 2006;2(4):188-93. Epub 2006 Jul 12. (SCI)

29.      Hsieh YY, Chang CC, Lin CS*. Seminal malondialdehyde concentration but not glutathione peroxidase activity is negatively correlated with seminal concentration and motility. Int J Biol Sci 2006; 2:23-29. (SCI)

30.      Hsieh YY, Chang CC, Tsai HD, Lin CS*. Leukemia inhibitory factor in follicular fluid is not related to the number and quality of embryos as well as implantation and pregnancy rates. Biochem Genet. 2005 Oct;43(9-10):501-6 (SCI)

31.      Hsieh YY, Chang CC, Tsai FJ*, Hsu CM, Lin CC, Tsai CH. The C-related genotype and allele for E-cadherin 3’-UTR Pml I polymorphism are associated with higher susceptibility to endometriosis. Genet Mol Biol 2005;28:661-4. (SCI)

32.      Hsieh YY, Chang CC, Tsai FJ*, Peng CT, Yeh LS, Lin CC. Polymorphism for transforming growth factor beta 1-509 (TGF-B1-509): association with endometriosis. Biochem Genet. 2005 Jun;43(5-6):203-10. (SCI)

33.      Hsieh YY, Chang CC, Tsai FJ*, Hsu CM, Lin CC, Tsai CH. Interleukin-2 receptor beta (IL-2Rbeta)-627*C homozygote but not IL-12Rbeta1 codon 378 or IL-18 105 polymorphism is associated with higher susceptibility to endometriosis. Fertil Steril. 2005 Aug;84(2):510-2. (SCI)

34.      Hsieh YY, Chang CC, Tsai FJ*, Lin CC, Yeh LS, Peng CT. Androgen receptor trinucleotide polymorphism in leiomyoma. J Assist Reprod Genet. 2004 Dec;21(12):453-7. (SCI)

35.      Lin HC, Tsai FJ*, Tsai CH, Hsieh YY, Hsu CM. Cytokine polymorphisms and chronic lung disease in small preterm infants. Arch Dis Child Fetal Neonatal Ed. 2005 Jan;90(1):F93-4. (SCI)

36.      Hsieh YY, Chang CC, Tsai FJ, Lin CC, Tsai CH. T homozygote and allele of epidermal growth factor receptor 2073 gene polymorphism are associated with higher susceptibility to endometriosis and leiomyomas. Fertil Steril. 2005 Mar;83(3):796-9. (SCI)

37.      Hsieh YY, Chang CC, Tsai FJ, Lin CC, Tsai CH. Estrogen receptor alpha dinucleotide repeat and cytochrome P450c17alpha gene polymorphisms are associated with susceptibility to endometriosis. Fertil Steril. 2005 Mar;83(3):567-72. (SCI)

38.      Hsieh YY, Chen IP, Wang HI, Chang CC, Huang CW, Lin CS*. PROGINS Alu sequence insertion is associated with hyperprolactinemia but not leiomyoma susceptibility. Clin Endocrinol 2005;62:492-7 (SCI)

39.      Hsieh YY, Chang CC, Tsai FJ*, Lin CC, Tsai CH. Cytochrome P450c17alpha 5'-untranslated region *T/C polymorphism in endometriosis. J Genet. 2004 Aug;83(2):189-92. (SCI)

40.      Hsieh YY, Chang CC, Tsai FJ*, Hsu CM, Lin CC, Tsai CH. Angiotensin I-converting enzyme ACE 2350*G and ACE-240*T-related genotypes and alleles are associated with higher susceptibility to endometriosis. Mol Hum Reprod. 2005 Jan;11(1):11-14. (SCI)

41.      Lin JC, Chen YO, Hsieh YY*. Incomplete uterine perforation after Intrauterine device Insertion: diagnosis and retrieval by flexible hysterofibroscopy in three very rare cases. Taiwanese J Obstet Gynecol 2004;43(4):243245.

42.      Hsieh YY, Chang CC, Tsai FJ*, Lin CC, Yeh LS, Tsai CH. Tumor necrosis factor-alpha-308 promoter and p53 codon 72 gene polymorphisms in women with leiomyomas. Fertil Steril. 2004 Oct;82(Suppl 3):1177-1181.(SCI)

43.      Hsieh YY, Chang CC, Tsai FJ, Lin CC, Chen JM, Tsai CH*. Glutathione S-transferase M1*null genotype but not myeloperoxidase promoter G-463A polymorphism is associated with higher susceptibility to endometriosis. Mol Hum Reprod. 2004 Oct;10(10):713-717. (SCI)

44.      Hsieh YY, Chang CC, Tsai FJ*, Yeh LS, Lin CC, Peng CT. T allele for VEGF gene-460 polymorphism at the 5'-untranslated region: association with a higher susceptibility to endometriosis. J Reprod Med. 2004 Jun;49(6):468-72. (SCI)

45.      Hsieh YY, Chang CC, Hsu CW, Lin CS*. Gene transfections with p53 and p21 inhibit cell proliferation, collagen type I, leukemia inhibitory factor, and tumor necrosis factor-alpha expression in leiomyoma cells. Fertil Steril. 2004 Jun;81(6):1665-70. (SCI) (NSC 90-2314-B-039-025-)

46.      Hsieh YY, Chang CC, Tsai FJ, Peng CT, Yeh LS, Lin CC. Insulin-like growth factor II gene ApaI polymorphism is not associated with endometriosis susceptibility. Genet Mol Biol 2004; 27:165-6

47.      Chou IC, Tsai CH, Hsieh YY, Peng CT, Tsai FJ*. Association between polymorphism of interleukin-1beta-511 promoter and susceptibility to febrile convulsions in Taiwanese children. Acta Paediatr. 2003 Nov; 92(11): 1356. (SCI)

48.      Hsieh YY, Chang CC, Tsai FJ*, Lin CC, Tai CT, Ho M. Association of an A allele for interleukin-10 -627 gene promoter polymorphism with higher susceptibility to endometriosis. J Reprod Med. 2003 Sep;48(9):735-8. (SCI)

49.      Hsieh YY, Chang CC, Tsai FJ, Tsai HD, Yeh LS, Lin CC, Tsai CH. Estrogen receptor thymine-adenine dinucleotide repeat polymorphism is associated with susceptibility to leiomyoma. Fertil Steril. 2003 Jan;79(1):96-9. (SCI) (NSC 91-2314-B-039-028-)

50.      Hsieh YY, Tsai FJ, Chang CC, Tsai CH. Lin CC, Yeh LS. Cytochrome P450c17α (CYP17) gene polymorphism is not associated with leiomyoma susceptibility. Genet Mol Biol 2002;25:361-4.

51.      Tsai FJ, Chou IC, Hsieh YY, Lee CC, Lin CC, Tsai CH. Interleukin-4 intron 3 polymorphism is not related to susceptibility to febrile seizures. Pediatr Neurol. 2002 Oct;27(4):271-4. (SCI)

52.      Hsieh YY, Lin WC, Chang CC, Tsai FJ, Yu MT, Tsai HD, Tsai CH. Turner syndrome with pseudodicentric Y chromosome mosaicism. J Assist Reprod Genet. 2002 Jun;19(6):302-3. (SCI)

53.      Hsieh YY, Huang CC, Cheng TC, Chang CC, Tsai HD, Lee MS. Laser-assisted hatching of embryos is better than the chemical method for enhancing the pregnancy rate in women with advanced age. Fertil Steril. 2002 Jul;78(1):179-82. (SCI)

54.      Tsai FJ, Hsieh YY, Chang CC, Lin CC, Tsai CH. Polymorphisms for interleukin 1 beta exon 5 and interleukin 1 receptor antagonist in Taiwanese children with febrile convulsions. Arch Pediatr Adolesc Med. 2002 Jun;156(6):545-8. (SCI)

55.      Hsieh YY, Sun YL, Chang CC, Lee YS, Tsai HD, Lin CS. Superoxide dismutase activities of spermatozoa and seminal plasma are not correlated with male infertility. J Clin Lab Anal. 2002;16(3):127-131. (SCI) (NSC 92-2320-B-039-052-)

56.      Hsieh YY, Chang CC, Tsai FJ, Hsu Y, Tsai HD, Tsai CH. Polymorphisms for interleukin-4 (IL-4) -590 promoter, IL-4 intron3, and tumor necrosis factor alpha -308 promoter: Non-association with endometriosis. J Clin Lab Anal. 2002;16(3):121-6. (SCI)

57.      Hsieh YY, Lin CS, Sun YL, Chang CC, Tsai HD, Wu JC. In vivo gene transfer of leukemia inhibitory factor (LIF) into mouse endometrium. J Assist Reprod Genet. 2002 Feb;19(2):79-83. (SCI)

58.      Chang CC, Hsieh YY, Tsai HD, Lin CC. Tubo-ovarian abscess presenting as pneumoperitoneum. J Assist Reprod Genet. 2002 Jan;19(1):42-3. (SCI)

59.      Chang CC, Hsieh YY, Chung JG, Tsai HD, Tsai CH. Leukemia inhibitory factor decreases the arylamine N-acetyltransferase activity in human cumulus granulosa cells. J Assist Reprod Genet. 2001 Dec;18(12):660-4. (SCI)

60.      Tsai MH, Lin CD, Hsieh YY, Chang FC, Tsai FJ, Chen WC, Tsai CH. Prognostic Significance of the Proline Form of p53 Codon 72 Polymorphism in Nasopharyngeal Carcinoma. Laryngoscope. 2002 Jan;112(1):116-9. (SCI)

61.      Chang CC, Hsieh YY, Tsai FJ, Tsai CH, Tsai HD, Lin CC. The proline form of p53 codon 72 polymorphism is associated with endometriosis. Fertil Steril. 2002 Jan;77(1):43-5. (SCI) (NSC 91-2314-B-039-028-)

62.      Hsieh YY, Chang CC, Tsai HD. Zona-free oocyte fertilized with intracytoplasmic sperm injection and underwent further division: case report and literature review. Chang Gung Med J. 2001 Sep;24(9):599-602. (MI)

63.      Chang CC, Hsieh YY, Chung JG, Tsai HD, Tsai CH. Kinetics of acetyl coenzyme A: arylamine N-acetyltransferase from human cumulus cells. J Assist Reprod Genet. 2001 Sep;18(9):512-8. (SCI)

64.      Hsieh YY, Chang CC, Tsai FJ, Wu JY, Shi YR, Tsai HD, Tsai CH. Polymorphisms for interleukin-1 beta (IL-1 beta)-511 promoter, IL-1 beta exon 5, and IL-1 receptor antagonist: nonassociation with endometriosis. J Assist Reprod Genet. 2001 Sep;18(9):506-11. (SCI)

65.      Chang CC, Hsieh YY, Tsai HD. Doppler study of the fetal middle cerebral artery at three locations: preliminary report. Chang Gung Med J 2001 Jul;24(7):418-22 (MI)

66.      Hsieh YY, Chang CC, Tsai HD. Antral follicle counting in predicting the retrieved oocyte number after ovarian hyperstimulation. J Assist Reprod Genet. 2001 Jun;18(6):320-4. (SCI)

67.      Hsieh YY, Chang CC, Tsai FJ, Wu JY, Tsai CC, Tsai HD. Androgen receptor trinucleotide polymorphism in endometriosis. Fertil Steril. 2001 Aug;76(2):412-3. (SCI)

68.      Hsieh YY, Tsai FJ, Chang CC, Chen WC, Tsai CH, Tsai HD, Lin CC. p21 gene codon 31 arginine/serine polymorphism: Non-association with endometriosis. J Clin Lab Anal 2001;15(4):184-7. (SCI)

69.      Chang WC, Hsieh YY, Cheng TC, Chang CC, Tsai HD, Lee MS. Effect of methylglyoxal on mouse embryogenesis. Chang Gung Med J. 2001 Apr;24(4):251-7 (MI).

70.      Hsieh YY, Wu JY, Chang CC, Tsai FJ, Lee CC, Tsai HD, Tsai CH. Prenatal diagnosis of oculocutaneous albinism two mutations located at the same allele. Prenat Diagn. 2001 Mar;21(3):200-1. (SCI)

71.      Hsieh YY, Chang CC, Tsai HD, Tsai CH. Longitudinal survey of blood flow at three different locations in the middle cerebral artery in normal fetuses. Ultrasound Obstet Gynecol. 2001 Feb;17(2):125-8. (SCI)

72.      Hsieh YY, Tsai FJ, Lin CC, Chang FC, Tsai CH. Breech deformation complex in neonates. J Reprod Med. 2000 Nov;45(11):933-5. (SCI)

73.      Hsieh YY, Chang FC, Tsai HD. Doppler evaluation of the uterine and spiral arteries from different sampling sites and phases of the menstrual cycle during controlled ovarian hyperstimulation. Ultrasound Obstet Gynecol. 2000 Aug;16(2):192-6. (SCI)

74.      Hsieh YY, Chng FC, Tsai HD, Tsai CH. Longitudinal survey of fetal ventricular ejection and shortening fraction throughout pregnancy. Ultrasound Obstet Gynecol. 2000 Jul;16(1):46-8. (SCI)

75.      Hsieh YY, Chang FC, Tsai HD, Hsu TY, Yang TC. Accuracy of sonography in predicting the outcome of fetal congenital diaphragmatic hernia. Chung Hua I Hsueh Tsa Chih (Taipei). 2000 Oct;63(10):751-7. (MI)

76.      Tsai HD, Chang CC, Hsieh YY, Lo HY. Leukemia inhibitory factor expression in different endometrial locations between fertile and infertile women throughout different menstrual phases. J Assist Reprod Genet. 2000 Sep;17(8):415-8. (SCI)

77.      Hsieh YY, Tsai HD, Chang FC. Routine blastocyst culture and transfer: 201 patients' experience. J Assist Reprod Genet. 2000 Sep;17(8):405-8. (SCI)

78.      Tsai HD, Chang CC, Hsieh YY, Hsu LW, Chang SC, Lo HY. Effect of different concentrations of recombinant leukemia inhibitory factor on different development stage of mouse embryo in vitro. J Assist Reprod Genet. 2000 Jul;17(6):352-5. (SCI)

79.      Hsieh YY, Chang FC, Tsai HD, Hsu TY, Yang TC, Yeh LS, Chang WC. Gender prevalence in twin-twin transfusion syndrome. Chang Keng I Hsueh Tsa Chih. 2000 Aug;23(8):476-9. (MI)

80.      Hsieh YY, Chang CC, Li PC, Tsai HD, Tsai CH. Successful application of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation as lifesaving therapy for a patient with amniotic fluid embolism. Am J Obstet Gynecol. 2000 Aug;183(2):496-7. (SCI)

81.      Hsieh YY, Tsai HD, Chang CC, Lo HY, Chen CL. Low-dose aspirin for infertile women with thin endometrium receiving intrauterine insemination: a prospective, randomized study. J Assist Reprod Genet. 2000 Mar;17(3):174-7. (SCI)

82.      Hsieh YY, Tsai HD, Chang CC, Hsu LW, Chang SC, Lo HY. Prolonged culture of human cryopreserved embryos with recombinant human leukemia inhibitory factor. J Assist Reprod Genet. 2000 Mar;17(3):131-4. (SCI)

83.      Hsieh YY, Tsai HD, Chang CC, Lo HY. Sperm cryopreservation with empty human or mouse zona pellucidae. A comparison. J Reprod Med. 2000 May;45(5):383-6. (SCI)

84.      Hsieh Y, Tsai H, Chang C, Lo H. Comparison of a single half-dose, long-acting form of gonadotropin-releasing hormone analog (GnRH-a) and a short-acting form of GnRH-a for pituitary suppression in a controlled ovarian hyperstimulation program. Fertil Steril. 2000 Apr;73(4):817-20. (SCI)

85.      Hsieh Y, Tsai H, Chang C, Lo H. Cryopreservation of human spermatozoa within human or mouse empty zona pellucidae. Fertil Steril. 2000 Apr;73(4):694-8. (SCI)

86.      Tsai HD, Chang CC, Hsieh YY, Lee CC, Lo HY. Artificial insemination. Role of endometrial thickness and pattern, of vascular impedance of the spiral and uterine arteries, and of the dominant follicle. J Reprod Med. 2000 Mar;45(3):195-200. (SCI)

87.      Hsieh YY, Chang CC, Lee CC, Tsai HD. Fetal renal volume assessment by three-dimensional ultrasonography. Am J Obstet Gynecol. 2000 Feb;182(2):377-9. (SCI)

88.      Hsieh YY, Tsai HD, Chang CC, Yeh LS, Yang TC, Hsu TY. Precipitate delivery and postpartum hemorrhage after term induction with 200 micrograms misoprostol. Chung Hua I Hsueh Tsa Chih (Taipei). 2000 Jan;63(1):58-61. (MI)

89.      Hsieh YY, Chang CC, Tsai HD, Lee CC, Tsai CH. Longitudinal doppler sonographic measurements of vascular impedance in the central and peripheral spiral arteries throughout pregnancy. J Clin Ultrasound. 2000 Feb;28(2):78-82. (SCI)

90.      Hsieh YY, Chang JG, Liu SC, Chang CC, Tsai HD. Microdeletions of azoospermic factor Genes in Taiwanese with azoospermia or severe oligozoospermia. Mid-Taiwan Journal of Medicine 2000 Dec;5(6):216-20

91.      Hsieh YY, Hsu TY, Lee CC, Chang CC, Tsai HD, Tsai CH. Prenatal diagnosis of thoracopelvic dysplasia. A case report. J Reprod Med. 1999 Aug;44(8):737-40. (SCI)

92.      Hsieh YY, Chang CC, Tsai HD, Yang TC, Lee CC, Tsai CH. Twin vs. singleton pregnancy. Clinical characteristics and latency periods in preterm premature rupture of membranes. J Reprod Med. 1999 Jul;44(7):616-20. (SCI)

93.      Hsieh YY, Tsai HD, Chang CC, Chang CC, Lo HY, Lai AC. Ultrarapid cryopreservation of human embryos: experience with 1,582 embryos. Fertil Steril. 1999 Aug;72(2):253-6. (SCI)

94.      Hsieh YY, Chang CC, Tsai HD, Yang TC, Lee CC, Tsai CH. The prenatal diagnosis of Pierre-Robin sequence. Prenat Diagn. 1999 Jun;19(6):567-9. (SCI)

95.      Tsai HD, Chang CC, Hsieh YY, Lo HY, Hsu LW, Chang SC. Recombinant human leukemia inhibitory factor enhances the development of preimplantation mouse embryo in vitro. Fertil Steril. 1999 Apr;71(4):722-5. (SCI)

96.      Hsieh YY, Chang CC, Tsai HD, Lee CC, Tsai FJ, Tsai CH. Prenatal diagnosis of dyssegmental dysplasia. A case report. J Reprod Med. 1999 Mar;44(3):303-5. (SCI)

97.      Hsieh YY, Chang CC, Tsai HD, Yang TC, Chiu TH, Tsai CH. Primary hyperparathyroidism in pregnancy--report of 3 cases. Arch Gynecol Obstet. 1998;261(4):209-14. (SCI)

98.      Hsieh YY, Lee CC, Chang CC, Tsai HD, Hsu TY, Tsai CH. Prenatal sonographic diagnosis of Cantrell's pentalogy with cystic hygroma in the first trimester. J Clin Ultrasound. 1998 Oct;26(8):409-12. (SCI)

99.      Hsieh YY, Lee CC, Chang CC, Tsai HD, Yeh LS, Tsai CH. Successful prenatal digoxin therapy for Ebstein's anomaly with hydrops fetalis. A case report. J Reprod Med. 1998 Aug;43(8):710-2. (SCI)

100.     Hsieh YY, Lin WC, Chang CC, Yeh LS, Hsu TY, Tsai HD. Laparoscopic radical hysterectomy with low paraaortic, subaortic and pelvic lymphadenectomy. Results of short-term follow-up. J Reprod Med. 1998 Jun;43(6):528-34. (SCI)

101.     Hsieh YY, Chang CC, Lee CC, Tsai HD, Lin CC, Tsai CH. Conjoined twin's cephalothoracopagus janiceps monoymmetros: a case report. Arch Gynecol Obstet. 1998;261(3):163-6. (SCI)

102.     Chang CC, Tsai FJ, Tsai HD, Tsai CH, Hseih YY, Lee CC, Yang TC, Wu JY. Prenatal diagnosis of Apert syndrome. Prenat Diagn. 1998 Jun;18(6):621-5.

103.     Hsieh YY, Chang CC, Tsai HD, Chiu TH, Yang TC, Hsu TY. Rupture of rudimentary horn pregnancy: a case report. Chung Hua I Hsueh Tsa Chih (Taipei). 1998 May;61(5):289-94. (MI)

104.     Hsieh YY, Chang CC, Tsai HD, Yeh LS, Hsu TY, Yang TC. Intramural pregnancy with negative maternal serum beta-hCG. A case report. J Reprod Med. 1998 May;43(5):468-70. (SCI)

105.     Chang CC, Hsieh YY, Tsai HD, Yang TC, Yeh LS, Hsu TY. Acute pancreatitis in pregnancy. Chung Hua I Hsueh Tsa Chih (Taipei). 1998 Feb;61(2):85-92. (MI)

106.     Tsai HD, Chang CC, Hsieh YY, Chang CC, Yang TC, Chen CM. Sonographic diagnosis of triplet tubal pregnancy after in vitro fertilization and embryo transfer. J Clin Ultrasound. 1998 Mar-Apr;26(3):159-62. (SCI)

金影后小芬暌20多年出拍影「本日公休」，片中化身全民，起早安、念三位女有有婚、房子，一子在男士家庭客人剪，著：「人生不是算的。

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不孕症，管，女性不孕症，男性不孕症，台中不孕症，台中管

」身人母的理阿姨阿蕊，後竟上「本日公休」的牌子家出走，去做一件所有人都不值得的事。

片感取材自演傅天余母，述一位四十年男士家庭的理阿姨故事，真表露上一代的人貌、新一代之的隔情感。念真提及初看到本就十分心：「她差我二十，想到一那年的演，竟然拍一我所期待的影。」

念真也分享年拍影「多桑」，本想找侯孝演，但侯孝看到本就：「自己的爸爸自己拍。」他首次起演筒，拍出自身父的故事。秉持著的理念，念真同也鼓演傅天余：「自己的自己拍。」傅天余坦言初十分心，非常感念真的一句：「你一定要努力把部影拍出！」鼓舞她有信心母的故事拍成影。

耀元，耀元科，其真耀元科，耀元其真科，耀元博士
耀元不孕症科，耀元科不孕症科，其真耀元科不孕症科，耀元其真科不孕症科，耀元博士不孕症科
耀元管科，耀元科管科，其真耀元科管科，耀元其真科管科，耀元博士管科
不孕症，管，女性不孕症，男性不孕症，台中不孕症，台中管

影找庭妮、施名、方志友演出三位女，起影后三人表示十分心，施名形容小芬「是一很可的」，自然到像在家跟嘴。方志友拍前跟小芬一起上美累共患情感，的下看到她第一眼就喊：「！」直人相起的母女感「很味！」「本日公休」於3月3日在台上映。

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