Ovarian stimulation ihomoni kurapa kwakanangwa, sezita rayo rinoratidza, kukurudzira maovari kuti vawane kunaka ovulation. Izvi zvinovhara maprotocol akasiyana ane maitiro akasiyana maererano nezviratidzo, asi ane chinangwa chakafanana: kuwana nhumbu. Ovarian stimulation inogona kurongerwa yega kana kuve chikamu cheART protocol, kunyanya mumamiriro eiyo in vitro fertilization (IVF).

Schematically, pane zviitiko zviviri:

Nyore ovulation induction kurapwa, inotarwa kana pane ovulation kusagadzikana (dysovulation kana anovulation) nekuda kwesemuenzaniso kuwedzeredza kana kufutisa, polycystic ovary syndrome (PCOS) isingazivikanwe kwakabva.

Ovarian kukurudzira sechikamu cheART protocol :

• intrauterine insemination (IUU): kukurudzira kwe ovulation (zvishoma munyaya iyi) kunoita kuti zvikwanise kuronga nguva ye ovulation uye nokudaro kuisa mbeu (yaimbova yakaunganidzwa uye yakagadzirwa) panguva yakakodzera. cervix. Iko kukurudzira kunoitawo kuti zvikwanise kuwana kukura kwemafollicles maviri uye nekudaro kuwedzera mikana yekubudirira kwekugadzira insemination.
• IVF kana IVF ine intra-cytoplasmic sperm jekiseni (ICSI): chinangwa chekusimudzira ndechekukura huwandu hukuru hwemaoocyte akakura kuti akwanise kutora akati wandei follicles panguva yefollicular puncture, uye nekudaro kuwedzera mikana yekuwana mhando yakanaka. embryos neIVF.

Kune akasiyana maprotocol ehurefu hwakasiyana, uchishandisa mamorekuru akasiyana zvichienderana nezviratidzo. Kuti ushande uye udzivise mhedzisiro, iyo ovarian kukurudzira kurapwa ndeyechokwadi munhu.

Iyo inonzi "nyore" ovulation induction

Chinangwa chayo ndechekusimudzira follicular kukura kuitira kuwana kugadzirwa kweimwe kana maviri akura maoocyte. Kurapa kwakasiyana kunoshandiswa zvichienderana nemurwere, zera rake, chiratidzo asiwo maitiro evarapi:

• anti-estrogens: inotungamirirwa nemuromo, clomiphene citrate inoita nekuvhara estrogen receptors mu hypothalamus, iyo inotungamirira kuwedzera kwechivharo cheGnRH iyo inosimudza chiyero cheFSH uye ipapo cheLH. Ndiwo mutsara wekutanga kurapwa mune zviitiko zvekusabereka kweiyo ovulatory mavambo, kunze kweiyo yepamusoro mavambo (hypothalamus). Kune maprotocol akasiyana asi kurapwa kwechinyakare kwakavakirwa pamazuva mashanu ekutora kubva ku5 kana 3th zuva rekutenderera (5);
• gonadotropins : FSH, LH, FSH + LH kana urinary gonadotropins (HMG). Inotungamirirwa zuva nezuva panguva yefollicular phase ne subcutaneous nzira, FSH inotarisira kukurudzira kukura kwemaoocytes. Kunyanya kurapwa uku: chete boka re follicles rakagadzirirwa ne ovary rinokurudzirwa. Kurapa uku kwakachengeterwa vakadzi vane follicle cohort yakakura zvakakwana. Zvinozopa kusimbaradza kuunza mafollicles pakukura ayo anowanzo shanduka nekukasira kusvika pakuora. Iri zvakare rudzi urwu rwekurapa runoshandiswa kumusoro kweIVF. Ikozvino kune marudzi matatu eFSH: purified urinary FSH, recombinant FSH (inogadzirwa negenetic engineering) uye FSU ine basa renguva refu (inoshandiswa chete kumusoro kweIVF). Urinary gonadotropins (HMGs) dzimwe nguva inoshandiswa panzvimbo yerecombinant FSH. LH inowanzoshandiswa pamwe chete neFSH, kunyanya muvarwere vane LH kushomeka.
• pombi yeGnRH inochengeterwa vakadzi vane anovulation yemhando yepamusoro (hypothalamus). Chishandiso chinorema uye chinodhura, chakavakirwa pakutonga kwegonadorelin acetate iyo inotevedzera chiito cheGnRH kuitira kukurudzira kuvharirwa kweFSH neLH.
• metformin inowanzo shandiswa mukurapa chirwere cheshuga, asi dzimwe nguva inoshandiswa seye ovulation inducer muvakadzi vane PCOS kana kuwandisa / kufutisa, kudzivirira ovarian hyperstimulation (2).

Kuti uongorore kushanda kwekurapa, kuderedza njodzi ye hyperstimulation uye pamuviri wakawanda, ovulation monitoring ne ultrasounds (kuongorora nhamba uye saizi yekukura follicles) uye hormonal assays (LH, estradiol, progesterone) nekuongororwa kweropa kunoiswa mukati menguva yese. yeprotocol.

Kuita zvepabonde kunorongwa panguva ye ovulation.

Ovarian kukurudzira mumamiriro eART

Kana ovarian kukurudzira kunoitika sechikamu cheIVF kana artificial insemination AMP protocol, kurapwa kunoitika muzvikamu zvitatu:

• chikamu chekuvharira : maovari "anoiswa kuzorora" nekuda kweGnRH agonists kana GnRH vanopikisa, iyo inovhara pituitary gland;
• chikamu chekusimudzira ovarian : Gonadotropin therapy inopiwa kukurudzira follicular kukura. Ovulation monitoring inobvumira kutarisa kwemhinduro chaiyo yekurapa uye follicle kukura;
• kutanga kwe ovulation : kana iyo Ultrasound ichiratidza mature follicles (pakati pe14 ne20 mm mudhayamita paavhareji), ovulation inokonzereswa ne:
  • jekiseni reurinary (intramuscular) kana recombinant (subcutaneous) HCG (chorionic gonadotropin);
  • jekiseni recombinant LH. Zvinodhura zvakanyanya, zvakachengeterwa vakadzi vari panjodzi ye hyperstimulation.

Maawa makumi matatu nematanhatu mushure meiyo hormonal trigger, ovulation inoitika. The follicular puncture inobva yaitika.

Kutsigira kurapwa kwe luteal phase

Kuvandudza kunaka kweiyo endometrium uye kukurudzira kuisirwa embryo, kurapwa kunogona kupihwa panguva yeluteal phase (chikamu chechipiri chekutenderera, mushure mekuvhiya), zvichibva pane progesterone kana zvinobuda: dihydrogesterone (nemuromo) kana micronized progesterone (mumuromo kana kumukadzi).

Dambudziko guru remishonga yekusimudzira ovarian ndeye Ovarian hyperstimulation syndrome (OHSS). Muviri unopindura zvakanyanya kukurapa kwehomoni, zvichikonzera zviratidzo zvakasiyana-siyana zvekiriniki uye zvipenyu zvekuoma kwakasiyana: kusagadzikana, kurwadziwa, kusvotwa, dumbu rakatsemuka, kuwedzera kweiyo ovarian vhoriyamu, dyspnea, zvakanyanya kana kushoma zvakanyanya biological abnormalities (yakawedzera hematocrit, yakakwira creatinine, yakakwira. ma enzymes echiropa, nezvimwewo), kukurumidza kuwedzera uremu, uye mumatambudziko akanyanya, acute kufema kunetseka syndrome uye acute renal kukundikana (3).

Venous kana arterial thrombosis dzimwe nguva inoitika seyakaoma yeOHSS yakaoma. Risk factors dzinozivikanwa:

• polycystic ovary syndrome
• yakaderera body mass index
• zera risingasviki makore makumi matatu
• nhamba yakawanda yefollicles
• yakanyanya kuwanda estradiol, kunyanya kana uchishandisa agonist
• kutanga kwenhumbu (4).

A personalized ovarian stimulation protocol inobatsira kuderedza njodzi yeOHSS yakaoma. Mune zvimwe zviitiko, kudzivirira anticoagulant therapy inogona kurongerwa.

Kurapa ne clomiphene citrate kunogona kutungamirira pakuonekwa kwehutano hwemaziso izvo zvinoda kurega kurapwa (2% yematambudziko). Zvinowedzerawo njodzi yekuva nepamuviri pakawanda ne8% muvarwere vane anovulatory uye ne2,6 kusvika 7,4% muvarwere vanorapwa idiopathic infertility (5).

Kuwedzera kwengozi yekenza yekenza muvarwere vanobatwa ne ovulation inducers, kusanganisira clomiphene citrate, yakaonekwa mune zvidzidzo zviviri zvepidemiological, asi ruzhinji rwezvidzidzo zvinotevera haruna kusimbisa chikonzero uye hukama hwehukama (6).

Chidzidzo cheOMEGA, kusanganisira vanopfuura varwere makumi maviri nevashanu vakakurudzira ovarian sechikamu cheIVF protocol, yakagumisa, mushure memakore anopfuura 25 ekutevera, kuti pakanga pasina njodzi yekenza yemazamu pakaitika ovarian stimulation. (000).