Kukondoweza kwa ovarian ndi mankhwala a mahomoni omwe cholinga chake, monga momwe dzina lake limanenera, kulimbikitsa thumba losunga mazira kuti apeze kutulutsa kwabwino kwa ovulation. Izi zikuphatikiza ma protocol osiyanasiyana omwe njira zawo zimasiyana malinga ndi zomwe zikuwonetsa, koma zomwe cholinga chake ndi chofanana: kupeza mimba. Kukondoweza kwa ovarian kumatha kuperekedwa kokha kapena kukhala gawo la ART protocol, makamaka pankhani ya in vitro fertilization (IVF).

Schematically, pali milandu iwiri:

Chithandizo chosavuta cha ovulation induction, zotchulidwa ngati vuto la ovulation (dysovulation kapena anovulation) chifukwa cha kunenepa kwambiri kapena kunenepa kwambiri, polycystic ovary syndrome (PCOS) yosadziwika bwino.

Kukondoweza kwa ovarian ngati gawo la ART protocol :

• intrauterine insemination (IUU): kukondoweza kwa ovulation (pang'ono pamenepa) kumapangitsa kukhala kotheka kupanga nthawi ya ovulation ndipo motero kuyika umuna (omwe unatengedwa kale ndi kukonzekera) pa nthawi yoyenera. khomo pachibelekeropo. Kukondoweza kumapangitsanso kupeza kukula kwa ma follicles awiri ndipo motero kuonjezera mwayi wopambana wobereketsa wochita kupanga.
• IVF kapena IVF yokhala ndi jakisoni wa intra-cytoplasmic sperm (ICSI): cholinga cha kukondoweza ndikukulitsa kuchuluka kwa ma oocyte okhwima kuti athe kutenga ma follicle angapo panthawi yopumira, ndikuwonjezera mwayi wopeza zabwino. mazira ndi IVF.

Pali ma protocol osiyanasiyana a kutalika kosiyanasiyana, pogwiritsa ntchito mamolekyu osiyanasiyana kutengera zisonyezo. Kuti zikhale zogwira mtima ndikupewa zotsatira zoyipa, chithandizo chokondoweza cha ovarian chimakhaladi chamunthu.

Zomwe zimatchedwa "zosavuta" ovulation induction

Cholinga chake ndikulimbikitsa kukula kwa follicular kuti apange ma oocyte okhwima amodzi kapena awiri. Mankhwala osiyanasiyana amagwiritsidwa ntchito kutengera wodwalayo, zaka zake, zomwe akuwonetsa komanso machitidwe a asing'anga:

• anti-estrogens: kuperekedwa pamlomo, clomiphene citrate imachita mwa kutsekereza zolandilira estrogen mu hypothalamus, zomwe zimabweretsa kuwonjezeka kwa kutulutsa kwa GnRH komwe kumakweza mlingo wa FSH ndiyeno wa LH. Ndilo chithandizo chamzere woyamba pakangochitika kusabereka kochokera ku ovulatory, kupatula komwe kumayambira kwambiri (hypothalamus). Pali ma protocol osiyanasiyana koma chithandizo chanthawi zonse chimachokera pamasiku a 5 kuchokera pa 3 kapena 5 tsiku la kuzungulira (1);
• gonadotropins FSH, LH, FSH + LH kapena gonadotropins ya mkodzo (HMG). Imayendetsedwa tsiku ndi tsiku panthawi ya follicular ndi subcutaneous njira, FSH ikufuna kulimbikitsa kukula kwa oocyte. Chapadera cha mankhwalawa: gulu lokhalo la follicles lokonzedwa ndi ovary ndilolimbikitsa. Choncho mankhwalawa amasungidwa kwa amayi omwe ali ndi gulu lalikulu lokwanira la follicle. Zidzapereka mphamvu kuti zibweretse ma follicles kuti akhwime, omwe nthawi zambiri amasintha mofulumira kwambiri kuti awonongeke. Ndi chithandizo chamtunduwu chomwe chimagwiritsidwa ntchito kumtunda kwa IVF. Pakali pano pali mitundu itatu ya FSH: purified urinary FSH, recombinant FSH (yopangidwa ndi genetic engineering) ndi FSU yokhala ndi nthawi yayitali (yomwe imagwiritsidwa ntchito kumtunda kwa IVF). Ma gonadotropin a mkodzo (HMGs) nthawi zina amagwiritsidwa ntchito m'malo mwa FSH yophatikizanso. LH nthawi zambiri imagwiritsidwa ntchito limodzi ndi FSH, makamaka kwa odwala omwe ali ndi vuto la LH.
• pampu ya GnRH Amasungidwa kwa amayi omwe ali ndi vuto la kutsekemera kwapamwamba (hypothalamus). Chipangizo cholemera komanso chokwera mtengo, chimachokera ku kayendetsedwe ka gonadorelin acetate yomwe imatsanzira zochita za GnRH pofuna kulimbikitsa kutulutsa kwa FSH ndi LH.
• metformin Nthawi zambiri amagwiritsidwa ntchito pochiza matenda a shuga, koma nthawi zina amagwiritsidwa ntchito ngati ovulation inducer mwa amayi omwe ali ndi PCOS kapena onenepa kwambiri / kunenepa kwambiri, kuteteza ovarian hyperstimulation (2).

Kuti muwone momwe chithandizo chimagwirira ntchito, kuchepetsa chiopsezo cha hyperstimulation ndi mimba yambiri, kuyang'anira ovulation ndi ultrasounds (kuyesa chiwerengero ndi kukula kwa follicles kukula) ndi kuyesedwa kwa mahomoni (LH, estradiol, progesterone) ndi kuyesa kwa magazi kumakhazikitsidwa nthawi yonseyi. za protocol.

Kugonana kumakonzedwa panthawi ya ovulation.

Kukondoweza kwa ovarian mu nkhani ya ART

Pamene kukondoweza kwa ovarian kumachitika ngati gawo la IVF kapena insemination AMP protocol, chithandizochi chimachitika mu magawo atatu:

• gawo lotsekereza : mazirawo "amapumula" chifukwa cha GnRH agonists kapena GnRH antagonists, omwe amalepheretsa gland pituitary;
• gawo la ovarian stimulation : Chithandizo cha gonadotropin chimaperekedwa kuti chilimbikitse kukula kwa follicular. Kuwunika kwa ovulation kumathandizira kuyang'anira yankho lolondola pazamankhwala ndi kukula kwa follicle;
• chiyambi cha ovulation : pamene ultrasound ikuwonetsa ma follicle okhwima (pakati pa 14 ndi 20 mm m'mimba mwake pafupifupi), kutulutsa mazira kumayambitsidwa ndi:
  • jakisoni wa mkodzo (mu mnofu) kapena recombinant (subcutaneous) HCG (chorionic gonadotropin);
  • jakisoni wa recombinant LH. Zokwera mtengo kwambiri, zimasungidwa kwa amayi omwe ali pachiwopsezo cha hyperstimulation.

Maola 36 pambuyo pa kuyambitsa kwa mahomoni, ovulation imachitika. Kenako, follicular puncture imachitika.

Chithandizo chothandizira cha luteal phase

Kupititsa patsogolo ubwino wa endometrium ndikulimbikitsa kukhazikitsidwa kwa mwana wosabadwayo, chithandizo chikhoza kuperekedwa panthawi ya luteal (gawo lachiwiri la dzira, pambuyo pa ovulation), kutengera progesterone kapena zotumphukira: dihydrogesterone (mwakamwa) kapena progesterone ya micronized (pakamwa kapena kumaliseche).

Chovuta chachikulu chamankhwala olimbikitsa ovarian ndi Ovarian hyperstimulation syndrome (OHSS). Thupi limayankha mwamphamvu kwambiri pakuchiza kwa mahomoni, zomwe zimapangitsa kuti pakhale zizindikiro zosiyanasiyana zachipatala komanso zachilengedwe mosiyanasiyana: kusapeza bwino, kupweteka, nseru, kutuluka m'mimba, kuchuluka kwa ovarian, dyspnea, zovuta zachilengedwe zochulukirapo (kuchuluka kwa hematocrit, creatinine yokwera, kukwezeka). ma enzymes a chiwindi, ndi zina zotero), kunenepa kwambiri, ndipo nthawi zovuta kwambiri, kupuma movutikira komanso kulephera kwaimpso (3).

Venous kapena arterial thrombosis nthawi zina zimachitika ngati vuto la OHSS yoopsa. Zowopsa zimadziwika:

• sycystic ovary syndrome
• chiwerengero chochepa cha thupi
• zaka zosakwana zaka 30
• chiwerengero chachikulu cha follicles
• kuchuluka kwa estradiol, makamaka mukamagwiritsa ntchito agonist
• chiyambi cha mimba (4).

Ndondomeko yolimbikitsira ovarian yokhazikika imathandizira kuchepetsa chiopsezo cha OHSS yoopsa. Nthawi zina, mankhwala oletsa anticoagulant amatha kuperekedwa.

Kuchiza ndi clomiphene citrate kungayambitse kuoneka kwa vuto la maso lomwe lingafunike kusiya chithandizo (2% ya milandu). Zimawonjezeranso chiwopsezo chotenga pathupi kangapo ndi 8% mwa odwala omwe angotaya madzi m'mimba komanso 2,6 mpaka 7,4% mwa odwala omwe amalandila chithandizo cha idiopathic infertility (5).

Kuwonjezeka kwa chiopsezo cha zotupa za khansa kwa odwala omwe amathandizidwa ndi ovulation inducers, kuphatikizapo clomiphene citrate, adadziwika mu maphunziro awiri a epidemiological, koma maphunziro ambiri otsatirawa sanatsimikizire chomwe chimayambitsa ndi zotsatira zake (6).

Kafukufuku wa OMEGA, kuphatikizapo odwala oposa 25 omwe adalimbikitsidwa ndi ovarian monga gawo la ndondomeko ya IVF, adamaliza, patatha zaka zopitirira 000 zotsatila, kuti panalibe chiopsezo cha khansa ya m'mawere pakachitika chiwopsezo cha ovarian. (20).