1. ???????? ART????????????

1
???????????

• ??????????
• ???

2
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• ??
• ????
• ????????????
• ?????????????
• ?????????????
• ??????

3
???????????

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• ????
• ??????
• ????,
• ??????

4
?????????

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• ????
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5
1. ????????ART????????????

• Significant breakthroughs have been made in the
  treatment of idiopathic male infertility since
  the development of ICSI.
• However,traditional treatment should also be
  taken into account for individual male
  infertility.
• Medicine as traditional method is still one of
  important way.

6
7057???????????

• ????? 1.7
• ??????? 6.6
• ????? 2.1
• ????? 2.6
• ?????? 12.3
• ????? 0.6
• ????? 3.1
• ???? 3.0
• ???????(OAT???)????? 75.1

7
??????????????

• ?????
• ?????
• ????
• ?????
• ????

8
2.???????

• ????
• ??4??,????????1.5?
• ??????????
• 35????????????25????50,
• 38??????25,
• ??40?????5?
• ????????ART?????????
• ????????
• ??????

9
3. ????????????????

• ????????????????????????????????????????,????????
  ???????
• ?????????????????????,????????????????,?????,????
  ????,??????????????,???????????

10
????????????????????

• ?????????????,????????????
• ?????????????????????????1?3???26????????????,?
  ????????????????

11
??????????????????

• ????(???????????)
• ???(???)
• ?????(HCG?HMG)
• ?????????(GnRH)
• ???????(????????)
• ????(???)
• ?????
• ?????
• ?????(??????Q10 )
• ????(?????????????)

12
????

• ???????????
• ????????????
• ??????????????,?????????????????????????,????GnRH?
  FSH?LH????,??T???????,?????????????????
• Vandekerckhove(2000)???????????????,???????????,??
  ????15.4,???12.5,???????
• Dimitrios?(2003)??????????????????212?,??????33.9
  ,???10.3,????

13
Patankar SS, Kaore SB, Sawane MV, Mishra NV,
Deshkar AM.Effect of clomiphene citrate on sperm
density in male partners of infertile couples.
Indian J Physiol Pharmacol. 2007
Apr-Jun51(2)195-8.

• ??25mg/d,??25?,????3??,??25???????????????40?????
  ?????????????. ??????????????????.
• Check JH.2007??,???FSH, LH and/or T
  ???????????,?????????????

14
2. ???

• ????????????????????
• Vandekerckhove?(2000)?11???????????,??????????????
  ????????????????????????????????????????????????
  ?????????????????

15
3. ?????HCG?HMG???FSH

• Schill(1986)??39?????????,HCG/HMG?????????????,???
  814?
• Kamischke(1999)Meta??223?????FSH?????????????
• Foresta(2002)????????????????FSH????B?????????????
  ??????
• Baccetti(2004)??????FSH??????????????,??ICSI??????
  ?

16
?????HCG?HMG???FSH

• ??????????????????,???????????FSH?????????????,???
  ???????????????????,??????????Attia AM,2007?
• ?????????FSH???????,???????????????????FSH????????
  ???????
• Foresta C, Selice R, Ferlin A, Arslan P, Garolla
  A.Hormonal treatment of male infertility FSH.
  Reprod Biomed Online. 2007 Dec15(6)666-672.

17
4. ?????????GnRH

• Victor?(2000)??GnRH??????????,GnRH?????30min?FSH??
  ??1.5??????????,FSH???????

18
5. ????????????????

• ?????????????????????,????GnRH??????????,?????????
  ????????,??????????????????
• ?Clark?(1989)?????(testolactone),2g/d,8??????25???
  ?????,????8???????,??????16???E2?T???,???????,????
  ??
• Kawakami?(2004)???????????????,????E2??,??T??,????
  ???????

19

• 6. ????(???)
• Vandekerckhove?(2000)??,???????????????,??????????
  ????????????
• 7. ?????
• ODonovan?(1993)???????5?????,??????????,?????????
  ??2???Kamischke(1999)?????197???,???????
• 8. ?????
• ?????????,??cAMP???Merino?(1997)?????????47?,?????
  ????

20
9. ?????????????Q10

• ??????????????????????????????????????????????????
  ?,???????,??????????????
• Balercia???Coenzyme Q10,200mg,2/d,6??,??22?????,??
  ???????CoQ10??????,??????????(???????9???16)???6
  ????????(???????16???9.5)?Balercia G, Mancini
  A, Paggi F, Tiano L, Pontecorvi A, Boscaro M,
  Lenzi A, Littarru GP. Coenzyme Q10 and male
  infertility. J Endocrinol Invest. 2009
  Jul32(7)626-32.

21
10. ??????????????????

• ?????????????????????????
• X?????????????????????????????????????,??????????,
  ?????????????
• ??????????????????????????????????
• ??????????????????????,???????????????????????????
  ?????
• Turner T, Lysiak JJ. J Androl, 200829(5)488-498

22
????

• Omu AE?(2008)?????????????(??malone???TNFa????,???
  ???????????)??,???(Zine)????????????????????DNA???
  ????,???????
• Dokmeci D,2007 ?????????????,?????????????

23
??????????

• ????,???????
• ??????????????????????
• ??????????????????????
• ??????DNA?????(ROS)?????
• ??,??????,??????
• ??????

24
?????????????

• ???????????
• ??????
• ??????????
• ??????????????
• ??????????

25
??????

• ????Lenzi?(1992,1993)?????????????20?????????????
  ?????,????????30???????????,???????????????,??????
  ??????????????
• ????Gupta?(2002)??4mg????3??,??30?????,??????????
  ?,????????,???????????20?
• ???,????E??????
• ???

26
??????????

• sairei-toMina?(2003)???????????sairei-to??47?????
  ???,???????????????
• CONCLUSION Saffron(???), as an antioxidant, is
  positively effective on sperm morphology and
  motility in infertile men, while it does not
  increase sperm count.
• Heidary M, Vahhabi S, Reza Nejadi J, Delfan B,
  Birjandi M, Kaviani H, Givrad S.Effect of saffron
  on semen parameters of infertile men. Urol J.
  2008 Fall5(4)255-9.

27
??????????

• 37 ????7??????????,???????????????????37?????15??
  ?????7?????????15???????????
• 7????5???????2????????????3????3????1??????????
• Tempest HG, Homa ST, Routledge EJ, et al. Plants
  used in Chinese medicine for the treatment of
  male infertility possess antioxidant and
  anti-oestrogenic activity. Syst Biol Reprod Med.
  2008 Jul-Aug54(4-5)185-95.

28
11. ????

• ???viagra
• ???
• a?????
• ????
• ?????
• ??????????(???)
• ????
• ???
• ?????(C?A?)

29
Dimitriadis F, Tsounapi P, Saito M, Watanabe T,
Sylakos A, Tsabalas S, Miyagawa I, Sofikitis N.
Is there a role for PDE5 inhibitors in the
management of male infertility due to defects in
testicular or epididymal function? Curr Pharm
Des. 200915(30)3506-20.

• PDE5 inhibitors enhance the Leydig cell secretory
  function and play a role in the regulation of the
  contractility of the tunica albuginea and the
  epididymis.
• PDE5 inhibitors increase the prostatic secretory
  function that results in an improvement in sperm
  motility in several cases.
• PDE5 inhibitors in the regulation of sperm
  capacitation process.

30
???????????????

• ????????????????????????????????

31
?????????

• ????????????????,?????????????
• ??????????????????????,?????????
• ?????????????????????????????????????????????????
  ????????????????????????
• ????????????,????????????????,????????????

32
??????????????

• ????
• ????
• ????
• ?????
• ?????

33
???????????????

• ????(HMG?HCG?clomiphen)
• ?????? (a blocker)?

34
?????????

• ????(??????)
• ??????3-12??
• ????(50mg Qd)?????(10mg Bid)
• a?????
• ????
• (1)????????? (2)?????(3) ???
• ??????(???)
• ??(???,????,????)

35
???????????!

• ?????????.
• ??????????????.
• ??????????.
• ?????????(???????????????????

36
a-???????????

• ??????????????????????????????????????????????????
  ???????????????????????????????????????
• a-blocker possesses considerable promise as a
  future regimen of medical treatment for
  idiopathic male infertility.
• ?????????,???????????
• ? ?36???
• ? ??????
• ? ???????????????????
• 1. ???????????????
• 2. ??????????????

37
?????????

• ?? 1. ??????
• 2. ??????
• ????????????????????????????????????
• ??????????,???,?????(???),??????,???(????),??????
  ??,??,???E?A?C,????,???,???????,??

38
??????????

• ????
• ??????????????????
• ?????
• ?????

39
????????

• ?????????
• ???????????,???C,????????????? HCG?
• ????a-??????????
• ??????18??19?????????????????,????3-5??
• ????????IUI???????
• ????

40
????????????

• ??????????
• ????26??,?????????,??????????????????
• ??26??????,???????,???ART?
• ????????????,????????????12??,??????ICSI?

41
??????????!

• ????????????????
• ???????60-80
• ????? 30-40(????????)

42
????????OAT?????EAU??

• ?????
• GnRH????,?????,???
• HCG/HMG?????,???
• FSH?????,???????
• ????????,???
• ????(?????????-?????)??,??????
• ??????
• Kinin(????????)????????????,???
• ????????,???
• ????????????,???????
• ???????????,???????,???????
• a??????????,???
• ??????????,???,????AsAb?????ART??
• ????????????,???

43
???????????(Clinical Pathways)??

• ?????????
• ???????????????
• ??????
• ??????

44
???????????

• 1. ?????
• 2. ???????
• 3. ????
• 4. ??????
• 5. ????????
• 6. ?????
• 7. ?????????
• (??)
• 8. ???????!!!

45
???????????????

• ??????????
• ??????,????????????
• ???????
• ????????????????????
• ??????,?????????
• ???????????,?????????!
• ????

46
????????????????

• ??????
• ????
• ????
• ??????????????
• ???? (????,???????)
• ????????????????????????????
• ??????!!!

47
???????????

• depression?ED and sexual problem are main
  problems male infertility has to be faced(Shindel
  AW,2008)
• 1.?????????????
• 2.???????(??????)?
• 3.???????????????????
• 4.????????(????????)

48
??????

• ?????108??,?????,
• 2009?2?,??148?
• ?????????????
• 42.5??,???????,
• 2007?5?,??45?
• ?????62??,???????,
• 2003?4?,??68?

49
???????!