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謝耀元，張其真，不孕症，試管嬰兒婦產專科免疫性不孕症的治

不孕的醫學定義為一年以上未採取任何避孕措施，性生活正常而沒有成功妊娠。主要分為原發不孕及繼發不孕。原發不孕為從未受孕；繼發不孕為曾經懷孕以後又不孕。根據這種嚴格的定義，不孕是一種常見的問題，大約影響到至少10%～15%的育齡夫婦。引起不孕的發病原因分為男性不育和女性不孕。<謝耀元不孕症專科>

病因:

引起不孕的發病原因分為男性不孕和女性不孕，1992年被世界衛生組織在診斷和治療不孕症最廣泛應用該分類。首要的病因診斷依次是：排卵障礙、精液異常、輸卵管異常、不明原因的不孕、子宮內膜異位症和其他如免疫學不孕。另外因素是宮頸因素，包括佔所有宮頸因素超過5%的宮頸狹窄。女性不孕主要以排卵障礙，輸卵管因素，子宮內膜容受性異常為主，男性不孕主要是生精異常及排精障礙。

1.女性不孕症

(1)輸卵管性不孕輸卵管在撿拾卵子和運輸卵子、精子和胚胎方面發揮著重要作用；輸卵管也是精子獲能，精卵相遇、受精的場所。感染和手術操作極易使輸卵管黏膜受損，進而纖毛消失，蠕動障礙，以及阻塞或與周圍組織粘連，影響輸卵管的通暢性功能。因此，輸卵管阻塞或通而不暢是女性不孕的重要原因。①感染盆腔感染是導致輸卵管性不孕的主要因素。感染不僅引起輸卵管阻塞，且因瘢痕形成，使輸卵管壁僵硬和輸卵管周圍粘連，改變其與卵巢的關係，影響輸卵管的拾卵及運送功能。感染的病原體可由需氧和厭氧菌所致，也可由衣原體、結核桿菌、淋病雙球菌、支原體等所致。②子宮內膜異位症盆腔子宮內膜異位症、卵巢子宮內膜異位症可形成腹膜粘連帶，使輸卵管傘端外部粘連或卵巢周圍粘連，使成熟卵不能被攝入輸卵管；引起的廣泛粘連還可影響受精卵的運行。③輸卵管結核輸卵管結核在生殖器結核中最常見，表現為輸卵管增粗肥大、傘端外翻如煙斗狀，甚至傘端封閉；輸卵管僵直、結節狀，部分可見乾酪樣團塊或腹膜有粟粒樣結節。約半數輸卵管結核患者同時有子宮內膜結核。④輸卵管絕育術後引起輸卵管積水較常見，成為輸卵管复通術後影響功能的重要因素。絕育術後輸卵管近端組織和細胞的病變與絕育時間長短有關，因此絕育術後時間越長，复通成功率越低。

(2)排卵障礙導致的不孕症慢性排卵障礙是很多內分泌疾病的共同表現，佔婦女的20%～25%。臨床表現主要為月經不規則甚至閉經，週期短於26天或長於32天提示有排卵異常。病史還可反映多毛症、男性化、溢乳及雌激素過少等內分泌病紊亂的信號。1993年世界衛生組織（WHO）制定了無排卵的分類標準，共分為三大類。WHOⅠ型（低促性腺激素性無排卵），WHOⅡ型（正常促性腺激素性無排卵），WHOⅢ型（高促性腺激素性無排卵）。WHOⅠ型：包括下丘腦閉經（壓力、減重、鍛煉、神經性厭食及其他）、Kallmann綜合徵（促性腺激素釋放激素前體細胞移行異常）和促性腺激素缺陷等。典型的表現是低促性腺激素性腺功能減退：FSH低、E2低而泌乳素和甲狀腺素正常。WHOⅡ型：臨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亂，伴有不同程度的無排卵或月經稀發。包括：PCOS，卵泡膜細胞增生症和HAIRAN綜合徵（多毛，無排卵，胰島素抵抗和黑棘皮症）。典型表現是：FSH、E2和泌乳素正常，但LH/FSH常異常升高。WHOⅢ型：患者主要是終末器官的缺陷或抵抗，表現為高促性腺激素性腺功能減退，包括卵巢早衰和性腺發育不全（卵巢抵抗）。典型表現為FSH及LH升高，低E2。這類患者的特點是對誘發排卵的反應差，卵巢功能已減退。

(3)免疫性不孕症目前與不孕有關的自身抗體分兩類：非器官特異性自身抗體和器官特異性自身抗體。前者指針對存在於不同組織的共同抗原的抗體，如抗磷脂抗體（APA）、抗核抗體（ANA）、抗DNA抗體等；後者指只針對某個特異性器官組織自身抗原的抗體如抗精子抗體（ASAb）、抗卵巢抗體（AOVAb）、抗子宮內膜抗體（AEMAb）和抗絨毛膜促性腺激素抗體（AhCGAb）等。目前對非器官特異性自身抗體針對的抗原性質比較了解，檢測APA和ANA的技術也較為成熟和標準，臨床資料豐富；而器官特異性自身抗體針對的抗原成分複雜，檢測的標準化程度低，它們與不孕的關係亦因檢測數據分析、統計困難而不易明確，從而影響對自身抗體陽性的不孕患者的處理。

(4)不明原因的不孕症一對不孕夫婦所檢查的各項指標都正常，而不孕原因又無法解釋的時候，即診斷為不明原因的不孕症。推測不明原因不孕症的病因可能有以下幾方面：①不良的宮頸分泌物影響；②子宮內膜對早期胚胎的接受性較差；③輸卵管的蠕動功能不良；④輸卵管傘端拾卵功能缺陷；⑤黃素化不破裂綜合徵；⑥輕微的激素分泌欠佳，如黃體功能不足；⑦精子和卵子受精能力受損；⑧輕度子宮內膜異位症；⑨免疫因素，如抗精子抗體、抗透明帶抗體或抗卵巢抗體；⑩腹膜巨噬細胞功能異常；腹腔液中抗氧化功能受損。

謝耀元，張其真 - 醫學博士婦產科

謝耀元婦產科 │地址:台中市南區台中路12號 │電話:04-222016660

不孕症、試管嬰兒、生殖內分泌學、內視鏡微創手術│中華民國婦產科專科醫師、中華民國人工生殖科醫師、中華民國生殖醫學會專科醫師會員、中國醫藥大學附設醫院婦產部主治醫師、教育部部定助理教授、教育部部定講師、中國醫藥大學婦產學科助理教授、中國醫藥大學婦產學科講師、中華民國子宮內膜醫學會會員、中華民國婦產科醫學會雜誌副主編、中華民國婦產科醫學會雜誌編輯、新加坡大學生殖醫學中心不孕症研究員, 著名國外不孕症雜誌“FERTILITY AND STERILITY”,“Human Reproduction”,“J Assist Reprod Genet”論文審查者

2.男性不孕症

(1)生殖器官等異常①先天異常：睾丸的先天性發育異常包括無睾症、曲細精管發育不全（Klinefelter）、XYY綜合徵、男性假兩性畸形等。Klinefelter綜合徵染色體核型多為47，XXY；患者乳房女性化；睾丸小而硬，曲細精管玻璃樣變和纖維化，精子發生完全停止或嚴重減少。睾丸下降異常也是男性不育的重要原因。睾丸下降異常時曲細精管內生殖細胞的數目減少，睾丸體積縮小，重量也下降。睾丸在腹壁或腹腔內的位置越高，則曲細精管的損傷越大。雙側睾丸下降異常患者如不治療，生育的可能性很小。②輸精管梗阻：輸精管、精囊先天性缺如，特徵是精液量少，常不足1ml，精漿無果糖；炎症性梗阻，如雙側附睾結核；射精管梗阻較少見。手術損傷或輸精管結紮等；以及前列腺炎、精囊炎均可引起精液質量明顯下降。③精索靜脈曲張：可導致睾丸血液淤積，有效血流量減少，生精的正常微環境遭到破壞，最終使精原細胞退化、萎縮，精子生成減少，活力減弱，畸形精子增多，嚴重者可無精子。④雄激素靶器官病變，分兩種類型：完全性如睾丸女性化；不完全性如Reifenstein綜合徵。

(2)內分泌異常①主要原因是促性腺激素合成或分泌功能障礙。Kallmann綜合徵又稱選擇性促性腺功能低下型性腺功能減退症，為下丘腦GnRH脈衝式釋放功能障礙，是常染色體隱性遺傳病。臨床特徵是性成熟障礙，伴有嗅覺喪失，睾丸小、睾丸下降異常、小陰莖及尿道下裂。血清睾酮水平低，LH和FSH水平處於同年齡組正常值下限。②選擇性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，乳房發育，但睾丸大小正常，精液內有少量精子，故又稱“生育型”無睾綜合徵。③垂體瘤對LH的分泌影響最為明顯，垂體瘤是高泌乳素血症的最常見原因，PRL過高可導致患者性慾減退、勃起功能障礙、乳房發育溢乳以及生精功能障礙。④腎上腺皮質增生症中常與不育相關的是21-羥化酶缺陷，皮質激素合成減少，引起ACTH增加，腎上腺皮質受到ACTH的過度刺激而合成大量睾酮，後者抑制垂體促性腺激素的分泌，從而導致不育。

(3)性功能障礙包括性慾減退、勃起功能障礙、早洩、不射精和逆行射精等，精液不能正常射入陰道。

(4)免疫因素分為兩類，由男性產生的抗精子自身免疫和由女性產生的抗精子同種免疫。精子與免疫系統由於血睾屏障的作用而隔離，故無論對男性或女性，精子抗原為外來抗原，具有很強的抗原性。血睾屏障及精漿內免疫抑制因子等因素共同建立了一套完整的免疫耐受機制，當發生睾丸炎、附睾炎、前列腺炎、精囊炎，或行輸精管結紮等手術後，上述免疫耐受機制被破壞，即可能發生抗精子免疫反應。

(5)感染因素腮腺炎病毒可引起睾丸炎，嚴重者可引起永久性曲細精管破壞和萎縮而發生睾丸功能衰竭；梅毒螺旋體也可以引起睾丸炎和附睾炎；淋病、結核、絲蟲病可引起輸精管梗阻；精液慢性細菌感染，或支原體、衣原體感染可使精液中白細胞計數增多，精液質量降低，未成熟精子增加。

(6)理化因素與環境污染生精上皮為快速分裂細胞，故易受理化因素損害。①熱、放射線和有毒物質均可使生精上皮脫落，或影響間質細胞和支持細胞功能，妨礙生精過程。生精上皮對放射線敏感。環磷酰胺、氮芥等化療藥物直接損害生精上皮和間質細胞功能。②某些環境毒素與天然激素有類似的作用或結構，例如多氯聯苯（PCB）、四氯聯苯（TCDD）、二氯二苯雙氯乙烷（DDT）、己烯雌酚（DES）等。這些毒素通過污染空氣、水和食物鏈而影響人類健康，包括男性精子的數量和質量持續下降。

(7)藥物手術史鴉片類藥物，抗癌藥物，化療及抗高血壓藥物等可直接或間接影響精子生成。既往盆腔手術史、膀胱、前列腺手術史有可能引起射精功能減退；疝修補術或睾丸固定術有可能影響精索或睾丸供血。

(8)不明原因的不育男性不育中約31.6%的患者經過目前常用的檢查方法仍不能查出確切病因。

<謝耀元不孕症專科診斷治療>

診斷

結合不孕症患者的臨床表現、病史以及各種實驗室檢查進行診斷。

<謝耀元婦產科不孕症、試管嬰兒專科治療>

1.輸卵管性不孕症的治療

根據病變部位、粘連程度、累及範圍、不孕年限、是否合併其他不孕原因、以及患者意願選擇合適的治療輸卵管性不孕的方法。

(1)雙側輸卵管阻塞的治療根據輸卵管阻塞部位和程度的不同選擇不同的治療方案。①輸卵管傘端粘連阻塞可行盆腔粘連松解術和輸卵管傘成形術。如為輕度輸卵管積水可行輸卵管造口術，可能較輸卵管切除術對卵巢功能的影響小，一方面既引流了有害的輸卵管積水，又寄望通過機體的改建，恢復輸卵管的功能，從而保留自然妊娠的可能；但有術後粘連再次形成積水可能。針對積水嚴重、其功能已完全喪失不能保留的輸卵管可行輸卵管切除術。切除時應盡量保留其係膜，減少對卵巢血供的可能影響。②輸卵管間質部阻塞手術复通難度大，复通率低，建議直接行IVF-ET。③單純的輸卵管結紮後峽部阻塞可以考慮行結紮部位切除後的輸卵管峽部端端吻合術。

(2)輸卵管通而不暢的治療如通而不暢是由傘端部分阻塞和單側輸卵管峽部阻塞引起，可分別按雙側輸卵管阻塞的方法進行治療；輸卵管間質部和峽部部分阻塞的患者，腹腔鏡可能沒有陽性發現，可以行宮腔鏡下輸卵管插管疏通術治療。

(3)輸卵管慢性炎症的治療僅適用於輸卵管粘連、阻塞程度較輕，病變時間短者等，否則治療效果不佳。可行口服活血化瘀中藥，中藥保留灌腸和穴位注射，配合超短波物理治療等方法促進局部血液循環，有利於炎症消除。

(4)體外受精-胚胎移植技術（IVF-ET）經過輸卵管和盆腔整形手術後6個月至一年仍不能獲得自然妊娠的患者，獲得自然妊娠的機會已很低，一般不主張再做成形手術，而建議直接採用試管嬰兒（IVF-ET）。輸卵管因素不孕的患者傾向於採用IVF，尤其是年齡大、不孕年限長，合併其他不孕因素，或上述手術與非手術治療效果不好時，應盡快採用IVF，以免錯過女性最佳生育期，導致妊娠率下降。

2.排卵障礙性不孕症的治療

誘導排卵俗稱促排卵，是治療無排卵性不孕的主要手段，指對有排卵障礙的患者採用藥物或手術方法誘發卵巢的排卵功能。一般以誘導單卵泡或少數卵泡發育為目的。主要應用於排卵障礙性不孕的治療和/或結合宮腔內人工受精技術應用。

3.免疫性不孕症的治療

可從減少AsAb產生、抑制AsAb產生、去除結合精子的AsAb、克服AsAb干擾幾方面著手。

(1)AsAb產生——隔絕療法採用為期6個月以上的安全套避孕，使體內原有的抗體效價降低或消失，又避免了精液抗原進入女性生殖道產生新的抗體，療效不確定。目前一般與其他治療方法聯合應用，或僅在非排卵期使用避孕套。

(2)抑制AsAb產生——藥物治療分下列幾種，①針對免疫性不育的病因，如生殖系感染、前列腺炎、精囊炎、附睾炎等，採用合適的抗菌藥物。②免疫抑制療法，主要應用皮質類固醇類藥物，如潑尼松、甲基潑尼松龍、倍他米松、地塞米松等，一般療程約六個月。

(3)克服AsAb干擾——輔助生殖技術（ART）保守治療無效可行宮腔內人工授精助孕治療，以避開宮頸黏液屏障。對於不明原因不孕、且高度懷疑免疫問題，而前述治療方法又無效者建議盡快採用合適的ART技術（IVF）。

4.不明原因性不孕症的治療

（1）期待治療對不明原因不孕自然過程的遠期預後目前尚沒有研究資料。現有的研究多為短期觀察。長期觀察的結果可能證明預後是很好的。當不明原因不孕的夫婦來諮詢時，重要的是告知他們不經治療也可能有較好的妊娠機率，對這種不經治療妊娠率基線的評估，臨床試驗發現不明原因不孕的夫婦被分至對照組（不治療）每月有3%～4%的妊娠率。當不孕夫婦諮詢時一般希望能直接治療，診斷為不明原因的不孕的並不是不育的判決，應該打消她們的疑慮。不明原因的不孕自然妊娠的可能性很大程度上依賴於女方的年齡、不孕持續時間和既往妊娠史。多年來許多不同人群證實不孕與年齡呈負相關，自然妊娠隨著年齡增加而下降，並且當婦女近39～40歲時加速下降。因此，對不明原因的不孕的治療，年輕的婦女比年齡大的婦女有較高的累積妊娠率，妊娠的可能性也隨著不孕持續時間而下降，這可能是由於年齡增加和已經到了生育力低下的階段。既往妊娠史也是很重要的，繼發性不孕的夫婦比原發性不孕的夫婦有較高的自然妊娠的機率。

（2）藥物治療對年齡較輕而不孕年限較短的夫婦，應給予他們充分的時間等待，一般至少2年。在此期間，應予注意與妊娠有關的其他健康問題，例如戒菸、減輕超重的體重，改善原有的不良習慣等。將不明原因不孕的治療步驟歸納為“三步曲”：誘導排卵、宮腔內人工授精、體外受精－胚胎移植。

在不明原因的不孕治療方面，促排卵聯合或不聯合宮腔內人工授精（IUI）開始於80年代中期，目前還在繼續應用且有顯著的增加趨勢，氯米芬（CC）和促性激素應用在促排卵的治療中。

關於卵巢刺激，促排卵得以使受精的卵子數目以增加妊娠的可能性。在IUI的促排卵中需要多少枚優勢卵泡最為合適尚無定論，一般認為1～2枚卵泡是最佳數目。同樣地，通過人工授精增加運動精子的密度可能進一步增加每月的妊娠概率，某種程度上，促排卵和/或IUI導致每月妊娠率的增加，經過一段時間治療會有累積效應。

體外受精和胚胎移植（IVF－ET），如果持續3個週期以上的促排卵加IUI治療仍未成功，意味著該治療的效果已經不很樂觀。IVF也提供了一個對不明原因不孕病因的診斷，看是否不孕的問題發生在受精環節，在不明原因不孕症夫婦採用IVF常規受精時，可有11%～22%受精失敗的風險。這類患者在以後的周期改用單精子卵泡漿內註射（ICSI）的受精方法可以獲得較高的妊娠率。

5.男性不孕症的治療

應根據不同的致病因素採用不同的治療方法。對於病因明確的，應積極採用相應的措施治療，以提高其精液質量。對於不明原因造成的精子質量低下，可以嘗試採用中藥聯合調整精神狀態、生活習慣來改善精液質量，若效果不明顯，或合併其他不孕原因、女方年齡大、不孕年限長等，應及時採用輔助生殖技術。

SCI論文發表 :

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

(男女不孕症、試管嬰兒專門科)

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. 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):243–245.

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, Chang 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)

記者游承霖／新北報導

鄭女不慎追撞到前方曹姓男子的公車。（圖／翻攝畫面）

▲鄭女不慎追撞到前方曹姓男子的公車。（圖／翻攝畫面）

新北市新莊今天（17日）上午傳出2公車追撞事件！一名鄭姓女公車司機，行經中正路時，不慎追撞前方曹姓男子所駕駛的公車，造成曹男車上的3名乘客受傷，其中1人牙齒斷裂，所幸並無生命危險，至於確切車禍事故原因仍待釐清。

謝耀元，謝耀元婦產科，張其真謝耀元婦產科，謝耀元張其真婦產科，謝耀元醫學博士
謝耀元不孕症專科，謝耀元婦產科不孕症專科，張其真謝耀元婦產科不孕症專科，謝耀元張其真婦產科不孕症專科，謝耀元醫學博士不孕症專科
謝耀元試管嬰兒專科，謝耀元婦產科試管嬰兒專科，張其真謝耀元婦產科試管嬰兒專科，謝耀元張其真婦產科試管嬰兒專科，謝耀元醫學博士試管嬰兒專科
不孕症，試管嬰兒，女性不孕症，男性不孕症，台中不孕症，台中試管嬰兒

據了解，這起車禍發生在今天（17日）上午9時許，47歲曹姓公車司機載送5名乘客沿著新莊中正路往桃園方向行駛，行經公園一路口時，見到號誌已經轉為黃燈，想要保持路口淨空，便停車未通過路口，後方的60歲鄭姓女公車司機反應不及，當場追撞。

突如其來的撞擊，導致曹男的公車上有2女1男乘客受傷，其中67歲高姓女乘客下巴輕微撕裂傷、牙齒斷裂；81歲郭吳姓婦人額頭挫傷；54歲羅姓男子額頭輕微撕裂傷，被送往醫院後並無大礙，警方發現2駕駛酒測值均為0，確切原因仍待釐清。

警方到場交管。（圖／翻攝畫面）