Kuomesa mazai… Kune vamwe vakadzi vanorwara nezvirwere zvisingaperi kana kuti zvakakomba, nzira iyi yekuzvara vachibatsirwa nemishonga dzimwe nguva ndiyo nzira chete yekuchengetedza mbereko yavo netariro yekuona hurongwa hwavo hwekubereka rimwe zuva huchizadzika. Asi oocyte cryopreservation inewo zvimwe zviratidzo zvisinganyanyi kuzivikanwa. Kupfupisa kwechiitiko ichi muFrance.

Maoocyte anotonhora, anozivikanwawo seoocyte cryopreservation, inzira yekuchengetedza kubereka. Inosanganisira kutora maoocyte, mushure mekusimudzira ovarian kana kuti kwete, isati yaoma mu nitrogen yemvura uye kuichengeta kuitira pamuviri unotevera.

MuFrance, oocyte cryopreservation inodzorwa nemutemo uye kunyanya chinyorwa L-2141-11 cheHealth Code, senge ese marapirwo ekuchengetedza mbereko (embryonic kana chando chembeu, kuchengetedzwa kweovarian tissue kana testicular tissue). Rugwaro urwu runoti "chero munhu ane kurapwa kungangokanganisa kubereka, kana ane njodzi yembereko yekukanganisika nguva isati yakwana, anogona kubatsirwa kubva mukuunganidzwa uye kuchengetedzwa kwemagametes avo aine tarisiro yekutevera, kuti abatsirike, mune zvekurapa. kubatsira kubereka, kana kuti nechinangwa chekuchengetedza uye kudzorera kubereka kwake. “

Saka ichi ndicho chiratidzo chekutanga chekutonhora kweoocyte: kubvumira vakadzi kuchengetedza kubereka kwavo kana vachitora kurapa kunorema kunogona kukuvadza yavo ovarian reserve. Oocyte cryopreservation saka ndiyo inonyanya kuitirwa vakadzi kuti vabatwe nekemotherapy (kunyanya avo vane chekuita neiyo bone marrow transplant) kana radiotherapy, kunyanya munharaunda yepelvic.

Mubvunzo:

• Mishonga iyi ine muchetura zvakanyanya kumaovari (anonzi gonadotoxic), masero ekare (immature oocytes) uye ovarian basa;
• Ivo zvakare vanowanzoda kuti varwere vasiye hurongwa hwavo hwekuzvara kwenguva yakareba, dzimwe nguva nemakore akati wandei, nguva yekuita kurapwa uye kuve nechokwadi chekutevera kwakakodzera kwekuzvitakura.

Asi kenza handizvo chete zvirwere zvinogona kurongedzerwa kuchengetedza mbereko. Saka, kuomesa iyo oocyte kunogona kukurudzirwa muchiitiko che:

• kutora imwe gonadotoxic kurapa. Iyi ndiyo nyaya, semuenzaniso, mukutarisira kwenhengo dzemuviri kana zvirwere zvekudzivirira zvirwere (immunosuppressive drugs) kana mune zvimwe zvirwere zvehematological zvakadai sesickle cell anemia;
• kuvhiyiwa kunogona kukanganisa kubereka;
• congenital ovarian chirwere. Kazhinji genetic, zvirwere izvi, zvakadai seTurner syndrome, zvinogona kutungamirira kukukundikana kwe ovarian nguva isati yakwana.

Ongorora: muchiitiko chekurwara, kuomesa mazai kunonyanya kukurudzirwa muvakadzi vane pubescent, kazhinji vari pasi pemakore makumi matatu nemanomwe. Nekune rimwe divi, kana kuchengetedzwa kwembereko kunoratidzwa mumusikana mudiki kana mudiki achiri kuyaruka, nzira yekuchengetedza ovarian tishu inogona kufarirwa nechinangwa chekuita autograft yematishu aya gare gare.

Kure nezviitiko izvi zvakanyatsobatanidzwa nechirwere, pane chimwe chinoratidza kutonhora kwemaoocyte: shanduko yevakadzi.

Chokwadi, panguva yekuchinja kwevakadzi, marapiro anokurudzirwa ekurapa kana ekuvhiya anogona kukanganisa kubereka. Saka, kana uri kutanga rwendo rwechirume, unogona kurairwa kuchengeta uye nekudaro kuomesa maoocyte ako. Nhasi kuchine chinhu chikuru chisingazivikanwe: kushandiswa kweaya geteti akaomeswa nechando mukati mehurongwa hweMAP (kubatsirwa nemishonga kubereka), iyo ichiri kuganhurirwa nemutemo weBioethics unoshanda kubvira 2011. kuvarwere ava.

Vaviri vakato nyoresa muMAP kosi yekushaya mbereko vanogona zvakare kutendeukira kune oocyte cryopreservation kana:

• iyo puncture inoita kuti zvikwanise kuwana supernumerary oocytes isingagoni kuiswa fertilizer;
• kuunganidzwa kwesperm kunokundikana pazuva rekuti in vitro fertilization. Chinangwa chinobva chave nyore: kudzivirira "kurasikirwa" nemagametes akabviswa uye nekuachengeta kusvika pakuedza kunotevera kuIVF.

Nyika zhinji dzeEurope dzava kubvumidza kuomeswa kweanonzi "comfort" oocyte kuitira kuti vakadzi vachengetedze ma gametes avo epamuviri panotevera pasina chiratidzo chekurapa. Saka chinangwa chikuru ndechekukwanisa kudzosera shure zera rekuva amai pasina kutambura kudzikira kwembereko kune chekuita nekukura.

MuFrance, kutonhora kwemaoocyte ekunyaradza (kunonziwo kuzvichengetedza kwemaoocyte) parizvino kunobvumidzwa mune imwe nyaya: mupiro weoocyte. Pakutanga yakachengeterwa vakadzi vakuru vakatova nemwana, mupiro uyu wakashanduka nemutemo weBioethics waJuly 7, 2011. Hutsva hwemashoko aya: nulliparas (vakadzi vasina kuita vana) vava nekodzero yekupa vana vavo. maoocyte uye akabvumirwa kuchengeta mamwe acho achitarisira pamuviri unotevera.

Uku kutonhora kwemaoocyte pasina chiratidzo chekurapa kunoramba kuripo, zvisinei, zvishoma:

• Mupi anofanira kuziviswa pachine nguva mberi nezvemikana yake inotevera yekuve nepamuviri kubva kumaoocytes ayo akakwanisa kuchengeta;
• Inoita kuti hafu yeoocyte yakaunganidzwa ichave yakatsaurirwa kupa mupiro pahwaro hweanosvika 5 oocytes (kana 5 oocytes kana mashoma akatorwa, ese anoenda kumupiro uye hapana kutonhora kunogoneka kune mupi);
• Mupi anogona kupa zvipo zviviri chete.

Chokwadi chinoramba chiripo chekuti shanduko yeoocyte donation inovhura de facto kodzero yekuzvichengetedza iyo inoramba ichikakavadzana: inofanirwa kuvhurwa kune vese vakadzi kunze kwekupihwa, zvichipihwa kufambira mberi kwezera rekusununguka? Pano zvakare, kudzokororwa kwemutemo weBioethics kunogona kupa mhinduro yepamutemo kumubvunzo uyu. Zvichakadaro, nzanga dzakadzidza uye Academy yeMishonga kunyanya vakabuda vachifarira.

Iko kutonhora kwemaoocyte nhasi kwakavakirwa pahunyanzvi: oocyte vitrification. The musimboti ? Iwo maoocyte anonyudzwa akananga munitrogen yemvura kwaanoomeswa nechando zvakanyanya-kukurumidza patembiricha ye -196 ° C. Inonyanya kushanda kupfuura nzira yekunonoka kutonhora yakamboshandiswa, vitrification inoita kuti kuve nechokwadi chekupona kuri nani kwemaoocyte echando, kunyanya ne. kudzivirira kuumbwa kwemakristasi ayo akamboshandura ma gametes, achiita kuti arege kushandiswa.

Kuti zvigoneke, kutonhora kweoocyte chikamu cheprotocol yekurapa. Izvi zvinosiyana zvichienderana nekukurumidzira kurapwa uye chirwere chiri mubvunzo. Kana uine hanya iwe, muzviitiko zvese, unofanirwa kutanga waonana nachiremba wako uyo achakutsanangurira:

• toxicity yekurapa;
• mhinduro dzekuchengetedza mbereko dziripo kwauri;
• mikana yekuzvitakura (iyo isingambovimbiswi) uye dzimwe nzira dzinogona kuitika;
• kudzivirira pamuviri kunofanira kuiswa panzvimbo yakamirira kutanga kurapwa.

Iye anozokumbira kuti uite nguva yekubvunzana kwakasiyana-siyana kuchengetedza kubereka, izvo zvinosarudza mamiriro ekurapa kwako. Zvisarudzo zviviri zvinogoneka:

• Kana iwe uri wezera rekubereka, usina zvinopesana nemishonga yehomoni uye kurapwa kwako (chemotherapy, radiotherapy, nezvimwewo) hakusi kwekukurumidzira, kurapwa kwako kunotanga nekukurudzira ovarian kukurudzira kusvika pakukura kwehuwandu hwemaoocyte. Muchirevo chechinyorwa ichi, iwe uchabatsirwa kubva ku "classic" yekutevera ye in vitro fertilization: kukurudzira, ultrasound uye biological kutevera, kukonzera ovulation uye oocyte puncture;
• Kana iwe usingakwanise kuve nekukurudzira (kurapwa kwako nekukasira, une kenza inoenderana nehomoni yakadai segomarara rezamu), chiremba wako anowanzo kurudzira vitrification protocol pasina kukurudzira. Inosanganisira chii? Mushure mekuputika kwemaoocyte asina kukura, ma gametes anogadzirwa murabhoritari kwemaawa makumi maviri nemana kusvika makumi mana nemasere kuti asvike pakukura. Izvi zvinonzi in vitro maturation (IVM).

Iwo maoocyte akakura anowanikwa (nekukurudzira kana neIVM) anobva aoma nechando asati ashandiswa zvakare muchirevo chekuzvara kunobatsirwa nemishonga. Cherechedza: mune dzimwe nguva, murapi anogona kukurudzira in vitro fertilization isati yatonhora. Usazeza kukurukura nyaya yacho nachiremba wako.

Nepo mikana yekuva nepamuviri mushure mekutonhora kwezai yakawedzera nekuda kwekufambira mberi kwehunyanzvi senge vitrification, zvakakosha kuchengeta mupfungwa kuti kubata nhumbu hakuna kumbovimbiswa.

Mamwe manhamba anopupurira izvi, akanyorwa neAcademy of Medicine:

• Munguva ye vitrification maitiro, pakati pe8 uye 13 oocytes inounganidzwa paavhareji per cycle;
• Mushure mekunyungudutswa, 85% yeaya maoocyte mamwe chete anorarama;
• Zvadaro, IVF neICSI, iyo inoita kuti zvikwanisike kuisa maoocyte akasara, ine kubudirira kwe70%.

Mhedzisiro: huwandu hwepamuviri hwese nekunyunguduka kwemaoocyte hunochinja pakati pe4,5 ne12% zvichienderana nezera uye hutano mamiriro. Saka zvinofungidzirwa kuti zvakakosha kuti ubudirire kuomesa chando pakati pe15 ne20 oocytes kuti uwane tariro yekuberekwa. Izvi zvinowanzoreva kuunganidzwa kwakati wandei uye kutonhora kwakati kuti pakupedzisira tariro yekuve vabereki.